clinical research

1. Drug accountability
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By:- Upendra Agrawal

2. Contents
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1. Introduction
2. Role of documentation
3. Benefits of documentation
4. What should be documented
5. What steps should be carried with investigational drug
6. Responsibilities
7. FDA inspection
8. Conclusion
9. References

3. Introduction
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Drug accountability : It concern with study drug storage,
handling, dispensing , and documentation of administration,
return and/or destruction of the drug.
Purpose: To create uniform study drug dispensing and
accountability standards & establish procedure for the proper
control, storage, dispensing and handling of investigational
drug in accordance with regulatory standards.

4. Role of Documentation
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Documentation is the to accountability
Accurate drug accountability records demonstrate that the study drug was
dispensed and administered according to the protocol , support study data
validity and conclusion drawn from those data. If the investigator
adequately maintains the study drug accountability documentation, and the
monitor conducts ongoing reviews, then the records should reflect that the
researcher maintained proper control of administration and distribution of
the study drug. The records, when kept according to the recommendations
presented here, should also indicate that the clinical trial is according to
regulatory obligations.

5. Benefits of documentation
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1. Help verify patient clinical records and detect possible lot variations.
2. Help verify patient case report form and detect any incompliance.
3. Help identify patients who may have received the drug, as well as the quantities
that they may still have in their possession, should recovery of any unused drug
become necessary to minimize health risks.
4. Support the validity of study data and conclusions drawn from those data.
5. The paper trail would show the receipt of the supplies at the site, the dispensing to
each subject, the amount the subject used or did not use, the amount the subject
returned, and the amount the research pharmacist returned to the sponsor or
destroyed on-site . At any stage of the study, the site staff, the monitor, and the
sponsor can know where their drugs are.

6. What should be documented
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The site should document drug receipt, subject dispensing and , return of used and
unused supplies to the sponsor (or on-site destruction), and should maintain a
current accounting of all supplies in inventory/storage. The balance-on-hand or
dispensing log should contain he protocol no. ,the investigator site , the drug name
and the medication unit-such as tablets , capsule or vial.
A well mentioned balance-on-hand log allows the study monitor to efficiently assess
drug accountability during routine site visit and at the final drug reconciliation
The final step in the drug accountability process is drug return or destruction. This
action should be properly documented, including protocol and drug identifiers,
units, and lot numbers.

7. Cont.
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Documentation completed on an ongoing basis of the following:
 When drug supplies arrive
 When a drug is dispensed
 When a drug is returned by subject
 When a drug is returned to the supplier, or is destroyed
 A pill count on the Drug Accountability Record when a subject
returns unused medication

8. What steps should be carried out with
investigational drug
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1. Receiving investigational drug shipments.
 Be sure that the sponsor's instructions about receipt of the study
drug are followed. Upon opening the package:
 Check the shipment and confirm that the contents are intact.
 Compare the invoice to the lot number, expiration date, quantity and
dosage.
 If there are any discrepancies, report the sponsor immediately.
2. Storing study drug.
 Securely lock study drug in a temperature-controlled drug
storage place separate from the other medicines. The drug store
should be according to the conditions specified in the protocol or
the shipping invoice. Keep temperature record, in order to verify
that the drug was stored under the proper conditions.

9. Cont.
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3. Dispensing according to clinical trial protocol.
 This document provides detailed information about dosing, including in-
structions for dose modification and discontinuation; how to prepare, ad-
minister and/or dispense study drug; and how to manage and report side
effects.
 Drug may be dispensed to patients according to the protocol. The study-
provided drug should only be used for the patient enrolled in the study and the
drug should only be distributed to the assigned patient. Never change the
medication from one patient to another! If the drug requires admixture, only a
specific nurse or clinical pharmacist can be to dispense and prepare that drug.

10. Cont.
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4. Disposing of or returning drugs.
 During the study, follow the sponsor's instructions concerning drug return
and/or disposal. Document all activities, including protocol and drug
identifiers and units and lot numbers. If applicable, returned supplies should be
attributed to specific study participants. In addition, the records should:
 Distinguish between unopened (not dispensed) and unused (by study subjects)
supplies.
 Explain broken or lost drug supply.
 Account for all supplies.
5. Inventory
Ensure patient treatment schedules against drug supply and monitor expiration
dates. If the drug is not available at the investigative site, do not substitute
from the office stock. Request the treatment immediately to the sponsor. If by
any chance office stock is used inadvertently, you have to document deviations
from the protocol Never use study-supplied drug to replace office stock or
vice versa.

11. Responsibilities
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1.Principle Investigator (PI):
 Accountable for receipt, storage, and dispensing of study drug (See
Procedure
 Section 1.0: Inpatient Drug Storage)
 Ensure that drug is used in accordance with protocol
2. Clinical research coordinator
 Maintaining all documentation related to study drug accountability
including all
 shipping receipts/invoicing as part of the study file .
 Receipt of drug from sponsor for all in-patient studies
 Initiate the Master Drug Accountability Log

12. Cont.
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 Dispense of study drug
 Monitor temperature for drug supply storage.
 Order drug supply for investigator initiated studies.
 Instruct subject on proper use and handling of drug.
3. Monitor
 The study monitor is the key to ensuring accurate drug accountability.
During routine visits, monitors should assess the site's drug preparation
and dispensing procedures, as well as subject compliance, and ensure
proper drug storage and log maintenance.
 The monitor should also verify that the clinical investigator or an
authorized personal is dispensing the supplies.

13. Cont.
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 monitors should confirm that all supplies are accounted for and returned or
destroyed report and investigate any discrepancies, and resolve all items
before site closure.
 By periodically reviewing drug accountability documentation throughout
the study, monitors can identify inappropriate practices as they occur and
retrain site staff as needed. Problems detected early are more easily
resolved. Proper review of drug records could uncover poor subject
compliance with drug administration, incorrect supplies at the site, errant
drug preparation, incorrect randomization, and potential un-blinding of
subjects who were dispensed coded labels.
 Upon noting problems, monitors should immediately implement corrective
action plans to prevent future occurrences.

14. Cont.
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4. Auditor
 An auditor should carefully assess drug accountability.
 He should confirm that the monitor review drug accountability periodically
and that final drug reconciliation was performed.
An investigative site audit tests the drug accountability process and help
gauge the readiness of records for an FDA inspection.

15. FDA inspection
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An FDA is the biggest test of the drug accountability process.
FDA inspector assess two main areas:
1. accountability
2.control of test article
FDA inspectors also look at whether the drug was shipped to
designated, authorized individuals listed on form FDA1572.

16. Common findings during FDA inspection
in drug accountability
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1. Incomplete or inaccurate dispensing records.
2. Failure to maintain adequate drug inventory, such records do
not identify the recipient of the particular lot of drug.
3. Discrepancies b/w drug administration forms and
accountability records.
4. Unavailability of drug distribution records.
These are the various common findings relating to drug
accountability

17. Conclusion
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Managing drug accountability demands attention to detail but
can be achieved with a trained research team dedicated to
following GCPs, standardized procedures and the study
protocol. Accurate drug accountability enhances patient safety
throughout the clinical trial.

18. References
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 http://www.bvs.sld.cu
 Module 4
 http://drexelmed.edu

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