Key Takeaways
- FIFO (First In, First Out) ensures oldest stock is used first to prevent expiration.
- DEA Form 222 is required for ordering Schedule II controlled substances.
- Look-alike/sound-alike (LASA) drugs require special safety measures like Tall Man lettering.
- Drug recalls have three classes: Class I (serious harm), Class II (temporary harm), Class III (unlikely harm).
- Medication errors must be documented and reported for quality improvement.
Last updated: January 2026
Inventory Management and Medication Safety
Quick Answer: Pharmacy inventory uses FIFO (First In, First Out) to rotate stock. DEA Form 222 is required for C-II orders. Medication safety includes Tall Man lettering for LASA drugs, barcode verification, and proper error reporting.
Inventory Management Principles
FIFO (First In, First Out)
FIFO means the oldest inventory is dispensed first:
- Place new stock behind existing stock
- Check expiration dates when stocking
- Return expired medications for credit or disposal
- Prevents dispensing expired medications
Reorder Points
| Term | Definition |
|---|---|
| PAR Level | Periodic Automatic Replenishment - target quantity |
| Reorder Point | Quantity that triggers a new order |
| Safety Stock | Minimum quantity to prevent stockouts |
| Lead Time | Time between order and delivery |
Reorder Point = (Average Daily Use x Lead Time) + Safety Stock
Inventory Turnover
Turnover Rate = Cost of Goods Sold / Average Inventory Value
Higher turnover = more efficient inventory management
Ordering Controlled Substances
DEA Form 222 (Schedule II)
| Requirement | Details |
|---|---|
| Format | Triplicate carbon form or electronic (CSOS) |
| Who signs | DEA registrant or power of attorney |
| Copies | Copy 1 to supplier, Copy 2 retained, Copy 3 to DEA |
| Retention | 2 years |
| Corrections | Cannot be altered - void if errors |
CSOS (Controlled Substance Ordering System)
- Electronic alternative to paper 222 forms
- Requires digital certificate
- Records maintained electronically
- More secure and efficient
Schedule III-V Ordering
- No DEA 222 required
- Regular invoice/purchase order
- Must maintain records for 2 years
Drug Recalls
FDA Recall Classes
| Class | Severity | Examples |
|---|---|---|
| Class I | Serious adverse events or death possible | Contaminated sterile products, wrong drug |
| Class II | Temporary or reversible adverse events | Subpotent products, labeling errors |
| Class III | Not likely to cause adverse events | Minor labeling issues |
Recall Procedures
- Receive recall notification (from wholesaler, manufacturer, or FDA)
- Identify affected products (lot numbers, NDCs)
- Remove from inventory immediately
- Quarantine products separately
- Check dispensing records for affected patients
- Notify patients if necessary
- Return products following manufacturer instructions
- Document actions taken
Medication Safety
Look-Alike/Sound-Alike (LASA) Drugs
Tall Man Lettering helps distinguish similar drug names:
| Drug 1 | Drug 2 |
|---|---|
| hydrALAZINE | hydrOXYzine |
| predniSONE | prednisoLONE |
| vinBLAStine | vinCRIStine |
| DOBUTamine | DOPamine |
| cloNIDine | cloZAPine |
| glipiZIDE | glyBURIDE |
| traMADol | traZODone |
High-Alert Medications
| Category | Examples |
|---|---|
| Anticoagulants | Warfarin, heparin, enoxaparin |
| Insulin | All types |
| Opioids | Morphine, fentanyl, oxycodone |
| Neuromuscular blockers | Succinylcholine, rocuronium |
| Chemotherapy | All antineoplastic agents |
| Concentrated electrolytes | KCl injection, NaCl >0.9% |
Error Prevention Strategies
| Strategy | Implementation |
|---|---|
| Barcode scanning | Verify NDC at dispensing |
| Tall Man lettering | Distinguish LASA drugs |
| Separate storage | High-alert drugs in distinct locations |
| Double-check | Two technicians verify high-risk meds |
| Patient counseling | Pharmacist verification of understanding |
| Automated dispensing | Reduce manual selection errors |
Storage Requirements
Temperature Ranges
| Storage Type | Temperature |
|---|---|
| Freezer | -25 to -10 C (-13 to 14 F) |
| Refrigerator | 2 to 8 C (36 to 46 F) |
| Cool | 8 to 15 C (46 to 59 F) |
| Room Temperature | 20 to 25 C (68 to 77 F) |
| Controlled Room Temp | 20 to 25 C, excursions 15-30 C allowed |
| Warm | 30 to 40 C (86 to 104 F) |
Light-Sensitive Medications
Store in amber containers or light-resistant packaging:
- Nitroglycerin
- Nifedipine
- Furosemide
- Methotrexate
- Vitamin A
Medication Error Reporting
Types of Errors
| Error Type | Example |
|---|---|
| Wrong drug | Dispensing metoprolol instead of metformin |
| Wrong dose | Dispensing 100mg instead of 10mg |
| Wrong patient | Giving medication to wrong person |
| Wrong route | Dispensing oral for injection |
| Wrong time | Significant timing error |
| Omission | Failing to dispense ordered medication |
| Duplicate therapy | Same drug from two prescribers |
Reporting Systems
| System | Description |
|---|---|
| MedWatch | FDA adverse event reporting |
| ISMP MERP | Medication error reporting to ISMP |
| State Boards | State-required reporting |
| Internal QA | Pharmacy quality assurance reports |
Error Documentation
When an error occurs:
- Prioritize patient safety - address harm first
- Notify pharmacist immediately
- Document the error objectively (what, when, how)
- Identify root cause - system vs. individual factors
- Implement corrective action - prevent recurrence
- Report as required - internal and external
Important: Error reporting should be non-punitive to encourage reporting and system improvement.
Controlled Substance Inventory
Biennial Inventory
| Requirement | Details |
|---|---|
| Frequency | Every 2 years |
| Date | Within 2 years of initial or last inventory |
| Content | All controlled substances on hand |
| Method | Exact count for C-II, estimate allowed for C-III to V |
| Retention | 2 years |
Perpetual Inventory
- Running count updated with each transaction
- Required for Schedule II in most pharmacies
- Allows immediate detection of discrepancies
- Must reconcile with physical counts
Discrepancy Procedures
- Recount inventory
- Check dispensing records
- Review receiving records
- Document discrepancy
- Notify supervisor/pharmacist-in-charge
- Report significant discrepancies to DEA
Test Your Knowledge
Which DEA form is required to order Schedule II controlled substances?
A
B
C
D
Test Your Knowledge
A drug recall is issued for a product that could cause serious adverse health consequences or death. What class is this recall?
A
B
C
D
Test Your Knowledge
Which inventory management principle ensures that the oldest medication stock is dispensed first?
A
B
C
D