Drug Loss/ Suspected Drug Tampering Medication Education Module 3 Drug Loss/ Suspected Drug Tampering Trainer Preparation Copies of PowerPoint handout Print p. 2 “Objectives” to test staff knowledge before & after the training (Use as your training documentation.) Copies of corresponding MAP Policy 10-7 and MAP Advisory Suspected Drug Tampering Responsibilities in Action (RIA) pages 190-195; can be downloaded at www.mass.gov/dph/map scroll down to "what would you like to do" and select View MAP training resources and curriculum, then select DDS MAP training resources; once there you will see MAP Curriculum and Adjunct Materials The lost tablet may or may not prompt a Drug Control Program inspection team site visit, whose focus is primarily on the security of countable meds and related documentation. If a visit is scheduled the tool the DCP inspector uses is located at http://www.mass.gov/eohhs/docs/dph/quality/drugcontrol/map/map-medication-security-inspection-form.pdf And/or www.mass.gov/dph/dcp

Objectives 1. Which meds are reportable? 2. Who do I report to? 3. Where do I document? What I know about lost (missing) medication and drug tampering before the training: 1. 2. 3. 4. What I learned about lost (missing) medication and drug tampering after the training: 4. What is drug tampering?

Reportable Drug Losses Include All prescription meds Schedules II-VI and Written prescriptions As a Supervisor you may want to let staff know of your internal reporting system if “over the counter meds” are reported as missing. OTCs that are missing are not reported to DPH.

Drug Loss A drug loss is not a med occurrence Unless the med is due and there are no meds available to administer due to the loss If this is the case, staff must report to both the: -MAP Consultant for a recommendation since no med was available to give and a med occurrence is submitted via HCSIS -Drug Control Program to report the missing med(s) and fax a drug incident report form to DPH/DCP

Security-Inventory-Record Keeping If the count is incorrect Notify the Supervisor and document Supervisor conducts an investigation DCP notified Depending on the severity of the case may also contact Massachusetts State Police Diversion Investigative Unit Local police department See Responsibilities in Action pages 190-195

Count Sheet Scenario Page 11 Page transfer This scenario demonstrates when the count is incorrect in a blister pack, the math documentation in the count book is correct, all medications appear to be administered and documented as ordered but a tablet is missing. The Certified staff who discovered the discrepancy should immediately contact their Supervisor and document what happened on the count sheet. The Supervisor should immediately review and document if the lost tablet cannot be accounted for and notify DPH using a DPH Drug Incident report form. 12/20/yr 7am There are only 5 Ativan 0.5mg tabs. Karen Mason, Supervisor notified. Reggie Newton 12/20/yr 7:45am Drug Incident form completed. DPH notified. 5 tabs Karen Mason

Shift Count Sheet Scenario 12/20/yr 7:00am When counting there is an Ativan 0.5mg tablet missing. Karen Mason, Supervisor notified. See count sheet page number 11. Reggie Newton This is an example of how to record an incorrect count due to a missing medication. 12/20/yr 7:45am All Ativan prior to today appear to be given and documented as prescribed. One Ativan 0.5mg tab is missing. Drug Incident form completed. DPH notified. See count sheet p. 11. Karen Mason

Reporting Drug Control Program (DCP) is notified within 24 hours of discovery Drug Incident Report Form (DIR) is completed and faxed to the DCP

Drug Incident Report The DIR form is located at: www.mass.gov/dph/dcp And/or https://www.mass.gov/files/documents/2016/07/nn/drug-incident-report-form.pdf

Suspected Drug Tampering Drug tampering is considered adulterating, altering or substituting a medication or the packaging of a medication, which is a serious event and can result in potential criminal consequences. Drug tampering can have a direct impact to the health and safety of the people supported at MAP sites. To comply with state regulations, suspected drug tampering must be reported to the Drug Control Program at DPH, using the Drug Incident Report form, within 24 hours of discovery. If drug tampering is suspected you need to Call the persons HCP Call the local police Complete a Drug Incident Report form and Follow any instructions given to you by the HCP, police or DCP In addition, the suspected tampered with drug must be removed from the medication storage area, including if it’s a countable medication, and should be secured in an area/container that only the supervisor has access to. If the medication is transferred to the police or an investigator be sure to complete a Transfer Form. See Medication Education Module 7- Medication Transfer and Responsibilities in Action page 175-176. If the tamper-suspected medication is not removed from the MAP site by an enforcement representative, the medication may be disposed of following MAP policy once the investigation is complete. See Medication Education Module 2-Disposal and Responsibilities in Action pages 184-189

Drug Tampering Blister pack with masking tape: although you cannot see the tablets on the other side, in the first example, Percocet tabs were replaced with Extra Strength Tylenol tabs. The second example: although it is hard to see there is scotch tape over ‘bubbles 1 and 2’. Ativan tabs were replaced with Sudafed.

Questions

Resources MAP Curriculum- Responsibilities in Action www.mass.gov/dph/map https://shriver.umassmed.edu/programs/cdder/webinars/map-training-resources/dds-map-training-resources MAP Policy Manual