2026 Southeastern Residency Conference

Title: Driving Accuracy and Accountability: A Systemwide Inventory Integrity Program

Authors: Veronica Bekheit, PharmD, MSMEd & Heath Jennings, PharmD, MBA, BCPS, FASHP, FACHE

Background:
The Central Florida Division historically relied on a third-party vendor to conduct biannual full inventory audits across pharmacy locations. While these audits provided external validation, they required significant internal labor to verify results and did not support continuous inventory oversight. A prior internal pilot demonstrated that full physical inventory counts could be completed across all campuses within one week using internal resources, supporting the feasibility of an internally managed model. Based on these findings, a Pharmacy Inventory Integrity Analyst Team was established to assume ownership of inventory processes and support a transition to an internal audit model. The goal of this initiative was to improve inventory accuracy to enable adoption of a perpetual inventory system. In June 2025, the team conducted a division-wide internal full inventory count, followed by a comparative validation against a subsequent external audit. These efforts informed the development of a standardized, system-wide inventory integrity program focused on ongoing accuracy, discrepancy reduction, and operational sustainability.

Methods:
A dynamic, risk-based audit framework was developed to prioritize medications with the highest operational and financial impact. To establish the initial audit baseline for January 2026, high-discrepancy medications were identified by averaging variance data from October through December 2025, generating a list of the top 30 discrepancy items per campus. For ongoing audits, this list is updated monthly using a rolling two-month lookback period to ensure prioritization reflects the most recent inventory performance and that previously identified discrepancies are resolved. High-cost medications were identified by estimating average on-hand inventory using PAR level midpoints ((minimum + maximum)/2) and multiplying by blended unit cost to approximate financial exposure. This analysis is also refreshed monthly to account for changes in utilization, pricing, and inventory levels, producing a current list of the top 50 high-cost medications per campus. The Pharmacy Inventory Integrity Analyst Team conducts standardized physical audits during the second week of each month. Physical counts are compared against PLX system inventory, and results are calculated as accuracy percentages and trended month-over-month. Audit findings are reported to campus leadership, and discrepancies undergo further review to identify root causes and support corrective actions.

Results:
A total of 1,248-line items were evaluated during the October 2025 audit. Internal team alignment with the inventory management system (IMS) was higher compared to the external vendor (73.7% vs. 67.0%). Full agreement between the internal team, vendor, and IMS occurred in 63.8% of line items, while complete disagreement was observed in 19.5%. Internal counting accuracy reached 92.0% (1,149/1,248), corresponding to an error rate of 8.0%, with variability observed across campuses. During the February–April 2026 audit period, 2,505 medications were evaluated. Internal team error rates demonstrated progressive improvement from 1.28% in February to 1.02% in March and 0.11% in April, representing a 91% reduction in error rate over the study period.

Conclusion: 
Implementation of a structured internal inventory integrity team and a data-driven audit process was associated with improved inventory accuracy and team performance across campuses. This approach supports scalable, standardized inventory management and progression toward a perpetual inventory system.