Summary: GAO was asked to report on the controls over drugs in Veterans Administration (VA) Medical Centers. Previously, GAO stated that substantial drug losses in VA centers could be reduced and patient care improved by converting from the ward stock pharmacy system to unit dose, an improved system which provides better drug controls. Recognizing that it may not be economically feasible to convert all medical centers to the unit dose system in a short period of time, the recommendations to VA focused on interim actions that should be taken to improve and strengthen drug controls under the ward stock system. GAO also recommended that VA establish a definite timetable for VA-wide conversion of ward stock centers to the unit dose system. GAO found that VA still does not have an effective program for controlling the use of, or accounting for, drugs dispensed at its ward stock centers. With a few exceptions, GAO found that the recommendations were not implemented by VA. To illustrate the types of internal control problems existing at ward stock centers, GAO focused on the pharmacy operations at one of the VA medical centers. At this center, the followup showed no adequate system of drug controls through the maintenance of records, monitoring of drug use, and audit of drug receipts and deliveries. In addition, GAO found that unused prescription pads were readily accessible to unauthorized persons and a number of physician signature cards were incomplete or outdated. GAO believes that without specific funding, local center directors will be hard pressed to convert existing ward stock pharmacy systems to unit dose systems. VA should identify the amount of funding necessary to permit systemwide conversion to unit dose and provide the resources required to the affected centers to achieve total conversion.
