Assessing baseline practice and the implementation and efficacy of a novel device for medication security

© Author(s) (or their employer(s)) 2021. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Medication stored in hospitals, nursing homes, general practice surgeries or pharmacies must be handled, stored, dispensed and disposed of securely to protect patients and staff in accordance with part 4, section 13 of the Health and Social Care Act. These standards were revised in 2014, requiring the service provider to ensure ‘proper and safe management of medicines’. The Care and Quality Commission (CQC) regulates compliance with this legislation by performing routine inspections of health and social care providers. In hospitals, controlled drugs (CDs) such as sedative or opiatebased medications are stored within locked cupboards. Both CD cupboards and drug trolleys, when open, must be constantly supervised by staff and if left unattended securely locked, even for short periods. In reality, guideline compliance in busy healthcare environments can be challenging to achieve. During planned CQC visits, staff may be at their most compliant, yet in 2012 inspectors reported that 14% of hospitals, 20% of nursing homes and 16% of residential homes across the UK failed to comply with the safe management of medicines standard during visits. Unlocked unattended medication trolleys have specifically been highlighted as issues of poor medication management in CQC reports, and in some cases this has affected care ratings of institutions and led to enforcement actions. 7 Ultimately, failure of adherence to CQC recommendations can result in medication theft and tampering for which healthcare staff, who have easy access to drug cabinets, are often found to be culprits; and this is highlighted in disciplinary hearings for the General Medical Council and Nursing and Midwifery Council. An anaesthetist sentenced to jail illustrates this, who used his old hospital pass to access and steal 2558 tablets of codeine from hospital cabinets, with costs totalling £3360. This occurred over 8 months with 75 different visits to the hospital, highlighting the ease with which recurrent theft may occur and the vulnerabilities of healthcare systems to medication diversion. Drug diversion is defined as the transfer of drugs from a lawful to an unlawful channel of distribution or use. This may only be the tip of the iceberg and there are likely many more incidents dealt with internally or remaining undetected. Summary box