Pilferage of controlled substances in hospitals

The incidence of pilferage of controlled substances and the systems of monitoring and surveillance of controlled substances in hospitals were studied. A questionnaire was mailed to a random samples of 285 pharmacy directors in short-term medical and surgical hospitals nationwide. Of the 162 respondents, 103 (64%) reported at least one documented or suspected case of pilferage in the past year. These 103 hospitals reported 352 separate incidence of controlled substances theft involving 11,285 dosage units. Drug diversion occurred in 76% of the hospitals with more than 100 beds and in only 28% of the hospitals with less than 100 beds. Nurses were implicated in 69% of the incidents; pharmacists and pharmacy technicians in 12%; housekeeping personnel in 4.7%; unit-ward clerks in 3.5%; and physicians in 2.4%. These incidents most frequency involved: meperidine, morphine, cocaine, oxycodone, hydromorphone, propoxyphene, pentazocine, diazepam, and codeine products. Larger hospitals, those with more frequent inventory audits, those that disperse controlled substances throughout their drug stock, and those that have more pharmacy personnel involved in the distribution of controlled substances all had a relatively higher incidence of pilferage. It was concluded that a substantial amount of pilferage of controlled substances occurs in hospitals and that more stringent methods of control and surveillance are needed.