Who’s Stealing From the Sample Closet?

The nurse may have had the best of intentions. Her friend’s son was sick and needed some medications. And the nurse had access to an overflowing closet of pharmaceutical samples at the office, so why not save her friend a trip to the pediatrician and the cost of the drugs? The sample closet is kind of like a really big personal medicine cabinet, a job perk, right? No one would miss a sample or two here and there.

But the medications the nurse swiped for the boy caused an adverse reaction, sending him to the hospital.

It’s not just a worst-case scenario. It happens, and if your office has an unmonitored sample closet, it could happen to you, potentially making you liable for the outcome.

A less harrowing scenario? You reach into the sample closet to help out a patient, expecting to find a recently stocked shelf, and like Old Mother Hubbard, your cupboards are bare.

“In some places it is a free-for-all,” says Cynthia Dunn, a senior consultant for MGMA Health Care Consulting Group.

Often no one is in charge of the sample closet, and some practices assume drug reps are managing the samples. “They don’t even notice stuff is missing,” says practice consultant Elizabeth Woodcock. That is, she adds, until a worst-case scenario happens.

Rising prescription drugs costs and increased government scrutiny has made stocking drug samples more risky for practices. Last fall, the Wisconsin Medical Society announced a tougher policy on samples, saying practices should limit how often they dole them out, and instead consider a voucher system; which would allow patients to obtain medications but shield the practice from the burden and liability of providing drug samples.

The decision to provide samples comes with responsibility. Of course you’re busy with a thousand other tasks - not the least of which is caring for patients each day - and strict controls on the sample closet might seem a little unreasonable. But there are simple ways to avoid a sample closet disaster and protect your patients, your employees, and your practice.

• Treat all drugs equally. Practices must first adjust their perception of drug samples and begin treating them just as carefully as nonsamples, says Mike Schoppmann, a healthcare attorney at Kern Augustine Conroy & Schoppmann. Apply the same record keeping and restrictions used for controlled substances to the sample medications. “We need to get practices away from only being crisis oriented and instead thinking about this as standard protocol,” he says. “Practices won’t leave Demerol lying around, but they will leave samples lying around.”

• Lock the closet. A wide open closet is an invitation for snoopers and thieves, including employees and patients. Some practices even store samples in an exam room - bad plan, says Dunn, as nearly anyone can go in there and take them. If a locked door is not an option for your busy practice, at least consider making the closet more secure and hidden away from any patients or passersby who may have a case of sticky fingers.

• Get organized. Take a peek into your sample closet. Does it look like a natural disaster tore through there? Are boxes squeezed onto shelves and stacked on the floor? Take some time to organize the area, carefully placing medications in the proper spot - not lumped in alongside other office supplies or even crammed next to other drugs with dangerously similar names. The more organized the closet, the easier it will be for your practice to keep tabs on what goes in and what goes out.

• Keep a log. Practices should keep records of every sample, Woodcock says, including identifying lot numbers, when the sample was provided, instructions for use, expiration dates, and potential side effects. Designate one person on staff to monitor the inventory, and log the pharmaceuticals in each time they are stocked and log them out when they are dispensed to patients. An inventory is certainly an added step, but could save many headaches in the long run.

• Limit staff access to the samples. It might be easier to let any and all staff have unfettered access to the samples, but it’s not a great idea. Remember, it isn’t a personal medicine cabinet or perk of the job. Designate closet access only to clinical staff, including the person in charge of the inventory, Dunn says. While you’re at it, stop letting pharmaceutical reps have free reign in the open closet, she suggests. This will make it easier to maintain inventory, and keep track of the comings and goings of your samples.

• Write a policy. No longer should your practice’s handling of samples be haphazard or confusing. Create a written policy outlining who is authorized to receive and dispense samples, how often your sample closet is checked (say, the first Wednesday of every month), and which staff member is responsible for checking the inventory. “We are attaching a very strict formality to samples that hasn’t been given in the past,” Schoppmann says.

Having a sample closet in your practice without safeguards in place can expose the practice to a whole host of troubles. It’s not just potentially bad news for those who might steal or distribute the medicines (and their friends or family, for that matter), but it also could mean legal troubles for the practice. You could be sued for an adverse outcome from a sample, Schoppmann says, or risk losing your license or DEA registration. It’s a hefty risk, and not one your practice should take lightly. “When you have sample drugs,” Dunn adds, “you have some added responsibility.”

Sara Michael is an associate editor for Physicians Practice. She can be reached at sara.michael@cmpmedica.com.

This article originally appeared in the October 2009 issue of Physicians Practice.