Checklist template

Prescription pad and controlled drug security for clinics

A ready-to-use checklist with 119 items in 6 sections, covering Storage, Access, Counts, Disposal, Electronic prescribing access, Incidents. Use it as-is in Bindy, or adapt it to your own standards in minutes.

  • 6 Sections
  • 119 Items
  • 99 Yes / No checks
  • 6 Scored ratings
  • 129 Points

Use this template How audits work

1. Storage 20 items

  1. Controlled drugs are kept in a locked cabinet or safe fixed to the wall or floor Yes / No 1 pt
  2. The cabinet has a second lock where company policy requires double locking Yes / No 1 pt
  3. The controlled drug cabinet is in a room patients cannot enter unescorted Yes / No 1 pt
  4. The controlled drug cabinet was found locked at the time of the visit Yes / No 1 pt
  5. The controlled drug cabinet holds nothing but controlled drugs and their log Yes / No 1 pt
  6. No controlled drug was found in exam room drawers, on counters or on procedure trays during the walk Yes / No 1 pt
  7. Refrigerated controlled drugs are kept in a locked box or a locked refrigerator Yes / No 1 pt
  8. An emergency kit that contains controlled drugs is closed with a numbered seal Yes / No 1 pt
  9. The controlled drugs in stock are limited to the list approved by the medical director Yes / No 1 pt
  10. Deliveries of controlled drugs are locked away immediately by an authorized employee Yes / No 1 pt
  11. The receiving record of the last delivery is signed by two employees Yes / No 1 pt
  12. Order and receiving documents are kept as required by local regulation Yes / No 1 pt
  13. The registration or license to hold controlled drugs is current, as required by local regulation Yes / No 1 pt
  14. Controlled drugs are kept in the manufacturer's labeled containers, with none loose or repackaged Yes / No 1 pt
  15. Blank prescription pads are locked in a cabinet outside the exam rooms Yes / No 1 pt
  16. Printer trays loaded with prescription security paper are locked or in a staff-only room Yes / No 1 pt
  17. Blank prescription pads found unsecured during a walk of 3 exam rooms Number
  18. No pre-signed blank prescription was found Yes / No 1 pt
  19. The stock log lists the serial number range of each batch of pads received Yes / No 1 pt
  20. Storage of controlled drugs and prescription pads Rating
    • Everything locked and separated 5 pts
    • Locked, but stored with other items or a seal missing 3 pts
    • Drugs or pads found unsecured 1 pt

2. Access 20 items

  1. A written list names the people authorized to open the controlled drug cabinet Yes / No 1 pt
  2. People on the authorized access list Number
  3. Cabinet keys are carried by an authorized person during the shift, not kept in a drawer or on a hook Yes / No 1 pt
  4. Each handover of the keys between shifts is signed in the key log Yes / No 1 pt
  5. The spare key is sealed in a signed envelope in the manager's safe Yes / No 1 pt
  6. Each user of an electronic cabinet or keypad has a personal code Yes / No 1 pt
  7. Date the cabinet code or combination was last changed Date
  8. The code or combination was changed after the last authorized person left Yes / No 1 pt
  9. The most recent leaver was removed from the access list on the last day worked Yes / No 1 pt
  10. The access report of the electronic cabinet is reviewed monthly, where one is installed Yes / No 1 pt
  11. Students and temporary employees have no unsupervised access to the medication room Yes / No 1 pt
  12. The medication room is locked while cleaning crews are in the building after hours Yes / No 1 pt
  13. An alarm or camera covers the controlled drug cabinet, where company policy requires one Yes / No 1 pt
  14. An employee asked could state who may open the controlled drug cabinet Yes / No 1 pt
  15. Pads are issued to a prescriber only against a signature, with the serial numbers recorded Yes / No 1 pt
  16. Each prescriber holds no more pads than company policy allows Yes / No 1 pt
  17. The pads in the locked stock match the balance of the pad issue log Yes / No 1 pt
  18. Prescribers who left the clinic returned their unused pads Yes / No 1 pt
  19. No signature stamp of a prescriber is in use Yes / No 1 pt
  20. Control of access Rating
    • Restricted to named people and logged 5 pts
    • Restricted but logs incomplete 3 pts
    • Keys or codes shared 1 pt

3. Counts 20 items

  1. Each controlled drug has its own log page with a running balance Yes / No 1 pt
  2. Each dose in the log shows the date, the patient, the amount, the prescriber and the person administering Yes / No 1 pt
  3. Two people count all controlled drugs at the frequency set by company policy Yes / No 1 pt
  4. Both counters sign each count Yes / No 1 pt
  5. Scheduled counts missing in the last 14 days Number
  6. A count during the visit matched the log balance for every controlled drug Yes / No 1 pt
  7. Controlled drugs with a count difference during the visit Number
  8. The log is written in ink Yes / No 1 pt
  9. Corrections in the log are a single line with initials, with no correction fluid Yes / No 1 pt
  10. The log is a bound book with numbered pages, or a locked electronic record Yes / No 1 pt
  11. Partial doses wasted are recorded with a witness signature Yes / No 1 pt
  12. Tamper seals on vials and bottles in stock are intact Yes / No 1 pt
  13. 5 log entries sampled each traced to an order in the patient's chart Yes / No 1 pt
  14. Quantities received on the last 3 invoices were each entered in the log Yes / No 1 pt
  15. Expired controlled drugs remain in the count until they are disposed of Yes / No 1 pt
  16. The count sheet lists each controlled drug by name, strength and container size Yes / No 1 pt
  17. The medical director or the clinic manager signs the count records each month Yes / No 1 pt
  18. Usage by prescriber is reviewed for unusual patterns at the frequency set by company policy Yes / No 1 pt
  19. Date of the last full inventory of controlled drugs Date
  20. Accuracy of the controlled drug counts Rating
    • All counts done and balanced 5 pts
    • Counts balanced but some missed 3 pts
    • Unexplained differences 1 pt

4. Disposal 20 items

  1. Expired controlled drugs are separated inside the locked cabinet and marked "expired - do not use" Yes / No 1 pt
  2. Expired controlled drug items awaiting disposal Number
  3. No expired controlled drug has awaited disposal longer than the limit set by company policy Yes / No 1 pt
  4. Controlled drugs are disposed of through a licensed reverse distributor or another method allowed by local regulation Yes / No 1 pt
  5. Each disposal record shows the drug, the quantity, the date and two signatures Yes / No 1 pt
  6. Date of the last disposal of controlled drugs Date
  7. The disposal vendor's agreement is on file Yes / No 1 pt
  8. Partial doses are wasted immediately after use, with a witness present Yes / No 1 pt
  9. Wasted doses go into the drug deactivation container named in company policy, not into a sink or trash bin Yes / No 1 pt
  10. A drug deactivation container is available in the medication room Yes / No 1 pt
  11. The pharmaceutical waste container is kept in a staff-only area Yes / No 1 pt
  12. An employee asked described the waste procedure correctly Yes / No 1 pt
  13. Medications returned by patients are refused or handled per the company take-back policy Yes / No 1 pt
  14. Spoiled or voided paper prescriptions are marked "void" Yes / No 1 pt
  15. Voided prescriptions are shredded Yes / No 1 pt
  16. Misprints on prescription security paper are shredded, not placed in recycling Yes / No 1 pt
  17. Pads of prescribers who left were destroyed with a witness, with the serial numbers recorded Yes / No 1 pt
  18. Pads showing an old address or phone number have been destroyed Yes / No 1 pt
  19. Shredding bins used for prescriptions are locked Yes / No 1 pt
  20. Disposal of controlled drugs and prescription paper Rating
    • Witnessed and documented every time 5 pts
    • Done but records incomplete 3 pts
    • No documented disposal 1 pt

5. Electronic prescribing access 20 items

  1. Active prescriber accounts in the electronic prescribing system Number
  2. Each prescriber has a personal login to the electronic prescribing system Yes / No 1 pt
  3. Controlled drug prescriptions require a second authentication factor from the prescriber Yes / No 1 pt
  4. No authentication token or key fob was found left at a workstation Yes / No 1 pt
  5. Prescribers do not hand their token or password to staff Yes / No 1 pt
  6. Staff accounts can prepare a controlled drug prescription but cannot sign or send it Yes / No 1 pt
  7. The user list of the prescribing system was reviewed and signed in the last 3 months Yes / No 1 pt
  8. Date of the last review of prescribing system users Date
  9. The account of the most recent prescriber to leave was deactivated on the last day worked Yes / No 1 pt
  10. Workstations lock after the period of inactivity set by company policy Yes / No 1 pt
  11. No exam room workstation was found with a prescriber's session left open Yes / No 1 pt
  12. No password is written at any workstation checked Yes / No 1 pt
  13. Refill requests for controlled drugs are approved by the prescriber Yes / No 1 pt
  14. 5 charts sampled show the prescription monitoring database was checked before a controlled drug was prescribed, as required by local regulation Yes / No 1 pt
  15. The medical director reviews a report of controlled drug prescriptions by prescriber each month Yes / No 1 pt
  16. The audit trail of the prescribing system is switched on Yes / No 1 pt
  17. Prescriptions phoned to a pharmacy by staff are backed by a documented prescriber order Yes / No 1 pt
  18. Remote access to the prescribing system is limited to company-managed devices Yes / No 1 pt
  19. Prescriptions can be printed only on designated printers Yes / No 1 pt
  20. Control of electronic prescribing access Rating
    • Personal logins, two factors and regular review 5 pts
    • Personal logins but no regular review 3 pts
    • Shared logins or tokens 1 pt

6. Incidents 19 items

  1. A written procedure covers loss, theft and count differences of controlled drugs Yes / No 1 pt
  2. An employee asked knew whom to tell about a count difference Yes / No 1 pt
  3. Count differences are reported to the manager during the same shift Yes / No 1 pt
  4. Count differences recorded in the last 12 months Number
  5. Each count difference of the last 12 months has a written investigation with its outcome Yes / No 1 pt
  6. Unresolved losses were reported to the authorities as required by local regulation Yes / No 1 pt
  7. Lost or stolen pads were reported, with their serial numbers, as required by local regulation Yes / No 1 pt
  8. Calls from pharmacies to verify a prescription are logged Yes / No 1 pt
  9. Each forged or altered prescription reported by a pharmacy was investigated Yes / No 1 pt
  10. Suspected diversion is escalated to the medical director or the compliance officer, per the written procedure Yes / No 1 pt
  11. The procedure states what to do when an employee appears impaired at work Yes / No 1 pt
  12. The incident log is kept locked Yes / No 1 pt
  13. Alarm activations and break-in attempts at the medication room are recorded Yes / No 1 pt
  14. Employees with access received training on drug diversion in the last 12 months Yes / No 1 pt
  15. Date of the last drug diversion training Date
  16. Corrective actions from the previous review have been completed Yes / No 1 pt
  17. Name of the person responsible for controlled drugs Short text
  18. Overall security of prescription pads and controlled drugs Rating
    • Locked, counted and balanced, with access limited to named people 5 pts
    • Secure, with gaps in logs or reviews 3 pts
    • Unsecured drugs or pads, or unexplained differences 1 pt
  19. Corrective actions required Comments

About this template

This checklist is part of the Bindy template library. Yes / No checks score 1 point when met; ratings score the points shown for each option. The overall score is the percentage of points earned, with N/A answers excluded. In Bindy you can add photos, assign corrective actions, require sign-off and compare results across sites.

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