Safeguarding medication stored and administered at state custodial facilities, Department of Public Health and Human Services PDF
Preview Safeguarding medication stored and administered at state custodial facilities, Department of Public Health and Human Services
s 615.4 L72sms 2002 Legislative Audit Division StateofMontana Reportto the Legislature Performance Audit February2002 Safeguarding Medication Stored and Administered at State Custodial Facilities DepartmentofPublicHealth andHumanServices / ,~7 DOCUMENTS COLLECTION EasternMontanaVeteransHome-Glendive EastmontHuman Services Center-Glendive ,IUL 2 4 2002 MentalHealthNursingCareCenter-Lewistown MONTANA STATE LIBRARY MontanaChemical DependencyCenter-Butte HELEN1A51,5MEO.N6TtAhNAAVE5.9620 MontanaDevelopmentalCenter-Boulder Montana StateHospital-Warm Springs MontanaVeteransHome-ColumbiaFalls Reviewofcontrols usedtosafeguard medicationstored in theseven DPHHSoperatedfacilitiesidentified a numberofpotentialimprovements. Recommendationsinclude: Assurefacilitiesstoremedicationsin physically-secured areaswith restrictedaccess. Implementprocedurestoensurenursingstaffadministermedication followinglegalandprofessionalguidelines. Ensurefacilitiesadheretooperational andphysicalsecurityregulatory requirementsforadministrationofcontrolledsubstances. Implementstepstoimprovegeneralmedication administration. Directcomments/inquiriesto: LegislativeAuditDivision Room 160,StateCapitol POBox201705 MT 01P-11 Helena 59620-1705 Helpeliminatefraud,waste,andabuseinstategovernment. CalltheFraud Hotlineat 1-800-222-4446 statewideor444-4446in Helena. 3 0864 1001 5346 I PERFORMANCE AUDITS Performance audits conducted by the Legislative Audit Division are designed to assess state government operations. From the audit work, a determination is made as to whether agencies and programs are accomplishing their purposes, and whether they can do so with greater efficiency and economy. The audit work is conducted in accordance with audit standards set forth by the United States General AccountingOffice. Members of the performance audit staff hold degrees in disciplines appropriate to the audit process. Areas ofexpertise includebusiness and public administration, statistics, economics, accounting, logistics, computerscience,andengineering. Performance audits areperformed at the requestofthe Legislative Audit Committee which isabicameral andbipartisanstandingcommitteeoftheMontanaLegislature. The committeeconsistsofsixmembersof the SenateandsixmembersoftheHouseofRepresentatives. MEMBERS OFTHELEGISLATIVEAUDIT COMMITTEE SenatorJohnCobb RepresentativeJoe Balyeat SenatorJimElliott Representative DeeBrown SenatorDanHarrington RepresentativeBill Eggers SenatorKenMiller RepresentativeHalJacobson SenatorCoreyStapleton RepresentativeJeffPattison, ViceChair SenatorJonTester, Chair RepresentativeDavidWanzenried LEGISLATIVE AUDIT DIVISION ScottA. Seacat. Legislative Auditor Deputy Legislative Auditors: John W. Northey, Legal Counsel Jim Pellegrini, Performance Audit Tori Hunthausen. IS Audit & Operations James Gillett. Financial-Compliance Audit February 2002 TheLegislativeAudit Committee oftheMontana State Legislature: Weconductedaperformance auditofthe securityandadministrationofmedication stored in Department ofPublic Health and Human Services facilities. The department currentlyoperates seven facilitiesthathousepatients andresidents who are eitherveterans, developmentally disabledorhave addictive ormental disorders. This reportfocuseson actions the department cantaketo improve medication-related operations at the sevendepartment facilities. Recommendationsaddress a numberofareas including: physical security, administrationofmedication, controlled substances, and general operations. We appreciatethecooperationand assistance ofdepartmentand facility staffduringthe audit. Legislative Auditor Room 160, StateCapitolBuildingPOBox201705 Helena,MT 59620-1705 Phone(406)444-3122 FAX(406)444-9784 [email protected] Digitized by the Internet Archive 1 2014 in http://archive.org/details/safeguardingmedi2002mont Legislative Audit Division Performance Audit Safeguarding Medication Stored and Administered at State Custodial Facilities DepartmentofPublic Health and Human Services Members ofthe auditstaffinvolved inthis auditwere Lisa Blanford. SusanJensen, and MaryZednick. Table ofContents ListofFigures, Photographs andTables ii AppointedandAdministrativeOfficials iii Report Summary S-l ChapterI - Introduction 1 Introduction 1 AuditObjectivesand Scope 1 AuditMethodology 2 ManagementMemorandum 4 AreaForFuture Review 5 ChapterII - Overview ofDepartment'sMedication Services 7 Introduction 7 DPHHS Facilities 7 Seniorand LongTerm Care Facilities 8 Disability Services Facilities 8 Addictive and Mental Disorders Facilities 8 Health Care Services 9 Pharmacy Services 9 StoringMedication inDPHHS Facilities 13 AdministeringMedicationto Patients/Residents 16 OtherMedication-RelatedDuties 17 ChapterIII-ImprovingControls OverMedication 19 Introduction 19 Why StrongControl SystemsOverMedicationAreNeeded 19 VariousCauses ContributetoLackofProperControl 21 LackofStaffAwarenessandManagement Inattention Contribute to Concerns 22 NumberofOtherFactors Contributeto Problems 22 Controls CouldBe Strengthened 23 Physical Security 23 MedicationAdministration 27 SafeguardsOverControlled Substances 33 Controlled Substance Records Reveal Discrepancies 37 General Administration 39 Updated Resident PhotographsandEquipmentNeeded 40 Operational Policies 42 Communication Between Inter-FacilityNurseManagement 43 Nurse Management and Supervision 45 Department Response DepartmentofPublic Health and Human Services A-3 Page i 1 List ofFigures, Photographs and Tables Figure 1 Pharmacy Delivery Servicesat DPHHS Facilities 10 Table 1 DPHHS Facilitiesand Average Populations 7 Table2 NumberofPrescriptions Dispensedat DPPHS Facilities 1 Table 3 Examples ofMedication Prescribed in DPHHS Facilities 20 Table4 Physical SecurityControls-Testing Results 25 Table5 MedicationAdministrationTesting Results 30 Table 6 Safeguards OverControlled Substances -Testing Results 36 Table 7 General Administration -TestingResults 40 Picture 1 Prescription Packaging Systems 12 Picture2 MedicationCart 14 Picture 3 Night Locker Storage Area 15 Picture4 Controlled Substance Storage Compartment 16 Page ii Appointed and Administrative Officials Department ofHealth and Gail Gray. Director Human Services John Chappuis. DeputyDirector DanAnderson. Administrator Addictive and Mental Disorders Division Joe Mathews. Administrator Disability ServicesDivision Mike Hanshew, Administrator Seniorand LongTerm Care Division Page iii
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