Vial Tracking / Narcotics DEA Journalling

AngelTrack will follow your narcotics vials from purchase to disposal, logging each vial's movement through your organization.

This is the knowledgebase article for AngelTrack's end-to-end vial-tracking system. AngelTrack also has a simple narcotics tracking system that collects vial IDs inside the PCR for all designated medications, but which does not follow each individual vial. To learn more about the simple narcotics tracking system, please visit the Simple Narcotics Tracking Guide.

 

Prerequisites

The vial-tracking system is built atop these AngelTrack systems:

• Product records aka the Supply Room System
• Medication records
• Station records
• Device records (drug boxes are 'devices' that can be assigned to vehicles)
• PCR-Medication records obviously

To utilize the vial-tracking system, you must already be using the aforementioned systems.

The purchase-order / reorder workflow, which is part of the supply room system, supports vial-tracking, but you can choose whether or not to use it.

Permissions

Here are the AngelTrack permissions necessary to use various parts of the vial-tracking system.

• Edit any station record, including the contents of drug safes:
  • Administrators
  • Captains
  • Dispatchers
• Edit any device record, including inspection history and the contents of drug boxes:
  • Administrators
  • Captains
  • Lieutenants
• Edit any medication record:
  • Administrators
  • Captains
• Edit any product record, and use the purchase order system:
  • Administrators
  • Captains
  • Lieutenants
  • Human Resources

Alternatives

The vial-tracking system is complicated. You don't have to use it. As mentioned above, you can use AngelTrack's simple narcotics tracking instead. AngelTrack's PCR already knows which of your medications are vial-tracked, and will prompt the attending to input vial IDs as necessary. You can later pull this data using the various narcotics compliance reports, which depend on dose IDs input by crews and therefore do not require vial-tracking.

This alternative does not provide end-to-end tracking of vials. It cannot tell you the current location of every vial. Consult your legal counsel for help in choosing the optimal narcotics tracking strategy.

Configuration

1. Every location that has a drug safe must be a station record in AngelTrack, so make sure those records all exist.
2. Next, update your medication list in AngelTrack, configuring every relevant medication record as such:
   ☑ Narcotic / DEA reportable (if applicable)
   ☑ Crew must record a vial ID number
3. Add a product record for every brand of every relevant medication record. If you use more than one brand of a medication, then add one product record for each brand, and link them all to the medication record. For each of these product records, the category "Narcotics" is probably best, but you can choose any category; it will inherit its vial-tracking settings from the linked Medication record.
4. If you use zones, then the 'float' feature for vehicles and drug boxes will cause confusion. To avoid this, assign every vehicle to a specific station, rather than allowing them to float.
5. Every drug box must be a device record in AngelTrack, with its "Type" field set to "EMS - Drug box". The device records can float or be assigned to specific vehicles. You can find your devices list by clicking on the "Equipment queue" dashboard on the Supervisor Home page.
6. To input your vials, open each station record, switch to its "Drug safe" tab, and input all vials presently at the station, including any vials already in its drug boxes. Alternatively, you can input vials using the "Vials" tab of the relevant product record, or using the "Vials" tab of the relevant drug-box's device record.
7. If you want to configure a minimum quantity-on-hand for your stations, then switch to the station's "Supply room" tab, uncheck the ☑ Hide products not allotted to this station tickybox, and configure the minimum quantity for each narcotic product. You can skip this step if you like; vials are not required to have station allotments, if you don't intend to use AngelTrack's purchase order system to reorder your narcotics.

Any product record linked to a vial-tracked medication will disappear from the following places where product records normally appear:

• Checklist item linkage to product records
• Checklist resupply
• Supply room audits
• Supply room takings journal

...because vials are tracked individually. Resupply of drug boxes from a drug safe, and resupply of a drug safe from a purchase order, is handled separately.

Quantity On Hand

For all products that are vial-tracked, AngelTrack will automatically maintain the quantity on-hand. AngelTrack's normal supply-room inventory management features -- including crew-initiated corrections, and supply room audits -- do not apply.

In any case, you can view the total quantity on hand, and the quantity on hand at each station, using the relevant columns, grids, and reports in the Supply Room system. The only difference is, you will not directly edit the quantity on-hand, or adjust it during an audit, since the quantities are auto-calculated from your vials records.

The displayed quantity on-hand takes account of expirations: An expired vial no longer counts towards your total. AngelTrack automatically updates vial counts every night just after midnight, to remove any expired vials from the totals.

Floating Drug Boxes / Floating Vehicles

As already noted, each drug box can be assigned to a vehicle, or else it can float. Likewise each vehicle can be assigned to a station, or else it can float.

Any vial that is in a floating drug box, or that is in a drug box assigned to a floating vehicle, is assumed to belong to the Headquarters station. It will therefore appear in the list of vials available at Headquarters. This means that any agency with just one station can leave everything marked 'float'.

The 'float' feature will be confusing if you use zones, or if you have multiple stations with drug safes... in which case we recommend assigning each drug box to a vehicle, and each vehicle to a station.

Remember that you can assign equipment to vehicles via the Equipment List, or via the Vehicle List (using each vehicle's "Equipment" tab).

Serial Numbers

If every drug vial already has a unique serial number printed on it, then you can input those into AngelTrack's vials records, and thus have end-to-end tracking of every vial.

If the unique serial numbers on the vials are barcodes, then you can buy a handheld USB barcode scanner that will spare you all that keypunch. Just place your cursor into the Serial Number field in AngelTrack, aim the scanner, and pull the trigger.

Alternatively, if your vials do not have unique serial numbers printed on them, or if they do but you want to use AngelTrack's simpler record IDs instead, then follow these steps when entering each new vial into the system:

1. From the respective Station Edit, Device Edit, or Product Edit page, click the add button to open the Vial Add popover.
2. Choose the correct product from the dropdown list. Remember that you might have multiple product records for the same medication, e.g. you might carry three different brands of diazepam, so double-check your selection.
3. Verify the Received Date and Expiration Date fields, which will be preset for you to "today" and "one year from today".
4. Input the vial's Lot Number, but leave the Serial Number field blank.
5. Click the "Add" button to finish.
6. AngelTrack will then display a slide-in message telling you the unique record ID that it assigned to the vial.

Now you must apply the record ID assigned by AngelTrack to each vial. Rather than fiddling with a labelmaker or permanent markers, go online and do a search for "preprinted serial security stickers".

Order several rolls, with serial numbers starting at "1". Make sure to buy the smallest possible sticker format -- less than a half inch -- so that the sticker does not cover up the important information printed on the vials. Keep the sticker rolls at your headquarters where you process newly arrived vials. Apply the stickers to the vials as you input them into AngelTrack.

Workflow

Here is a typical workflow for a vial, from the moment it arrives at your station to the moment a crew member throws it into the trash:

• The purchase order containing new vials arrives.
  • If this was an AngelTrack purchase order, then marking it "Completed" will automatically create the necessary vials records.
  • Otherwise, you must create the vials records manually.
• Input the lot numbers of the new vials into AngelTrack.
• Place tracking stickers (see discussion above) onto the vials to mark their AngelTrack record ID numbers.
• Store the vials in the drug safe.
• At the beginning of a shift, a paramedic checks-out a drug box by providing an electronic signature in AngelTrack.
• If the drug box is missing any items, or any are expired, the paramedic uses the "Drug box contents" editor in AngelTrack to mark vials as discarded or as transferred from the safe to the drug box.
• Upon administering any medication from his drug box, the paramedic uses AngelTrack's PCR-Medications page to designate the vial that was used (or wasted).
• Near the end of shift, the paramedic uses the "Drug box contents" editor again to indicate any more vials discarded from or added to his drug box.
• At end of shift, the paramedic checks-in the drug box by providing an electronic signature in AngelTrack.
• AngelTrack's supply room system will then indicate that the station's drug safe is short however many vials were discarded (used/wasted) or expired, and when this quantity falls below minimum, will offer to prepare the necessary purchase order.

Limitations

Every station can only have one drug safe. If there are multiple drug safes at a station, AngelTrack treats them all as one single drug safe.

Every vial-tracked drug must have a medication record and a product record linked to it. Multiple product records can link to a single medication record, i.e. you could stock three different brands of lorazepam, but every product record can link to only one medication record, i.e. you cannot have a vial that contains two different medications.

As far as AngelTrack is concerned, each vial is either inside a station's drug safe or inside a drug box; there is no third place it can be. That means every new narcotics order arriving at the station must be input into AngelTrack as soon as possible, since the vials in a purchase order are not yet known and therefore not yet tracked.

Once a vial is used or wasted, the attending can physically throw it away, but its record will remain in AngelTrack. Vial records marked 'used', 'wasted', or 'expired' are not normally shown by the UI, but they are still there, attached to a station record or to a drug box record.

Drug boxes can be assigned to vehicles or marked as 'float'. Vehicles meanwhile can be assigned to stations or marked as 'float'. If you want your drug boxes to be permanently assigned to a particular station, then you must assign them to vehicles which, in turn, are assigned to that station; otherwise, AngelTrack will assume they are all at your headquarters station.

Used and Wasted Vials

Vials which are (via the PCR) marked 'used' or 'wasted' remain as records in AngelTrack, but the drug-safe UI will stop displaying them unless the user deactivates the filter checkbox.

To un-mark a vial as 'used' or 'wasted', and return it to active status, you must delete the associated PCR-Medications records.

If you destroy or otherwise waste a vial while not running a call, you cannot mark it 'used' or 'wasted', since those designations come from the PCR. Instead, remove the destroyed vial's record from the drug box, and mark it 'deleted'.

Multi-Use Vials

One vial can be used for multiple administrations, even across multiple dispatches, if that is your practice. The vial-picker in the PCR-Medications page gives this option to the attending. Furthermore, a crew member can deliberately keep a half-used vial in his drug box, or a half-wasted vial, and administer the other half on a different call.

A vial can even be "used" for one call and "wasted" for another, if that is how the medication was utilized.

Expired Vials

AngelTrack follows each vial record's expiration date, and automatically subtracts it from your quantity on-hand on its expiration date.

The vial records remain in the system, for use during a future audit, but the UI will stop displaying them unless the user deactivates the filter checkbox.

Delete and Undelete Vials

If a vial was erroneously input into the system, or was test data during a training session, you can mark it 'deleted'. The record will remain in the system, but the UI will stop displaying it.

You can undelete it later if you change your mind.

You cannot delete a vial that is marked 'used' or 'wasted' by a linked PCR-Medications record.

If you delete a PCR-Medications record that has a linked vial, then AngelTrack will un-mark that vial as 'used' or 'wasted', and return it to 'active' status. If you later un-delete the PCR-Medications record, AngelTrack will re-mark that vial as 'used' or 'wasted'.

Drug Box Checkout

Once a crew comes on-shift, they can sign-out their drug box by clicking the "Drug box checkout" link on their Crew Home page. AngelTrack will offer them a list of drug boxes available at either their posting station or the station at which their vehicle is based. The list always includes drug boxes that are marked 'float', or which are assigned to vehicles that are marked 'float'. If the crew's vehicle has a drug box already assigned to it, then that drug box will be the pre-selected choice.

The crew must provide an electronic signature to complete the checkout.

Later, to return the drug box, or to switch to a different one, the crew can click the "Drug box return signature" link and repeat the process.

A dispatcher can view their shift record to verify their drug box choice, and from there can edit the drug box's contents as necessary, if the dispatcher has the necessary permissions (see above).

Drug Box Loading and Unloading by Crew Members

After a crew member checks-out the drug box for their shift, he or she can edit its contents, by clicking the "Drug box contents" link that AngelTrack offers on the Crew Home page.

In the drug box contents editor, AngelTrack shows all vials currently known to be in the drug box, including used and wasted vials. It also shows all vials currently known to be in the drug safe of the associated station.

If the crew member wants to discard a used or wasted vial, he just clicks the "Back" button to put the vial back in the station's drug safe. Although the vial is actually in the trash can, AngelTrack considers it to be "at the station", where its record will remain in case of an audit.

The same process is used when returning an active vial back to the drug safe, or an expired vial to the trash can.

If the crew member wants to take a vial from the drug safe, or from another drug box located at the same station, he just clicks its "Take" button.

(Obviously you will have your own physical-access protocol for the drug safe; the only thing AngelTrack does here is keep the record of where the vial is at any given time, and who put it there.)

A crew member can also input a brand new vial into AngelTrack, booking it into the drug safe or into his drug box, using the add feature on the Drug Box Edit page. This would be necessary if there was an oversight during earlier vial bookkeeping.

Note: Supervisors and administrators can load and unload any drug safe and any drug box, and add and delete vials, using the Station Edit, Product Edit, and/or Device Edit pages in AngelTrack, all of which have a "Vials" tab.

PCR bookkeeping must be finished first

Crew members should be trained to finish their charts before unloading used vials from their drug box, otherwise the unloaded vials will not appear as choices in the PCR-Medications page's vial picker.

Journalling

All changes to vial records are journalled. The journal is read-only, and subject to AngelTrack's data lifetime policy.

Every vial's journal is accessible from its Vial Edit page.

Drug Box Inspections

Because every drug box is a device record, each can have an inspection interval (e.g. 12 months), and AngelTrack will store its inspection history.

An inspection is whatever you make of it. AngelTrack just stores the inspection date, pass/fail, and comments.

A good use for this feature is for vial-audit reminders. You can configure a short inspection interval, say three months, and then AngelTrack will prompt you (via the Equipment Queue) to re-inspect and re-inventory the drug box every three months.

Purchase Orders

If you want AngelTrack to automatically include your narcotics vials in your purchase orders, via the Reorder Queue, you must set the desired quantity for each narcotics product at each station. This is done in the same way as for all other products, please refer to the Supply Room Guide for details; the only difference is, it's optional for vials. You can assign vials to any station with or without specifying a minimum quantity.

AngelTrack maintains the quantity-on-hand data for every vial-tracked product by adding up all vial records which are active and not-expired. Any vial that is expired, or is marked 'deleted', or is marked 'used' or 'wasted' via the PCR, does not count towards the quantity on hand or the reorder threshold.

When you mark a purchase order as 'completed', AngelTrack creates the necessary vials records in each respective station's drug safe. You must then input their lot numbers, and if not using AngelTrack's vial record IDs (see discussion above), you must assign your own vial serial numbers to the vials records that were created.

If you later mark a completed purchase order as 'cancelled', AngelTrack will automatically delete the associated vials records, as long as they have not yet been linked to a PCR-Medications record.

Tracking Down a Vial Later

If you ever need to track down the record for a particular vial, you can use any or all of these resources to find it:

• The "Vials" tab of the relevant Station Edit page
• The "Vials" tab of the relevant Drug Box page (remember that drug boxes appear in your Device and Equipment List)
• The "Vials" tab of the relevant Product Edit page
• The "Vials" tab of the relevant Purchase Order Edit page

Which one you choose will depend on what you know about the vial: Its station, or its drug box, or its product, or the purchase order by which it was received.

If all else fails, use the Data Hub / Report Builder to pull the "Vials" data category, filtering by the date range in which the vial was first acquired.

Reporting

There is a dataset named "Vials", in a category of the same name, in the Data Hub. It can pull all data for all vials across any date range, according to the "Purchase Date" datafield. If you have a Report Builder license then you can pull the data into a custom report, and slice and dice it any way you like.

You can review any vial's journal by finding the vial record using any of the above methods, and then switching to its "Journal" tab.

Retroactive Changes

Certain changes to medication records, product records, drug box records, and vial records are retroactive to any linked PCR records...

Changes to medication records

Under no circumstances should anyone ever change a medication record to refer to a different medication, or even a different concentration of a medication. Always create new medication records for new medications or new concentrations of existing medications. You can soft-delete your existing medication records if you no longer carry those drugs and/or concentrations.

If you do make such a change, either to the RxNorm code or to the drug's name, it will retroactively change all linked PCR-Medications records too. As such, you should only do so if the original medication record was incorrect.

You can freely alter anything else about a medication record without causing any negative consequences.

Changes to product records

Changes to a product record apply retroactively to checklist resupply records, purchase orders and fulfillments, and supply room journals, which is probably undesirable. Therefore changes to a product record should be done only to correct errors, never to change it into a different product. As with other records in AngelTrack, if you are switching to a different product, then deactivate the existing product record and create a new one.

Changes to a product record's medication link apply to any linked vials, no matter how old. Therefore this should be done only to correct an error in the medication designation.

Changes to drug box records

Your drug boxes can roam freely throughout your organization, moving from vehicle to vehicle and from station to station as you see fit. You can change their names and vehicle assignments whenever you like... but take care not to change their Primary Device Type field, it should stay "EMS - Drug box" or else the drug box will vanish from the vial-tracking system.

Changes to vial records

Any changes to a vial record apply retroactively to any linked PCR-Medications records.

Where such a linkage exists, AngelTrack will prevent you from marking a vial as 'deleted', however it will not prevent you from making other corrections -- even to the linkage to the product record that determines which drug is thought to be in the vial. Therefore all such edits should be done with great care, and only to correct an error.

NEMSIS Exports

When a PCR contains one or more PCR-Medications records that link to vial records, AngelTrack includes the vial data in the exported NEMSIS XML.

The NEMSIS standard does not provide a standard way to include vial data in the /eMedications node, so instead AngelTrack emulates ImageTrend's "itControlledSubstancesGroup" group, including all available vial data in an /eCustomResults group, and linking the group back to the relevant /eMedications record via its @CorrelationID attribute.

Medication Box API

AngelTrack's medication box API includes data about the relevant vials, where available, from the vial-tracking system. This allows your smart drug boxes to benefit from the vial data that AngelTrack is tracking. One such example is the Schedule2 narcotics tracking software, with which AngelTrack is already integrated.