Known Limitations for Infusion Auditing in ControlCheck

ControlCheck is a drug diversion software with daily auditing capabilities that assists healthcare organizations in monitoring their controlled substance continuous infusions and helps ensure compliance. The infusion auditing feature, however, has certain limitations that users must be aware of.

As we collect more and more feedback from you, we wanted to share the current functional limitations (and their eventual workarounds) in ControlCheck for Infusion auditing:

• Bulk vials dispensed direct-to-patient and compounded in the Pharmacy to an IV bag (Injectable dispensed → Infusion administered)
  • A limitation of ControlCheck is that it cannot audit infusions when bulk vials are dispensed directly to the patient or when medications are compounded in the pharmacy to an IV bag. This is because there is no unique medication identifier for the dispense event, making it difficult for ControlCheck to trace the medication from the bulk vial to the patient.
  • Pediatric hospitals are more common to run into this workflow because patients do not use standard dose sizes so providers have to compound a diluted dose infusion for the pediatric patient. Even when there is a unique medication identifier for the compounded product for the patient, there are still some limitations supporting a full audit workflow in the current solution. Pediatric Infusions can be captured as long as we are getting a unique dispense for the patient of the IV bag and a corresponding MAR documentation for the bag.
  • Customers are recommended to use the 'Event Editor' feature which allows end users to manually regroup event summaries so injectable dispenses could be manually grouped with infusion administrations.
• Data documented in a flowsheet or in a module ControlCheck does not have access to
  • Another limitation of ControlCheck is that it only audits infusions that are documented in the EHR system that is being queried and provided to ControlCheck. Typical customer setups do not include integration of flowsheet data. If for some reason the infusion is not documented correctly or is missing documentation, ControlCheck will not be able to capture the infusion.
• Non-Epic integrations like Cerner and Meditech
  • ControlCheck has limitations in auditing infusions for Non-Epic customers like Cerner and Meditech. This is because there are too many variabilities in the data from different EHR systems, making it difficult for ControlCheck to consistently capture the infusion data.
  • We continue to evaluate opportunities to expand infusion auditing support to Cerner and Meditech customers, with potential improvements slated for future releases. This remains on our product roadmap.
• PCAs and Epidurals
  • ControlCheck has limitations in auditing infusions administered through patient-controlled analgesia (PCA) and epidurals. These types of infusions require specialized documentation and monitoring processes, which are not currently supported by ControlCheck.
  • The PCAs and Epidurals are typically documented as New Bag but we are seeing blank values for the admin events in the Epic file causing our system to think they are "zero" or null events and therefore getting filtered with the existing logic. We have plans to build additional logic to support these products but at current, that is why they are unsupported.
• Reconciliation on total infused volume and remaining waste
  • ControlCheck does not currently receive total infused volume from any existing customers. Because of this data limitation, we cannot support an auditing solution that evaluates the total volume given to the patient and the amount wasted to reconcile against the amount pulled. Without this total volume, ControlCheck would always create a discrepancy for the continuous infusion case and the math would never add up.
  • As part of our H1-2026 roadmap, we are planning to improve infusion reconciliation capabilities to better capture the full amount administered in mass and reconcile dispense, administration, waste, and return data for a more complete auditing solution.
• New Bag Admin events created for unmapped medications with mass amounts
  • When an unmapped identifier comes into ControlCheck for a new infusion medication, we can use information such as the infusion rate on the admin event (e.g. 50 mcg/hr) to indicate that the event is for a continuous infusion. There are edge cases where we see a New Bag admin but the event amount is a mass (e.g. 1000 mcg) instead of a rate so we cannot properly handle the event amount in this scenario for any events created while the medication identifier is in an unmapped state. Once the medication identifier is mapped as an infusion, events will start to auto-resolve properly with the dispense and admin amount as 1 unit.
• Paper documentation
  • One of the most significant limitations of ControlCheck is that it can only audit infusions administered and documented through an electronic health record (EHR) system. If an infusion is given manually or through a non-integrated system, it will not be captured by ControlCheck. Therefore, it is important to ensure that all infusion processes are documented through the EHR system to be able to benefit from the infusion auditing feature.
• Lacosamide short-duration infusions
  • Feedback has been received regarding Lacosamide short-duration infusions and their documentation process. It has been noted that Lacosamide injections are documented with a New Bag event in Epic but are not documented with a rate, like other continuous infusions, and should be mapped as injectable medications. Mapping this medication, or ones like it, as an injectable instead of a continuous infusion is important because it allows ControlCheck to properly capture Lacosamide injections in your auditing workflow.
• IV Bags ordered from a 503b and loaded into the Narc Vault in the Pharmacy Purchasing module
  • IV Bags ordered from a 503b cannot be audited in ControlCheck because we are not receiving the purchasing and invoice information for the bags. This Known Limitation is for the Pharmacy module only. The IV bags purchased from a 503b can be audited in the Patient Care setting.
• Reaggregation of Event Summaries
  • For infusion medications that have periodic update events like rate changes or verifications, ControlCheck may recombine events when new data arrives, potentially moving events to different Event Summary IDs. This can cause issues for users who have added notes or are investigating specific summaries over multiple days. To prevent this reaggregation, users can add attachments to "freeze" event summaries they're working on:

Current Infusion Auditing Model

The current infusion auditing model in ControlCheck provides the following capabilities:

• Captures dispense amounts
• Converts New Bag events administered via a rate to a Bag or Unit administered
• Provides reconciliation of Bag to Bag or Unit to Unit
• Includes infusion data in IRIS metrics such as Med Trends

This model is currently only officially supported for Epic customers. For continuous infusion auditing, ControlCheck looks at a bag dispensed from your ADC and groups it with a New Bag administration from Epic. This is a unit-to-unit comparison where continuous infusions are audited as units, and the mass and/or rate from Epic is excluded from the reconciliation process

Summary

In summary, ControlCheck is a valuable tool for infusion auditing, but it is essential to understand its limitations and use it appropriately to ensure compliance and patient safety. Healthcare professionals must ensure that all infusion processes are documented through the EHR system, ensure accurate documentation, conduct regular audits, and use ControlCheck in conjunction with other monitoring methods to ensure compliance and patient safety.