Purpose Statement

Effective controlled-substance tracking is a lifecycle, not a single medication event. Accountability depends on maintaining a consistent record of where medication is stored, who has custody when applicable, what happens to inventory, who documents and signs each event, and how discrepancies or unusual circumstances are identified, documented, reviewed, and followed up on.

First Due connects Med Kits, pouches, Medication Forms, Counts, Usages, Transfers, Receives, Removes, Custody Exchanges, signatures, Occurrence Issues, Occurrence Reports, and the Med Log to help agencies maintain a complete and reviewable history of controlled-substance activity.

This article provides product best practices for medication administrators, supervisors, and agency leaders using First Due to support controlled-substance inventory accountability and investigate questions about medication activity.

Background Information

Controlled-substance accountability depends on continuity from one medication event to the next.

A reliable history begins with an accurate Med Kit and pouch configuration. Medication events document what happens to that inventory. Counts compare the inventory recorded in First Due with what personnel physically observe. Custody Exchanges document changes in possession for controlled-substance Med Kits. Signatures provide event accountability according to agency configuration.

When a controlled-substance Count identifies fewer medications than were documented in the previous Count, First Due automatically creates an Occurrence Issue to flag the discrepancy. Applicable workflows can also allow personnel to document and report an occurrence while the circumstances are known.

The Med Log provides administrators with historical medication activity that can be reviewed together when investigating questions about controlled-substance inventory.

A strong administrative process can therefore consider the complete accountability lifecycle:

Inventory Configuration → Medication Activity → Inventory Verification → Custody → Documentation and Signatures → Occurrence Documentation When Applicable → Med Log History → Administrative Review and Appropriate Follow-Up

Not every medication event includes every element of this lifecycle. The objective is to use the applicable First Due workflows consistently so the resulting history is understandable and useful for agency oversight.

Required Permissions

The permissions required depend on the responsibilities assigned to the administrator, supervisor, or medication manager.

Review the Medications: Comprehensive Permissions Guide to understand all Medications module permissions and best practices.

Building a Reliable Controlled Substance Tracking Process

Controlled-substance tracking starts before the first medication event occurs. The configuration in First Due should accurately represent how the agency organizes its medication inventory.

Align Med Kits and Pouches With Physical Inventory

Med Kits can contain multiple pouches, allowing medication to be tracked according to its specific location within the kit.

The same Medication Form can be configured in multiple pouches. First Due maintains those inventories separately so personnel can document activity against the location where the medication is actually stored.

Administrators should consider the following practices:

• Use recognizable Med Kit and pouch names.
• Configure Medication Forms in their intended pouches.
• Keep the First Due configuration aligned with the physical organization of the Med Kit.
• Review pouch assignments when physical stocking practices change.
• Ensure personnel understand that the same Medication Form in different pouches represents separate pouch-level inventory.
• Review Par and Min values when stocking practices change.

Accurate pouch configuration supports subsequent Counts, Usages, Transfers, Receives, Removes, Custody Exchanges, and pouch-level reporting.

Maintain Inventory-Specific Information

Depending on configuration, medication inventory can include identifying information such as:

• Medication Form
• Quantity
• Expiration date
• Lot number
• Serial number

These details can help distinguish inventory when multiple units, lots, or forms are present.

For controlled substances, selecting the correct inventory record helps create an accurate event history. A transaction documented against the wrong pouch, lot, serial number, or Medication Form can make later administrative review more difficult even when the overall quantity appears correct.

Maintaining Accurate Controlled Substance Inventory

Each inventory-changing event should represent what physically occurred so the resulting First Due history remains meaningful.

Receives Establish Inventory

Receive documents medication being added to inventory from a configured Pharmacy vendor. Depending on permissions and intended destination, medication can be received into Med Supply or a Med Kit.

When receiving into a Med Kit, the destination pouch matters because the resulting inventory becomes associated with that pouch.

Receive can also be used to add inventory when a configured Medication Form is currently at quantity 0.

Transfers Document Movement

Transfer documents existing medication moving between applicable inventory locations, including movement between Med Supply and Med Kits where applicable.

For Med Kits, personnel should verify the correct source and destination pouch. This becomes especially important when the same Medication Form exists in multiple pouches.

A Transfer can also replenish a Medication Form that is currently at quantity 0 in the destination pouch.

Usages Document Medication Used

Usage reduces the inventory associated with the selected source. Personnel should select the Medication Form and actual pouch from which the medication was taken and verify available inventory identifiers.

When only part of a container is administered, the Usage workflow can calculate the remaining amount as waste based on the amount administered.

If quantity reaches 0, the configured Medication Form may remain visible on the Med Kit Overview, but it is no longer available for additional Usage or other inventory-reducing medication actions.

Removes Document Medication Leaving Inventory

Remove documents medication being taken out of inventory for an applicable removal reason.

Personnel should verify the source, Medication Form, quantity, and available identifying information before completing the event.

If a Remove causes inventory to fall below Min, the medication becomes red Restock Needed. If the remaining quantity is exactly Min, it does not become red.

Document the Event That Actually Occurred

A reliable event history depends on using the medication event that represents the physical inventory activity.

For example, moving existing medication should be represented through a Transfer rather than creating unrelated activity that makes the destination quantity appear correct without accurately documenting where the medication came from.

Managing Pouch-Specific Controlled Substance Inventory

Pouch-level tracking gives administrators greater visibility into controlled-substance inventory, but it also requires personnel to consistently select the correct location.

If the same Medication Form exists in multiple pouches, First Due presents those inventories separately during applicable medication workflows.

Pouch selection can affect:

• Current inventory quantity
• Par and Min status
• Medication Counts
• Usage history
• Transfer and Receive activity
• Remove activity
• Pouch-level medication event reporting
• Administrative investigation of discrepancies

A Med Kit's overall inventory can therefore appear reasonable while inventory assigned to individual pouches is incorrect.

When investigating controlled-substance activity, administrators should consider the specific pouch and inventory record, not only the Med Kit as a whole.

Using Counts to Establish Inventory Accountability

Medication Counts provide an opportunity to compare First Due's recorded inventory with what personnel physically observe.

During a Count, controlled-substance inventory is presented by its configured pouch. When the same Medication Form is present in multiple pouches, each location is verified separately.

Only medication with current inventory is presented for physical verification. A configured Medication Form at quantity 0 can remain visible on the Med Kit Overview but does not appear during the Count.

Users can indicate that available inventory is present and correct or identify a discrepancy.

Seal Information Adds Context to the Count

For seal-secured Med Kits, First Due can use the current seal number as part of the Count workflow.

When the entered seal matches, the user may be able to proceed according to the available workflow without performing a full Count or choose Break and Count.

When the seal does not match, Break and Count is required by the First Due workflow.

For agencies using locks rather than seals, the seal entry does not appear.

Understand How Occurrence Issues Begin

When a controlled-substance Count identifies fewer medications than were documented in the previous Count, First Due automatically generates an Occurrence Issue.

For example, if the previous Count documented three units of a Medication Form and the current Count identifies only two, the system can flag that difference as an occurrence.

The occurrence identifies that the expected and observed inventory do not match. It does not determine why the difference exists or assign responsibility.

Where serial numbers are used, inventory records can help identify the specific unit involved. Where lot information is used, administrators can review the affected lot and quantity.

Maintaining Accountability During Custody Changes

For controlled-substance Med Kits, Custody Exchange documents a change in possession between providers within First Due.

Custody Exchange is separate from ordinary inventory-changing actions. It identifies the providers associated with the custody event and, when applicable, incorporates physical inventory verification.

Depending on Med Kit configuration, a Custody Exchange may involve:

• Verification of the current seal
• Break and Count
• Verification of controlled-substance inventory
• Authentication and signatures
• Occurrence reporting when a seal or inventory discrepancy is identified

Understand Exclusive Possession

Agency configuration under Medications > Setup > Exclusive Possession affects who can initiate custody activity.

When Exclusive Possession is enabled:

• The user who currently has possession can initiate a standard Custody Exchange.
• A user who does not currently have possession will not see the applicable Custody Exchange controls when viewing the Med Kit unless that user has Override Exclusive Possession permission.
• Override Exclusive Possession allows the applicable custody controls to be visible and accessed by an authorized non-possessor.
• Possession Override is additionally required to override the existing custody assignment itself.
• Meds - Global Custody Exchange does not override Exclusive Possession.
• Start Exchange is not displayed for selected Med Kits on the Medications Dashboard, regardless of whether the user has Meds - Global Custody Exchange.

When Exclusive Possession is disabled:

• A user who does not currently have possession must have Meds - Global Custody Exchange to initiate a standard Custody Exchange.
• On the Medications Dashboard, Start Exchange appears only when Exclusive Possession is disabled and the user has Meds - Global Custody Exchange.
• A Med Kit may still be visible or selectable on the Dashboard even when Start Exchange is unavailable.

Ensure the Appropriate User Initiates the Standard Exchange

For a standard Custody Exchange, the user who initiates the Custody Exchange is documented as the Transferring Provider.

This makes initiation part of accurate custody documentation.

As a product-use best practice, the current custodian or person actually relinquishing possession should initiate the standard Custody Exchange whenever possible.

Before completing signatures, verify that the displayed Transferring Provider reflects the intended person relinquishing possession.

Understand Custody Exchange Override

Custody Exchange Override is performed from the Med Kit. It is not initiated from the Medications Dashboard.

When Exclusive Possession is enabled and an authorized user needs to act while another user is recorded as possessing the Med Kit:

• Override Exclusive Possession provides access to the applicable custody controls.
• Possession Override allows the existing custody assignment to be overridden.

These permissions have different purposes and should not be treated as interchangeable.

The Meds - Global Custody Exchange permission does not create Custody Exchange Override access.

Use Custody History Together With Inventory History

When investigating a question about controlled-substance inventory, custody information can provide important context.

Administrators may consider:

• Who was recorded as possessing the Med Kit before the activity.
• Who initiated the Custody Exchange and was therefore recorded as the Transferring Provider.
• When custody changed.
• Whether a Count occurred during the exchange.
• Whether a discrepancy was identified.
• Which providers completed the exchange.
• Whether Custody Exchange Override was used.
• What medication events occurred before and after the custody change.

Avoid Leaving Custody Exchanges Incomplete

When a Custody Exchange is saved as a draft and later resumed, it resumes as a regular Count, not the original Custody Exchange.

Completing that Count does not transfer custody.

This distinction is particularly important because beginning a new standard Custody Exchange with a different initiating user affects who is documented as the Transferring Provider.

If Exclusive Possession is enabled and the recorded custodian is unavailable, an appropriately authorized user may need to use the Med Kit's Custody Exchange Override workflow.

Using Multi-Action Workflows to Preserve Related Activity

When multiple medication actions are part of the same operational activity, a Multi-Action Workflow can keep those events together and complete them through one overall signature process.

For example:

Usage → Transfer or Receive → Count

This can document medication being used, replacement inventory being added or moved into the affected pouch, and a final Count to verify the resulting inventory when applicable.

Use Replenishment to Reflect Actual Inventory Activity

An inventory-reducing action can cause medication to fall below Min. If replenishment physically occurs as part of the same operational process, personnel can add an applicable Transfer or Receive before completing the workflow.

This can correct the low-stock condition before the Multi-Action Workflow is finalized.

Agencies may configure Critical Low Stock notifications when inventory drops below Min and the condition is not corrected through the applicable workflow.

Using Signatures to Support Event Accountability

Medication signature requirements are configured by each agency and can vary by event type and between controlled and non-controlled substance workflows.

Depending on agency configuration, a medication event may include:

• Authentication
• Electronic signatures
• Multiple users
• Different signature requirements based on the medication event

Controlled-substance events can be configured to require multiple users and authentication.

User Roles and Required Signers

When multiple signatures are configured, First Due can present multiple users in the signature workflow. The applicable users complete the authentication and signature requirements configured by the agency.

Users from the agency can be selected from the available user list. Where supported, a user from outside the agency can also be documented with identifying information such as:

• Name
• ID type
• Agency
• License or ID number, when applicable

Administrators should ensure their First Due signature configuration reflects the agency's intended medication workflow and that personnel understand how to complete the configured process.

Monitor Pending Signatures

For workflows supporting Complete and Sign Later, the medication event and associated inventory changes take effect immediately. The outstanding signature is added to Pending Signatures for later completion.

This distinction is important during an investigation:

A Pending Signature does not mean the inventory transaction is still pending.

Administrators should evaluate both the completed medication event and any outstanding documentation.

Documenting Controlled Substance Occurrences

Occurrence documentation provides additional context when First Due identifies or personnel encounter a controlled-substance condition requiring attention.

Understand the Difference Between an Occurrence Issue and Occurrence Documentation

An Occurrence Issue can be automatically generated when a controlled-substance Count identifies fewer medications than were documented in the previous Count.

Applicable workflows can also allow personnel to Report or Generate occurrence information associated with a discrepancy.

These concepts work together:

• The Occurrence Issue flags that an expected-versus-observed inventory difference exists.
• The Occurrence Report or documentation gives personnel an opportunity to record context about what happened and, where supported, identify additional recipients.

Circumstances That Can Produce Occurrence Information

Based on the established First Due medication workflows, occurrence information can be associated with circumstances such as:

• A controlled-substance Count identifying missing medication.
• Medication marked with an X during a controlled-substance Count.
• A seal mismatch identified during a Count.
• A seal mismatch identified during a Custody Exchange.
• A controlled-substance discrepancy identified during a Custody Exchange Count.

When these conditions occur, personnel can use the occurrence options provided by the applicable First Due workflow and follow agency procedures for any additional actions outside First Due.

Preserve Context at the Time of the Event

Documenting an occurrence while the event is being performed can preserve information that may otherwise be difficult to reconstruct later.

Relevant context can include:

• Med Kit
• Pouch
• Medication Form
• Inventory record
• Expected quantity
• Observed quantity
• Seal condition
• Medication activity being performed when the issue was identified

Occurrence Notifications

For controlled-substance Count discrepancies, First Due can use agency-configured occurrence notification recipients.

When the workflow provides Generate, users can identify additional recipients for the occurrence. If the user selects Skip, additional recipients are not added; however, recipients already configured for occurrence notifications can still receive the applicable notification according to the agency's Medication Setup configuration.

Reviewing Controlled Substance Occurrences

Occurrence Issues become part of the medication activity available for administrative review in the Med Log.

An effective product-use practice is to connect the occurrence to the broader controlled-substance inventory lifecycle rather than evaluating the Count in isolation.

Reconstruct the Inventory History

When reviewing an Occurrence Issue, administrators can consider:

1. Review the previous known inventory state. Examine the previous Count and relevant inventory records to understand what First Due expected to be present.
2. Review the Count that identified the discrepancy. Examine the Med Kit, pouch, Medication Form, quantity, and available inventory identifiers.
3. Review medication activity between Counts. Examine applicable Usages, Transfers, Receives, and Removes to determine whether documented activity explains the difference.
4. Review pouch-specific activity. If the same Medication Form exists in multiple pouches, verify whether activity was documented against the expected pouch.
5. Review custody history. When relevant, review Custody Exchanges and applicable Custody Exchange Overrides to understand recorded changes in possession.
6. Review the Transferring Provider. For standard Custody Exchanges, remember that the user who initiated the exchange is documented as the Transferring Provider.
7. Review signatures and users. Examine users and signatures associated with relevant events and identify outstanding signatures where applicable.
8. Review reversed events. Determine whether eligible medication events were reversed and how those reversals affect interpretation of the history.

Consider Possible Explanations Without Assuming the Cause

A controlled-substance discrepancy may prompt administrators to evaluate whether:

• A Usage was performed but the documented history does not explain the inventory change.
• Medication was moved and the Transfer history does not reflect its physical location.
• Medication was physically removed but Remove activity does not explain the difference.
• Inventory was associated with the wrong pouch or inventory record.
• A previous Count contained an incorrect verification.
• Another medication event explains the discrepancy.

These are investigative possibilities, not conclusions First Due automatically assigns to an occurrence.

Following Up on a Controlled Substance Occurrence

The appropriate follow-up depends on what actually occurred and agency policy.

The established First Due Count workflow indicates that an occurrence visual cue can remain until the discrepancy is appropriately addressed through supported medication activity such as:

• Usage, when the medication was actually used and the corresponding activity needs to be represented.
• Remove, when the medication was actually removed and the applicable removal activity reflects what occurred.
• A subsequent Count, when the medication is physically present and the Count confirms the inventory.

Understand the Limits of the Established Occurrence Workflow

The established functionality confirms that First Due:

• Automatically identifies certain controlled-substance Count discrepancies as Occurrence Issues.
• Provides occurrence documentation and reporting within applicable workflows.
• Supports configured occurrence notifications.
• Displays occurrence and discrepancy information for administrative review in the Med Log.
• Maintains occurrence information as part of medication activity history.
• Allows certain Count discrepancies to be addressed through supported medication activity.

The established functionality does not define a universal administrative Approve, Resolve, or Close Occurrence Report workflow.

Administrators should therefore use the documented medication activity, occurrence information, and Med Log history for First Due-based review without assuming an additional occurrence-management process.

Distinguishing Occurrences, Discrepancies, and Incorrect Events

These conditions are related but should not be treated as interchangeable.

Occurrence Issue

An Occurrence Issue is automatically generated when a controlled-substance Count identifies fewer medications than were documented in the previous Count.

It flags the inventory condition for review but does not determine why medication is missing or assign responsibility.

Inventory Discrepancy

An inventory discrepancy is the difference between the inventory First Due expected and what personnel documented as physically present.

The discrepancy can be investigated using the available First Due history, but its existence alone does not establish the cause.

Zero Quantity

A Medication Form already recorded at quantity 0 is different from a discrepancy.

If First Due records no available inventory and personnel physically observe no inventory, the system and physical state agree. The zero-quantity Medication Form does not appear during the Count because there is nothing to verify.

Correctly Documented Event With an Occurrence

A medication event can be documented correctly and still include an occurrence requiring administrative attention.

For example, a Count may accurately document that a unit expected by First Due is physically missing. The Count itself may therefore be accurate even though the resulting discrepancy requires review.

Incorrectly Documented Medication Event

A medication event may instead be found to have been entered incorrectly—for example, an incorrect quantity, medication, pouch, or location may have been selected.

When the original event is eligible for reversal, an authorized user can use Reverse Event to document the correction.

Using the Med Log for Administrative Oversight

The Med Log provides historical medication activity administrators can use to understand controlled-substance activity over time.

When a question arises, administrators can connect multiple parts of the controlled-substance history, including:

• Previous Counts
• Usages
• Transfers
• Receives
• Removes
• Custody Exchanges
• Custody Exchange Overrides
• Occurrence and discrepancy information
• Signatures
• Reversed events

Together, these records provide a reviewable history that can help administrators understand what documented activity occurred between known inventory points.

The Med Log supports searches, filters, saved views, event-detail review, occurrence and discrepancy identification, signature review, reversals, exports, and reports.

Use Event Details During an Investigation

Available event information can include:

• Event type
• User information
• Medication details
• Quantity
• Medication Form
• Lot number
• Serial number
• Seal information
• Signatures
• Associated occurrence or discrepancy information

Use Reports According to the Review Need

Med Log reporting provides several options:

• Individual Event CSV — Supports review of an individual event but does not include signatures or personnel details provided through the PDF reporting options.
• List CSV — Supports filtered spreadsheet-based review but does not include signatures.
• History Log PDF — Provides medication history but does not display signature images.
• Individual Log PDF — Provides individual event information and applicable signatures.
• Detailed Log PDF — Provides a more comprehensive report with selected event information, signatures, and additional details where applicable.

Correcting Incorrectly Documented Events

Authorized users can reverse certain medication events from the Med Log when the original event was documented incorrectly.

The following events can be reversed:

• Receive
• Transfer
• Remove
• Usage

The following cannot be reversed:

• Count
• Report
• Count Failed occurrences
• Custody Exchange

Reversing an eligible event does not delete the original activity. First Due preserves the original record and creates a documented reversal identifying who performed the reversal and why.

Investigate Before Reversing

Before reversing a controlled-substance event, review:

• The original event.
• Affected Medication Form.
• Source and destination where applicable.
• Pouch selection.
• Quantity and inventory-specific details.
• Associated signatures.
• Events immediately before and after it.
• Related occurrence or discrepancy information.

If the event accurately represents what physically occurred, reversal may not be appropriate simply because an occurrence or discrepancy exists.

Establishing Routine Administrative Review Practices

Agencies can establish review practices appropriate to their policies, operational needs, and applicable requirements. First Due provides several areas that can be evaluated together.

Review Inventory and Counts

Administrators can review:

• Current controlled-substance inventory.
• Pouch-specific inventory.
• Red Restock Needed conditions.
• Yellow Monitor conditions.
• Zero-quantity configured Medication Forms.
• Count history.
• Count discrepancies.
• Occurrence Issues.
• Unfinished Counts displaying Resume Count.
• Inventory-specific information that may help explain a discrepancy.

Review Medication Movement

Consider:

• Usages.
• Transfers.
• Receives.
• Removes.
• Movement between Med Supply and Med Kits.
• Activity associated with unexpected pouches or inventory records.

Review Custody

Where custody tracking is used, administrators can review:

• Current recorded possession.
• Custody Exchanges.
• The initiating user documented as the Transferring Provider.
• Count activity associated with custody changes.
• Custody Exchange Overrides.
• Medication activity before and after recorded changes in possession.
• Whether Exclusive Possession and custody permissions align with the agency's intended workflow.

Review Documentation

Administrators can evaluate:

• Pending Signatures.
• Event signatures.
• Occurrence information.
• Users associated with medication events.
• Reversal reasons and associated signatures where applicable.

Review the Complete History When Something Does Not Align

When unexpected activity is identified, avoid immediately creating another medication event solely to make the current quantity match expectations.

Instead, review the physical inventory and available medication history to determine whether the difference reflects:

• An actual inventory change that was correctly documented.
• An Occurrence Issue requiring review.
• A discrepancy that has not yet been explained.
• An incorrectly documented event eligible for reversal.
• An unfinished Count.
• An outstanding signature.
• Activity documented against the wrong pouch or inventory record.
• Custody activity that provides relevant context.

Any follow-up documented in First Due should reflect what actually occurred.

Controlled Substance Oversight Checklist

Administrators and supervisors can use this checklist as part of their agency's established controlled-substance review process. The agency should determine when and how this review is performed based on its policies, operational needs, and applicable requirements.

Inventory and Configuration

• Confirm controlled-substance Med Kits and pouches reflect physical inventory organization.
• Verify Medication Forms are configured in the intended pouches.
• Review pouch placement when the same Medication Form exists in multiple pouches.
• Investigate unexpected pouch-level quantities rather than relying only on the overall Med Kit inventory.
• Review Par and Min values where configured.
• Remember that inventory at Min is not red; Restock Needed begins below Min.
• Review zero-quantity configured Medication Forms requiring replenishment.
• Review applicable expiration dates, lot numbers, and serial numbers where configured.

Counts and Occurrence Issues

• Review controlled-substance Count history.
• Review identified Occurrence Issues.
• Compare an occurrence with the previous Count and expected inventory.
• Investigate unexplained inventory discrepancies.
• Review occurrence indicators associated with affected medication.
• Check for unfinished Counts displaying Resume Count.
• Remember that zero-quantity Medication Forms do not appear during Counts.
• Compare physical inventory with relevant medication-event history when a discrepancy cannot immediately be explained.

Medication Activity

• Review relevant Usages, Transfers, Receives, and Removes.
• Confirm inventory movement was documented against the correct source, destination, and pouch.
• Review movement between Med Supply and controlled-substance Med Kits when applicable.
• Investigate unusual or unexpected medication activity using the surrounding event history.
• Review Medication Form, lot, serial number, and other available inventory information when relevant.

Custody

• Review Custody Exchange history when recorded possession is relevant.
• Review who initiated each standard Custody Exchange and was documented as the Transferring Provider.
• Review Counts performed as part of applicable custody activity.
• Review Custody Exchange Overrides where applicable.
• When Exclusive Possession is enabled, verify override access is assigned intentionally through Override Exclusive Possession and Possession Override.
• Remember that Meds - Global Custody Exchange does not override Exclusive Possession.
• Compare medication activity with custody history when investigating unexplained events.

Signatures and Documentation

• Review Pending Signatures for incomplete event documentation.
• Review event signatures when investigating controlled-substance activity.
• Review whether configured signature workflows are being completed as intended.
• Review occurrence documentation and configured notifications where applicable.
• Distinguish Pending Signatures from unfinished Counts and active Custody Exchanges.

Occurrences and Corrections

• Review medication events associated with occurrence or discrepancy indicators.
• Review activity before and after the occurrence.
• Determine whether Usage, Transfer, Receive, Remove, custody activity, or another documented event explains the discrepancy.
• Confirm any follow-up medication event reflects what actually occurred.
• Determine whether the original event was correctly documented before considering reversal.
• Review reversed medication events and their documented reasons.
• Continue administrative review of unexplained occurrence indicators according to agency policy.

Med Log Oversight

• Use the Med Log to review medication-specific history when questions arise.
• Review Counts, inventory events, custody information, signatures, occurrences, and reversals together when relevant.
• Use filters or saved views to focus administrative review.
• Use an appropriate Med Log report when signatures or additional event details are useful to the review.

Best Practices

• Treat controlled-substance tracking as a continuous history. Counts, inventory events, custody changes, signatures, occurrences, and corrections can each contribute to the record available for review.
• Keep physical and system organization aligned. Med Kits, pouches, Medication Forms, and inventory records should represent where medication is actually stored.
• Document what physically happened. Use the medication event that accurately represents the inventory activity.
• Treat pouch selection as an accountability decision. Correct overall quantity does not necessarily mean individual pouch quantities are correct.
• Understand the current Par and Min logic. Inventory at Min remains outside the red condition. Red Restock Needed begins below Min.
• Understand zero-quantity visibility. Zero inventory may remain visible on the Med Kit Overview but is unavailable for medication actions and is excluded from Count and Custody Exchange verification.
• Use Counts as inventory checkpoints. A controlled-substance Count identifying fewer medications than expected can generate an Occurrence Issue requiring review.
• Preserve occurrence context. Documenting what personnel observed during the workflow can provide useful context for later review.
• Ensure the appropriate provider initiates a standard Custody Exchange. The initiating user is documented as the Transferring Provider.
• Understand custody permission differences. Global Custody Exchange, Override Exclusive Possession, and Possession Override serve different purposes.
• Connect custody with inventory activity. When recorded possession is relevant, review Custody Exchanges alongside Counts and medication events.
• Monitor incomplete documentation. Supported medication events may already have updated inventory while their signatures remain pending.
• Investigate before reversing. Occurrence Issues, discrepancies, zero inventory, and incorrectly documented events are different conditions.
• Use the Med Log to reconstruct activity. Review related events together rather than treating individual records as isolated transactions.
• Keep agency policy separate from product functionality. First Due supports documentation, tracking, review, and reporting; agencies determine how those tools are used within their policies and applicable requirements.

Troubleshooting & FAQs

What causes a controlled-substance Occurrence Issue?

An Occurrence Issue is automatically generated when a controlled-substance Count identifies fewer medications than were documented in the previous Count. It flags that expected and observed inventory do not match.

What is the difference between an Occurrence Issue and an inventory discrepancy?

The inventory discrepancy is the difference between the controlled-substance inventory First Due expected and what personnel documented as physically present during the Count. The Occurrence Issue is the system-generated condition that flags that discrepancy for review.

Does an Occurrence Issue tell me what happened to the medication?

No. The occurrence identifies that inventory does not match expectations, but it does not determine the cause or assign responsibility. Administrators can review surrounding medication, Count, custody, signature, occurrence, and reversal history for additional context.

Does a Medication Form at quantity zero automatically create a discrepancy?

No. If First Due already records the Medication Form at quantity 0 and no physical inventory is present, those conditions agree. A zero-quantity Medication Form does not appear during Count because there is nothing physically available to verify.

Why is a zero-quantity controlled substance still visible on the Med Kit Overview?

A configured Medication Form can remain visible at quantity 0 so personnel can see that it belongs in the pouch and requires inventory. When Par and/or Min is configured, the zero-quantity card displays the applicable red Restock Needed condition.

Can I select a zero-quantity medication for Usage, Remove, or Transfer from that pouch?

No. There is no existing inventory unit to act upon. Use an applicable Receive or a Transfer into the pouch to replenish the inventory.

Does inventory become Restock Needed when it reaches Min?

No. Red Restock Needed begins when quantity falls below Min. When both Par and Min are configured, inventory exactly at Min remains yellow.

What happens if Par and Min are the same value?

Inventory at the matching Par and Min value displays yellow. It becomes red only after quantity falls below Min.

What can an administrator review when a controlled-substance Count identifies a discrepancy?

Start with the physical inventory and affected Med Kit, pouch, Medication Form, and available inventory identifiers. Then review the previous Count and relevant Usages, Transfers, Receives, Removes, custody activity, occurrence documentation, signatures, and reversals.

Can an occurrence be documented during the medication workflow?

Yes. Applicable Count and Custody Exchange workflows provide occurrence-reporting options when certain discrepancies, including seal mismatches or controlled-substance Count discrepancies, are encountered.

Does every Occurrence Issue mean the medication event should be reversed?

No. An event can be documented correctly and still result in an occurrence requiring review. Reverse Event should be used when an eligible Receive, Transfer, Remove, or Usage event itself was documented incorrectly.

How can a controlled-substance Count discrepancy be followed up in First Due?

The established workflow indicates that an occurrence visual cue can remain until appropriately addressed through a supported Usage, Remove, or subsequent Count confirming the medication is physically present. The event used should accurately represent what physically occurred.

Is there a separate administrative approval or closure workflow for every Occurrence Report?

The established functionality does not define a universal administrative Occurrence Report approval, status, or closure workflow. First Due provides occurrence documentation, configured notifications, Med Log visibility, and supported follow-up for certain controlled-substance Count discrepancies.

How can administrators find controlled-substance occurrences?

Occurrence and discrepancy information is available within the Med Log. Administrators can review the associated event and surrounding medication history to investigate what happened.

Who is documented as the Transferring Provider during a standard Custody Exchange?

The user who initiates the standard Custody Exchange is documented as the Transferring Provider. The appropriate person relinquishing possession should therefore initiate the standard exchange whenever possible.

What happens when Exclusive Possession is enabled?

The current possessor can initiate the standard Custody Exchange. A user who does not have possession does not see the applicable custody controls on the Med Kit unless that user has Override Exclusive Possession. Overriding the existing custody assignment additionally requires Possession Override.

Does Meds - Global Custody Exchange override Exclusive Possession?

No. Meds - Global Custody Exchange does not override Exclusive Possession.

When does Start Exchange appear on the Medications Dashboard?

For selected Med Kits, Start Exchange appears when Exclusive Possession is disabled and the user has Meds - Global Custody Exchange permission. When Exclusive Possession is enabled, Start Exchange is not displayed on the Dashboard.

Can Custody Exchange Override be started from the Dashboard?

No. Custody Exchange Override is performed from the applicable Med Kit, not from the Medications Dashboard.

What is the difference between Override Exclusive Possession and Possession Override?

Override Exclusive Possession allows an authorized non-possessor to see and access the applicable custody controls when Exclusive Possession is enabled. Possession Override allows that authorized user to override the existing custody assignment itself.

Why can custody information be useful when investigating inventory?

Custody history provides context about recorded possession during the period being investigated. Reviewing Custody Exchanges, Transferring Provider information, Counts, and medication events together can help reconstruct the sequence of recorded activity.

Does a Pending Signature mean the controlled-substance inventory has not been updated?

Not necessarily. For workflows supporting Complete and Sign Later, the medication event and inventory changes take effect immediately while the signature remains under Pending Signatures.

Why isn't an unfinished Count in Pending Signatures?

A Count saved as a draft does not create a Pending Signatures item. Instead, Resume Count appears on the applicable Med Kit Overview.

Can a Custody Exchange be completed later through Pending Signatures?

No. An active Custody Exchange requires the applicable providers to complete the signature process within the custody workflow and does not use Complete and Sign Later.

What happens if a Custody Exchange is saved as a draft?

When resumed, it becomes a regular Count rather than resuming the original Custody Exchange. Completing that Count does not transfer custody. If a new standard Custody Exchange is initiated later, verify that the correct user initiates it because that user will be documented as the Transferring Provider.

What if the recorded custodian is unavailable and Exclusive Possession is enabled?

An appropriately authorized user may need to perform a Custody Exchange Override from the applicable Med Kit. The user needs the applicable custody access, Override Exclusive Possession to access the controls as a non-possessor, and Possession Override to override the existing custody assignment.

Can administrators reverse a Count, Occurrence Report, or Custody Exchange?

No. Counts, Reports, Count Failed occurrences, and Custody Exchanges cannot be reversed. Receive, Transfer, Remove, and Usage events are eligible for reversal when an authorized user determines the original event was documented incorrectly.

Does using these First Due workflows establish controlled-substance compliance?

No. First Due provides functionality that supports medication inventory tracking, documentation, custody records, signatures, occurrence information, historical review, and reporting. Agencies are responsible for determining their own policies and how First Due is used in relation to applicable requirements.

What is a useful starting point for an unexplained controlled-substance inventory issue?

Start with the physical inventory and affected Med Kit, pouch, and Medication Form. Then use the Med Log to reconstruct relevant inventory movement, Counts, custody activity, signatures, occurrences, and reversals before determining the appropriate follow-up.