Tracking Spravato® inventory,
without the spreadsheet.

Why inventory is a compliance question at all

Three separate obligations meet in the medication fridge. Esketamine is a Schedule III controlled substance, so controlled-substance recordkeeping applies: what was received, what happened to it, and periodic inventories that reconcile the two — with state rules often adding requirements of their own on top of the federal baseline. The REMS program asks for the lot number on every Patient Monitoring Form, which means the session record and the stock record have to agree. And because most clinics buy and bill, every carton is also money on a shelf — unaccounted product is simultaneously a compliance gap and a write-off.

The questions a defensible record answers

• What is on hand right now, by lot? Not a number in someone's head — a count that survives the person who knows it taking a week off.
• Where did each carton go? A chain from delivery to a specific patient's session, or to documented waste — with nothing simply vanishing between the two.
• Does usage reconcile? Cartons received minus cartons used minus cartons wasted should equal cartons on the shelf. When it doesn't, you want to know that week, not at an audit.
• Which lot went to which patient? The monitoring form asks for it; a recall would demand it. If answering takes an afternoon of cross-referencing, the record isn't doing its job.

Why the spreadsheet stops working

Almost every clinic starts with a spreadsheet, and for the first months it holds. The failure mode isn't dramatic — it's drift. The count is updated after the session, then after the day, then when someone remembers. The lot number is transcribed from the carton to the sheet and separately from the carton to the monitoring form, and the two copies disagree by one character. Waste gets a verbal explanation instead of a row. None of it is negligence; it's what happens when the record is a second job performed from memory, after the work that actually matters. The audit, when it comes, doesn't grade effort — it grades the record.

What good tracking looks like

• Carton-level, not vial-level guesswork. The carton is the unit that arrives, is dispensed, and is wasted — track it as the unit and the counts stay honest.
• Recorded at the moment it happens. Receiving is logged at delivery, use is logged by the session it belongs to, waste is logged with a reason — not reconstructed at closing time.
• Tied to the treatment day. When the dosing step and the inventory record are the same action, the session's lot number and the stock movement can never disagree.
• Reconciled automatically. The system should notice that received − used − wasted ≠ on-hand, and say so — an invariant that runs continuously, not an annual surprise.

The physical count, and the day it does not balance

Every controlled-substance record eventually meets a shelf. Somebody counts what is physically there and compares it to what the system says should be there, and the interesting case is the one where the two numbers differ. Most clinics handle this badly, not by ignoring it but by treating it as an arithmetic problem to be corrected rather than an event to be recorded — the count gets adjusted to match the shelf, and the fact that there was ever a discrepancy disappears along with it.

That is precisely backwards. The adjustment is not the record; the discrepancy is. A count that comes up short, a carton the system does not know about, a lot whose numbers disagree — each of those should become a durable row saying who found it, when, what the difference was, who resolved it and why. A clinic that can show a handful of discrepancies found, investigated and closed is demonstrating a working control. A clinic whose numbers have simply always matched is either extraordinarily lucky or not really counting.

• Count on a schedule, not on suspicion. A regular cadence you actually keep beats an exhaustive audit you do once. The cadence itself is part of what you would be showing.
• Investigate before you adjust. Most shortfalls are a missed waste entry or a dose recorded against the wrong carton, and both are findable the same week and unfindable a month later.
• Resolve in writing. “Reconciled” is not a resolution. What happened, and what changed so it does not happen again, is.
• Escalate what you cannot explain. An unexplained loss of a Schedule III substance has reporting obligations of its own — that is a conversation with your counsel and your state board, not a spreadsheet edit.

The states a carton actually passes through

Clinics usually start by modeling two states, on hand and gone, and that is the root of most of the mess that follows. A carton has a longer life than that, and each of these is a real, distinct answer to “where did it go?” that a record has to be able to give:

• On hand — received into stock, counted, available.
• Used — tied to the specific session and patient it was dosed into.
• Wasted — with a reason and a witness. An 84 mg dose reduced to 56 mg leaves a device that is wasted, not returned to the shelf, and that is the single most commonly missed entry in the whole ledger.
• Expired — still physically present, no longer usable, and still very much your responsibility to account for.
• Quarantined — pulled from use pending a decision: a cold-chain excursion, damaged packaging, a recall notice.
• Returned — sent back through the channel it came from, which is a documented movement rather than a disappearance.

The test of a record is whether every carton you have ever received is in exactly one of those states right now, and whether you could say so without opening the fridge.

The recall question

Lot-level tracking usually gets justified on compliance grounds, but the sharpest argument for it is a clinical one. If a lot is recalled, the question arriving at your clinic is not administrative — it is which of our patients received product from this lot, and when. That is a question with a clock on it and a duty of care attached, and it is answerable in seconds or in an afternoon depending on a decision you made months earlier about whether the lot number lives next to the session.

The same structure answers the reverse question, which is the one a record review tends to ask: for this session, on this date, which carton was it, where did that carton come from, and what happened to the rest of it? One index, two directions. If either direction takes an afternoon, you do not have the index.

How Lucido handles it

Lucido ships with a Spravato® inventory as a standard part of the system — not an add-on. Cartons are received into stock, captured at dosing, by scan if the clinic has switched scanning on so the lot lands on the monitoring form without being typed, decremented by the session that used them, and wasted with a documented reason. The ledger reconciles continuously against the doses actually given, physical counts that disagree become discrepancy records an owner resolves with a note, and the clinic owns the switch if it prefers to track inventory elsewhere. See how it fits the rest of the day, or what it costs — one flat monthly price per location, with inventory included rather than sold as an add-on.

Related guides

• The Spravato® audit question: could you produce it?
• Spravato® REMS requirements, explained in plain language
• The two-hour monitoring window: what it actually requires
• The seven-day filing deadline, and how clinics miss it
• Starting a Spravato® clinic: the compliance checklist