Under lock and key. How Blockchain secures controlled drugs
23 February 2018
In the third of a series of blogs looking at how Blockchain can transform health-care systems and patient care, Ailis Mone, from PwC’s Blockchain team, explains how the current process for controlled drugs can be improved.
Some prescription medications, such as opioids, central nervous system depressants and stimulants, are classed as controlled drugs as they are open to abuse, misuse, illegal activity and can cause harm. When taken as recommended and supervised by a medical professional, these drugs have the potential to improve patients’ quality of life. However, many controlled drugs can lead to physical dependence and/or addiction to the drug, as well as potential death by overdose, if abused or misused. With drug misuse costing the NHS £488m a year, creating poor health, crime and devastating families, it is clear why effective systems are needed to support regulation.
Pharmacists must ensure that controlled drugs are secure in a locked safe and accounted for at all times. Most pharmacies use manual paper ledgers that record controlled drugs supply, delivery and destruction, and the pharmacist and witness will initial or sign each check and entry. This involves counting every tablet, every ampoule and measuring every milliliter of liquid and the running balance must be checked against the physical stock of every drug in the safe. The ledger balance must match the exact quantity of physical stock held in the pharmacy, and if it doesn’t it must be reported to the appropriate regulators for further investigation and possible sanctions.
Even with registers logging every move made by a controlled drug, there are still cases of theft and misuse. At times due to human writing style and natural “wear and tear”, ledgers can become difficult to read and discrepancies within the registers are common. Manual entry also causes delays in the dispensing process. This puts pressure on the pharmacist and leads to increased dispensing errors, poorly impacting on patients’ care.
Accountable officers are appointed to ensure controlled drugs are safely managed and governed within their organisation, while the police & pharmaceutical inspectors investigate any issues to ensure legal & regulatory standard compliance for all pharmacies. Yet, in order for them to have visibility of any problems with the controlled registers, they must go to the physical register to see the evidence, wasting valuable investigative time getting to the pharmacy site itself.
Solutions, such as an electronic spreadsheet to record the controlled drug register, could lead to issues regarding security of the software. Entries could be tampered with and authorities would not have real-time access to the information they need. Robotic Process Automation may allow their existing software to be used and the process to be automated, however it would not allow pharmaceutical inspectors the visibility to ensure the regulatory procedures are being followed and it would not record the witness signing off each check and entry when pharmacists are interacting with controlled drugs.
With Blockchain we could create a secure distributed ledger that allows witness ID to be recorded at the appropriate times. It would enable real time access for authorised individuals to view controlled drugs transactions and allow authorised individuals to update records with ease.
Every interaction with a controlled drug, including the opening and closing of the safe could be logged into the system with a precise time and date stamp. In the case of theft, the record of safe opening times and those who have access to the safe could be vital in catching criminals. In real time, the Accountable Officer or pharmaceutical inspector could watch the process happening and monitor who is trying to access the drugs.
Blockchain could work in tandem with the Internet of Things (IoT) to automate the recording of the register. If IoT technology is implemented, every time a drug is put into the safe it could be recorded onto a Blockchain ledger. This would mean that prescriptions could be dispensed at a faster pace as the pharmacist would not have to spend as much time on stock management, the controlled drugs safe would not be open for longer than necessary and human error from manual counting would be significantly reduced, improving drug and record accuracy.
It is clear how streamlined the process can become with Blockchain, giving pharmacists more time to ensure prescription accuracy and counselling their patients on the correct and safe use of their medications. We believe in a controlled drug journey that offers better visibility, better efficiency and most importantly, a safer health service for all involved.