Design of a revised controlled substances distribution system.

A controlled substances distribution system that uses daily audit and disposition forms for three different groups of drug products is described. In the previously used system, only Schedule II drugs were controlled, using shingled proof-of-use forms for each product. All other controlled substances were dispensed like regular prescriptions. Accountability, record retrieval, and security weaknesses led to the development of a new system. The new system has a separate audit and disposition form for Schedule II injections, Schedule II orals and miscellaneous drugs, and Schedule III and IV oral and injectable drug products. Each form lists the most frequently prescribed products in the category. Nurses record daily shift counts on the bottom of the form. Twenty-one shingles are attached to the form that are similar to the shingles on the proof-of-use forms of the old system; these serve as patient charge slips. Each nursing station uses at least one of each form every day. Pharmacy reviews these forms daily for discrepancies and to determine the restocking needs of the nursing stations. A quality assurance program to assess the performance of the new system is described. Use of the daily audit and disposition forms for controlled substances combines accountability, security, and efficiency for nursing personnel with an effective charging mechanism.