Reassessment of Veterans Administration's Controls Over Drugs:

Million-Dollar Problem Still Exists

HRD-80-86: Published: Jun 24, 1980. Publicly Released: Jul 24, 1980.

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The Veterans Administration (VA) does not have an effective program for accounting for or controlling the use of drugs dispensed by many of its pharmacy units. The basic pharmacy systems used by VA to dispense drugs include: the ward stock system, under which most drugs are stored in the wards; and the unit dose system, under which drugs are delivered by the pharmacy to the wards at least once every 24 hours. In a previous review, GAO found that conversion to the unit dose system would decrease VA drug losses and improve patient care. GAO recommended that interim controls be placed in effect to strengthen drug security and conversion of ward stock centers to unit dose. No effective program exists for adequately controlling the use of drugs at the ward stock centers reviewed. VA efforts to implement the recommended interim control measures were largely ineffective. Controls over VA prescription filling procedures are weak. Pharmacy units have filled a large number of prescriptions despite the lack of required documentation, and unused VA prescription pads were readily accessible to unauthorized persons. Under such conditions, the possibility of VA pharmacies filling fraudulent prescriptions is great and detection is almost impossible when required control procedures are not strictly enforced. VA has made some progress in converting its pharmacy units to unit dose. However, 84 percent of all drugs dispensed in VA centers continue to be dispensed by the ward stock system. Since the end of fiscal year 1978, no funding has been provided for additional conversions. The lack of significant progress in converting to unit dose is attributed to inadequate resources and higher priorities.

GAO believes that its prior recommendations for insuring accountability and control over drugs dispensed at its ward stock medical centers are still valid and should be implemented immediately. In view of the high turnover of medical staff, GAO believes that frequent reminders to prescribing physicians concerning compliance with security measures should be issued by local medical center directors. It appears that any significant increase in the number of unit dose conversions is questionable. Without specific funding, local center directors will find it hard to convert existing ward stock pharmacy systems to unit dose.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to take immediate steps to implement the interim ward stock control measures previously recommended by GAO; revise the pharmacy manual issued by the VA central office to include the interim control measures; require the VA Central Office Pharmacy Service to conduct periodic compliance checks at the medical center level; take steps to ensure that the pharmacy units in VA medical centers do not fill prescriptions that are incomplete and inaccurate; and strengthen the security over prescription forms by requiring prescribing physicians and dentists to store prescription pads in locations that are not readily accessible to unauthorized persons. The Administrator should identify the amount of funding necessary to permit system-wide conversion of ward stock systems to unit dose and provide the resources required to the affected medical centers to achieve total conversion.

    Agency Affected:

 

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