(Management Case Study) Implementation of Mobile Medication Tracking Technology for Controlled Substance Chain of Custody

Purpose: This research focused on implementing a Mobile Medication Tracking Technology for controlled substances at Houston Methodist Hospital (HMH). HMH had been using a paper tracking system for controlled substances transition documentation. The Mobile Medication Tracking Technology was implemented to overcome the gaps of the conventional paper-based tracking system, such as difficulties in auditing the process, documentation loss, and illegibility of signatures. The project was initiated as part of HMH's Controlled Substance Diversion Prevention Program (CSDPP) with the goal of ensuring 100% controlled substance chain of custody was completed at all transition points of medication use process, to obtain verifiable accountability.

Methods: This is a quasi-experimental study conducted at HMH's inpatient pharmacy sterile compounding suite. The study timeframe consisted of one month of pre-implementation phase to evaluate the effectiveness of the paper-based tracking system, four weeks of washout period for the transitional process, and two months of post-implementation phase to assess the effectiveness of the mobile medication tracking technology. The implementation process involved one week of IT build-out and three weeks of training for both inpatient pharmacy staff and all inpatient registered nurses. The mobile medication tracking technology went live at all inpatient units of Houston Methodist Hospital on April 1st, 2023. The primary endpoint was the positive ID capture rate for delivery and receiving personnel. The secondary endpoint was the controlled substance dispensing to administration time.

Results: During the study period, 209 patient specific controlled substances were dispensed during the pre-implementation phase, and 141 patient specific controlled substances were dispensed during the post-implementation phase. The paper-based tracking system had 29 missing documents and 64 unidentifiable signatures. During the post-implementation period, 140 out of 141 medications had receiving personnel information documented electronically, with no missing documentation and unidentifiable entries. The medication delivery personnel information capture rate improved from 67.4% to 92.9% (P < 0.0001) from pre- to post-implementation, respectively. The medication receiving personnel capture rate significantly increased from 44.5% to 99.2 (P < 0.0001). The study showed a not statistically significant decrease in the time from medication dispensing to administration, 337.5 mins pre-implementation to 304.5 mins post-implementation (P=0.628).

Conclusion: Results from the post-implementation phase showed that the mobile medication tracking technology significantly enhanced the traceability and accountability of controlled substances. The mobile medication tracking technology can ensure high visibility of the controlled substance chain of custody, effectively minimizing the risk of diversion and increasing the effectiveness of internal controlled substance auditing. The implementation process and study of the mobile medication tracking technology at Houston Methodist Hospital can serve as a model for other institutions aiming to adopt similar technologies for improvements in controlled substance chain of custody documentation and diversion prevention.