Digitising controlled substance accountability: implementation and use of a dashboard-based monitoring system in an...

Opioids are the cornerstone of severe pain management but they have a strong potential for abuse. To mitigate this risk, hospitals are required to track and account for these controlled substances (CS). Despite widespread adoption of electronic medication administration records (eMAR), nurses also performed paper-based registrations for CS. We hypothesised that a validated dashboard combining dispensing and eMAR data could be implemented for CS accountability. This study describes trends in accountability of dispenses through administrations before, during and after implementation of the dashboard that replaced the paper-based process. Furthermore, we describe its application in analysing signalled discrepancies.

This implementation study was performed in a university hospital. The dashboard was developed by a multidisciplinary team consisting of hospital pharmacists, pharmacy technicians, nurses and data analysts. Data from 2018 to 2024 were compared in three periods: prior implementation (2018-2019), during implementation (2020-2022) and after implementation (2023-2024) of the dashboard. Monitored CS medications were limited to oral solids. The data for dispenses and administrations were validated against the electronic health record (EHR) and electronic delta calculations were manually recalculated. The dashboard was piloted on a single ward by shadow running the dashboard for 6 months. Processes were optimised before hospital-wide implementation.

The dispense and administration data in the dashboard accurately reflected the registrations in the EHR and all predefined validation criteria were met. Subsequently, the paper process for accounting for CS was successfully digitised, allowing nurses to discontinue the double registration workflow. The CS accountability showed a slight upward trend from 88% prior to implementation to 91% after implementation. Furthermore, use of the dashboard resulted in a more efficient workflow and facilitated evaluation between the pharmacy and the wards, contributing to optimisation of prescribing, administration and the logistical processes.

The dashboard provided an accurate and reliable reflection of CS-related dispenses and administrations documented in the EHR, supporting its hospital-wide implementation for CS monitoring. The CS accountability dashboard reduced the administrative workload for nurses and the pharmacy and improved traceability.