Controlled Substance Inventory Frequency in Canada

Canada has no single national schedule for counting narcotics and controlled drugs in a pharmacy. Each provincial regulator sets its own interval, and that interval is a minimum rather than a timetable. This guide sets out the intervals by province, explains what a reconciliation involves beyond counting tablets, and covers how pharmacies decide when to count more often and how to run a count day that produces a clean, signed record.

The interval by province

In Nova Scotia, the physical count and its reconciliation are completed and documented monthly. In Prince Edward Island, narcotic and controlled drugs are counted monthly as well, and targeted substances are reconciled at least once every six months. Alberta, British Columbia, Saskatchewan, Manitoba, and Newfoundland and Labrador generally require reconciliation every three months. The Ontario College of Pharmacists expects narcotics and controlled substances to be reconciled at least every six months, which works out to twice a year at minimum. Alberta's standard also calls for an audit of the perpetual inventory each time there is a change in proprietor or licensee. A pharmacy group with locations in two provinces runs two different intervals, and each location follows its own college.

What a reconciliation involves

A reconciliation is more than a tally. It has four parts: a physical count of each drug and strength, a comparison against the expected on-hand figure calculated from receipts, dispenses, destructions and returns since the last count, an investigation of every variance, and a signed and dated record of the result. A count that stops at the first part leaves a pharmacy with a number and no evidence that it matches anything.

Why many pharmacies count more often than the minimum

The difficulty of explaining a variance grows with the number of transactions behind it. Take a pharmacy that dispenses around 40 prescriptions of hydromorphone 2 mg between monthly counts. A shortage of 6 tablets on a monthly count means reviewing about 40 dispenses, a handful of receipts and any destructions. The same shortage found on a count at the Ontario minimum means reviewing roughly six times as many entries, and some of the staff involved may no longer remember them. A common approach is to tier the inventory: fast-moving and frequently diverted products such as oxycodone, hydromorphone, fentanyl patches and methadone get weekly or shift-change spot counts, while slow-moving items follow the full schedule.

Events that call for an extra count

• A change of owner, licensee or designated manager
• A break-in, a robbery, or a delivery that arrived with damaged or opened packaging
• A spot count that turns up a variance that a recount does not resolve
• A staff member leaving while a concern about controlled drugs is unresolved
• A conversion to new dispensing or inventory software, counted before and after
• Moving or replacing the narcotic safe or cabinet
• A change of wholesaler or a new receiving process

Running a count day

A count that produces a record an inspector can rely on usually follows the same order each time:

• Pick a cut-off time and hold new transactions for the drugs being counted until the count is done
• Print or export the expected on-hand figure for each drug and strength as of the cut-off
• Work in pairs where staffing allows: one person counts, the other records
• Count blind, writing down the physical quantity before looking at the expected figure
• Count sealed manufacturer packs by package and verify the seal; count opened bottles by unit; measure liquids by volume
• Compare the counts to the expected figures and recount anything that does not match
• Investigate each remaining variance and note the cause, or note that none was found
• Sign and date a cover sheet that lists every drug counted, so the count is one complete document

Spot counts between full counts

Spot counts catch problems while they are still small. At a shift change, the outgoing and incoming pharmacist can count two or three high-risk products, write the expected balance, the physical count and the variance, and both initial the line. If the expected balance of oxycodone 10 mg is 184 and the count is 182, the variance of minus 2 is recounted and traced before either person leaves, rather than discovered weeks later. For what to do when a variance does not resolve, see our guide on what to do after a narcotic discrepancy.

Keeping to a schedule with NarcCount

NarcCount imports dispensing, purchase and destruction records so the expected on-hand figure is ready at the cut-off, and it flags variances as soon as the physical count is entered. Each reconciliation is kept as a dated record, on whatever interval the pharmacy follows under its provincial college.