This report details the investigation undertaken by the Health Ombudsman into the drug and complaint management protocols used by the Queensland Ambulance Service (QAS). The investigation commenced as a result of an invitation from the QAS to conduct a systemic investigation in order to review the steps taken by the QAS to address the areas of concern highlighted in a Department of Health internal audit of the QAS’s drug management practices and to advise on any future reporting that the QAS should undertake to satisfy the office that its procedures continue to ensure optimal patient safety.

Background

Between April and May 2015, the Office of the Health Ombudsman received several complaints about individual QAS staff—primarily paramedic staff—who were alleged to have misappropriated schedule 4 and schedule 8 drugs between 2012 and 2015. The drug misappropriations were also alleged to have gone undetected by the QAS. A further theme highlighted through these complaints was concerns with the QAS’s overall approach to internal complaints management.

On 21 August 2015, QAS Commissioner Mr Russell Bowles ASM wrote to the Health Ombudsman to advise that the Department of Health had conducted an internal audit of the QAS’s drug management practices. The results of that audit were handed down in April 2014 and highlighted four key areas for improvement and 27 associated recommendations. These recommendations were implemented by the QAS by 25 November 2014.

In this correspondence, the QAS welcomed a systemic investigation by the Office of the Health Ombudsman in order to review the steps taken by the QAS to address the highlighted areas of concern and advise on any future reporting that the QAS should undertake to satisfy the office that its procedures continue to ensure optimal patient safety.

Investigation scope

The Health Ombudsman’s investigation considered whether the QAS has effective and appropriate mechanisms in place for:

• safe medication management, particularly in relation to the procurement, storage, distribution, supply, administration, destruction, and monitoring of and accounting for schedule 4 and 8 drugs
• monitoring, investigating, reporting and otherwise appropriately responding to medication incidents—specifically in relation to the detection, recording and reporting of suspected or confirmed tampering, theft, diversion or other misuse of drugs by QAS officers
• handling of consumer complaints, including internal assessment and investigation processes, client engagement, notification and quality assurance reviews.

Findings

The Health Ombudsman found the QAS response to the Department of Health audit was unreserved and demonstrated a willingness to embrace all of the issues with the drug management regime and implement processes to promote a shift in the organisation’s focus to ensure best practice is followed. The changes also incorporated improvements to consumer complaints management, which was not identified via the Department of Health audit, but was highlighted through the QAS’s own reviews of its policies and procedures.

The Health Ombudsman observed that while some of the information technology changes proposed by QAS may take time to be fully implemented—for example the move to electronic drug registers and full integration of ADAPT across all QAS electronic programs—he was satisfied that the approach was comprehensive with short, medium and long-term strategies to ensure continuous and responsive improvement.