Patient Audit - Reconciling Event Summaries

Reconciling Variances in ControlCheck 

Variances listed on the Review Audit are those transactions that result when the sum of the drug administration, return, and/or waste transaction quantities do not add up to the dispense transaction quantities. If the sum of drug administrations, wastes and/or returns is larger than that of the dispense(s), then the Variance will be a positive number (+ in the Review Audit Missing column). If the sum of the drug administrations, wastes and/or returns is less than the dispense(s), then the Variance will be a negative number (- in the Review Audit Missing column).

Variances occur for a variety of reasons. Some of the most common reasons include, but are not limited to:

• Drug charted on the wrong order
• User charted the administration of the drug on a different patient
• User did not chart the drug as being administered
• User back charted
• Drug obtained from a source other than the automated dispensing cabinet (e.g., pharmacy)
• User did not return the drug

Notes

• User returned the drug to a different patient
• User did not waste the drug
• User wasted drug on a different patient
• User wasted the drug outside the set timeframe (e.g., removed at the beginning of the shift and wasted at the end of the shift)
• User documented waste somewhere other than the automated dispensing cabinet (eMAR, flowsheet, paper record etc.)
• Medication mapping issue in ControlCheck
• Missing information in ControlCheck
• Potential diversion

The objective of each individual responsible for the Review Audit is to determine the cause(s) for each Variance and close them within ControlCheck

• Closed Reconciled is intended for those variances where the source system documentation has been updated to reflect any missing or inaccurate values or the reason provided for the variance is deemed sufficient to mark the item as resolved.
• Closed Unable to Reconcile is intended for those variances where the user is unable to determine an acceptable path to resolution or verify corrected information in the source systems of record. These events are often considered true discrepancies.

Variance Reconciliation Workflow

Courses of action to investigate causes for Variances will vary depending on the scenario. Potential sources used to review, and Close Variance transactions include, but may not be limited to the following:

• Electronic Health Record (EHR, e.g., Epic, Cerner, Meditech, etc.)
  • Orders (e.g., pharmacy, nursing, etc.)
  • eMAR
  • Notes and documentation
  • Pain assessment/flowsheet
• Automated Dispensing Cabinet (ADC) system reports (e.g., Omnicell, Pyxis, Acudose, MedSelect, etc.)
  • Dispense, waste and/or return transactions (contact Pharmacy if necessary)
  • Discrepancies
• Pharmacy
  • Was medication provided directly from the pharmacy and documented on paper vs. ADC?
• Interviews
  • Employee(s) involved
  • Patient (verify medication administration, pain relief etc.)
  • Peers
• Other alternate hospital systems
  • Risk management (e.g., RL)

Best Practice Tips

As a reminder, when reviewing a variance, it’s important to provide complete, succinct documentation regarding your work on the variance. Below are some best practice examples for documentation of findings, conclusions, and next steps.