Help with CII Inventory Check

[pharmd1701]

Just started working as a pharmacy manager and I'm already having trouble with the CII inventory. Things just don't add up for some reason. I checked the CII drug log and did the math (count from last month, # received, # dispensed, etc) but it's nowhere near the actual count. To experienced rxms, any other reasons for this discrepancy? Spent so much time for this, it's frustrating. Thank you!

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[zelman]

Just started working as a pharmacy manager and I'm already having trouble with the CII inventory. Things just don't add up for some reason. I checked the CII drug log and did the math (count from last month, # received, # dispensed, etc) but it's nowhere near the actual count. To experienced rxms, any other reasons for this discrepancy? Spent so much time for this, it's frustrating. Thank you!

Drug test everyone

 

[johnpharm01]

I treat the inventory as a checkbook, except there are tablets not $. When you became RXM hopefully you did a complete and accurate controlled substance inventory. From there add in all received through orders and returns (filled not dispensed rxs). Subtract rxs filled, outdates pulled and sent back as returns/destruction. There should be paperwork for each one of these. If there were some unusual use or loss i.e. used in compounding or your pharmacy had a flood or a misfill, account for these. Do a physical inventory. Make sure all the bottles are put back in correct places. Compare on hands with physical inventory. They should match. If not you have a problem.

It is possible to keep a very accurate inventory. I am a fan of a perpetual paper inventory and back counting after each prescription is filled. Also limit access as much as possible preferably in a locked vault with a few as possible staff allowed access. Do not keep them on the counter. Also do regular inventories weekly.

 

[Apotheker2015]

Just started working as a pharmacy manager and I'm already having trouble with the CII inventory. Things just don't add up for some reason. I checked the CII drug log and did the math (count from last month, # received, # dispensed, etc) but it's nowhere near the actual count. To experienced rxms, any other reasons for this discrepancy? Spent so much time for this, it's frustrating. Thank you!

You might have expired items that are no longer in the C-II safe. Those are included in your counts until the second they're scanned out by the agent that picks up your expired controlled substances. If your discrepancy equals a package size/bottle size, say 30, 60, 90, 100, then you likely have full bottles somewhere.
There might also be broken tablets that are kept in a different drawer, that you don't know about, because you have not asked about them, and you won't know to ask, unless you're told to ask, but your pharmacists will not tell you these things.
You might also have controlled pills that were involved in some dispensing error, and are just sitting there somewhere in a ziplock bag, waiting to be logged.

Did you not do a full controlled substances inventory before tying your name to this pharmacy's license? It's required in most/all states. You should also tell us what company you work for. You don't have to post the streeet address. It just helps us give you more meaningful advice. Every pharmacy software has its quirks. The issues I mentioned, relate to Walmart before they adopted electronic C-II counts.

Like johnpharmD said, back-count after every fill. That whole thing of writing on the bottle, the number of tablets left, is nonsense; especially if you have overlap. If your C-II inventory is all paperless, then your pharmacists are not being truthful when confirming in the system, the number of tablets left. They're just clicking through prompts and moving on. Terrible practice.

It's your name attached to that license. You are responsible for everything that happens there, whether you are present or not. Effective immediately, have everyone acknowledge they understand all Standard Operating Procedures on the Pharmacy Operations Manual. "I didn't know" won't be an option.

All the best.

 

[Ninetails]

Someone might be slipping tablets out the door. If it is just a few that are incorrect, then this is likely a grab and pop or grab snd sell situation. If most all of them are in error....you might not have all your paperwork in order (did you check in each order yourself or did other people do it from time to time). If a bottle you haven't even had a script for since the last time you inventoried is off, it is 99% of the time theft. Remember if you suspect theft you must report within a very short time frame. Better crunch the numbers and double check all your paperwork again before you report it.

Are you hand counting or using pill counting machines for your back counts? Lots of things to consider.

 

[CetiAlphaFive]

Just started working as a pharmacy manager and I'm already having trouble with the CII inventory. Things just don't add up for some reason. I checked the CII drug log and did the math (count from last month, # received, # dispensed, etc) but it's nowhere near the actual count. To experienced rxms, any other reasons for this discrepancy? Spent so much time for this, it's frustrating. Thank you!

Check your received invoices.

Run an NDC report.

Check the counts on the other strengths of the same med.

When was the last official inventory?

 

[ranger99rx]

Going forward have all pharmacists verify the remaining quantity. I have my techs count twice and back count the stock bottle then write remaining quantity on stock bottle with a marker. When the rx comes to me to verify, I count the prescription bottle, back count stock bottle, record in the book, and the math have to match at that time. Now we keep CII inventory through the computer system, no more CII log book. It saves so much time and any discrepancy have to be resolved right away (when you input the remaining quantity, the system will let you know if your number is off) so no more tracking down dispensing history, receiving, etc)

 

[RxPreceptor]

Common scenarios I run into that are not Losses: RPh not marking an open stock bottle, disorganized C2 safe (i.e. bottle sometimes rolls down to lower levels, sometimes under the droors), RTS vials not in the correct location, Tech/RPh does a PA on an already filled C2 without pulling from waiting bin, multiple RPhs filling the same narcotic (duplicates - literally floaters everytime), computer fails to recognize an RTS (i.e. 30 off), RPh used different NDC/MFR than what the computer documents (this one truly pisses me off), double logging C2s (manually entering a 222 invoice then logging it the standard way)

More RPhs/floaters/hands = more problems

 

[pharmd1701]

Huge thank you for the advice/tips. Currently work for Walgreens, definitely did the cs inventory check in early May, just did one yesterday. For Norco, I was off by 112. I freaked out because it's not 100 (missing bottle) and it's not a significant loss. Then I realized that we had issues with the computer system which might have caused a glitch. additionally, 112 tablets are often dispensed for 28 day supply, maybe the dispensed script didn't go through...that's my best guess. Another c2 med was off by 90...again, that's a common amount/quantity dispensed per prescription. Hopefully that's the case. C2 drug logs wasn't able to prove my actual counts. Sigh, really stressed. 5 meds are off, liquid meds are a pain.

 

[CetiAlphaFive]

Huge thank you for the advice/tips. Currently work for Walgreens, definitely did the cs inventory check in early May, just did one yesterday. For Norco, I was off by 112. I freaked out because it's not 100 (missing bottle) and it's not a significant loss. Then I realized that we had issues with the computer system which might have caused a glitch. additionally, 112 tablets are often dispensed for 28 day supply, maybe the dispensed script didn't go through...that's my best guess. Another c2 med was off by 90...again, that's a common amount/quantity dispensed per prescription. Hopefully that's the case. C2 drug logs wasn't able to prove my actual counts. Sigh, really stressed. 5 meds are off, liquid meds are a pain.

If it comes down to it, you might have to flip through the C2 hard copies

 

[johnpharm01]

Since you work at Walgreens you'll want to get your dm and AP involved. The good news is that if there is a theft problem going on, it won't persist because Walgreens keeps tight controls. It could be an it issue or miscounts. Make sure you are following company policy and procedure don't leave narcotics on the counter, don't leave cabinet doors opened and never give a tech your keys.

If your nervous now imagine the dea showing up and interviewing employees or the state board of pharmacy knowing your counts are off. I can guarantee if your norco is short 100 they think its significant.

 

[zelman]

For Norco, I was off by 112. I freaked out because it's not 100 (missing bottle) and it's not a significant loss.

JFC! What do you think a significant loss is?!

 

[pharmd1701]

JFC! What do you think a significant loss is?!

Oh that was a typo...that is a BIG significant loss! And I freaked out since it's not an exact 100 tab loss that could easily be explained. Hopefully, I get to the bottom of this and will give an update so that future new managers can find out if they're in my situation.

 

[Sine Cura]

This is another reason not to take a PIC position. If the store is full of complete idiots you have quite a bit of work to do to hold people accountable

Bad floaters too should be held accountable. Otherwise you will never get rid of them

 

[Modest_anteater]

Just started working as a pharmacy manager and I'm already having trouble with the CII inventory. Things just don't add up for some reason. I checked the CII drug log and did the math (count from last month, # received, # dispensed, etc) but it's nowhere near the actual count. To experienced rxms, any other reasons for this discrepancy? Spent so much time for this, it's frustrating. Thank you!

Depending on how much C2 is missing you need to call the DEA and your regional manager immediately and report the loss. If you don't you risk being falsely arrested for theft/diversion and will be facing a long jail term and the suspension of your license.