1. 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 ; can be downloaded at 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
And/or

2. 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?

3. 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.

4. 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

5. 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

6. 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

7. 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 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 Karen Mason

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

9. Drug Incident Report The DIR form is located at: www.mass.gov/dph/dcp
And/or

10. 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
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

11. 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.

12. Questions

13. Resources MAP Curriculum- Responsibilities in Action
MAP Policy Manual