Program for Reviewing Returned Medications

A program for reviewing medication doses returned to the pharmacy department is described. Discrepancies concerning returned doses at a teaching hospital led to the creation of a returned-dose log sheet. A pharmacist enters the patient's name, medication, and administration schedule and forwards a copy to the charge nurse on the patient's unit, who records the reasons for the return. A pharmacist then uses the form to resolve any discrepancies in the pharmacy records and follows up if necessary. Monthly summaries of the forms are prepared. After a pilot phase and educational feedback, the rate of return of log sheets by nurses increased to 95%. It took nurses about 10 minutes per unit to complete a form, and pharmacists required 15 to 20 minutes for completion and follow-up. The percentage of dispensed doses that were returned decreased from 1.1% during the first month of the full program to 0.4% during the eighth month. The most common reason given by nurses for returned doses was that the dose had already been charted as having been given. The therapeutic classifications most frequently represented by the returns were gastrointestinal drugs, cardiovascular drugs, anti-infective agents, and electrolytic, caloric, and water balance drugs. The use of a log sheet to document and explain the return of scheduled doses to the pharmacy department improved communication, resolved discrepancies in the records, and reduced the rate of returns.