I have been walking hospital pharmacy floors since 1976. I have counted medications in trauma centers, community hospitals, VA medical centers, and long-term care facilities in every corner of this country. I have seen inventory technology evolve from handwritten clipboards to handheld scanners to AI-assisted systems.

And here is what I can tell you with complete confidence: the technology is only as good as the person holding it.

That is not a knock on technology. The barcode scanners we use today are extraordinary tools. They are fast, they are accurate, and they have transformed what is possible in a single shift. But I have watched facilities invest in expensive scanning systems and still come away with counts that are off by 6, 8, even 12 percent. The scanner was not the problem. The process was.

When our teams arrive at a hospital pharmacy, the first thing we do is not scan anything. We walk the floor.

We are looking for the things that scanners cannot find on their own: medications stored in non-standard locations, items that have been moved between shifts, partial units that have been separated from their primary stock, and products with damaged or missing barcodes. In a busy hospital pharmacy, these situations are not exceptions. They are the norm.

A technician who goes straight to scanning without that initial assessment will miss a meaningful percentage of inventory every single time. Not because they are careless — because they are following the tool instead of leading it.

National Drug Codes are the backbone of pharmaceutical inventory. Every medication has one. But here is what most people outside the industry do not realize: the same drug can have dozens of different NDCs depending on the manufacturer, the package size, and the lot number. Generic substitutions, wholesaler changes, and emergency procurement can introduce new NDCs into a pharmacy's inventory without anyone updating the master list.

When a scanner encounters an NDC that is not in the system, it either flags an error or, worse, silently skips it. Either way, that medication does not make it into the count.

Over the course of a full pharmacy inventory, those missed NDCs add up fast. I have seen facilities lose $40,000 or more in recoverable drug value simply because their scanning system was not current with their actual formulary.

Our process includes a pre-count NDC reconciliation. We cross-reference what is physically on the shelf against what the system expects to find, and we resolve discrepancies before the count begins. That single step is responsible for a significant portion of the accuracy gap between a 94% count and a 99% count.

Walk into any hospital pharmacy and you will find the most valuable medications in the refrigerator and the freezer. Biologics, insulin, vaccines, specialty drugs — these are often the highest-cost items in the entire inventory, and they are also the most frequently miscounted.

The reasons are practical. Cold storage is physically uncomfortable to work in for extended periods. Items are often packed tightly, stacked in ways that obscure labels, and stored in multiple locations across the pharmacy. Scanners can struggle with condensation on packaging. And the time pressure to get in and out of temperature-controlled environments creates shortcuts.

Our teams are trained specifically for cold storage counts. We work in rotation to manage exposure time, we use lighting equipment designed for low-visibility environments, and we have protocols for handling condensation and damaged packaging. It is not glamorous work. But it is where the money is, and it is where accuracy matters most.

Hospital pharmacies do not stop operating for inventory counts. Medications are being dispensed, returned, and restocked throughout the process. This creates a moving target that most counting systems are not designed to handle.

The standard approach is to freeze inventory at a specific time and count against that snapshot. In theory, this works. In practice, the gap between the snapshot and the physical count can be hours long, and a busy pharmacy can process hundreds of transactions in that window.

We use a concurrent reconciliation process that tracks dispensing activity during the count and adjusts the final figures accordingly. It requires more coordination and more experienced technicians, but it produces a count that reflects reality — not a snapshot from six hours ago.

I want to put a number on this, because I think the accuracy conversation often stays too abstract.

The average hospital pharmacy carries between $800,000 and $2 million in drug inventory at any given time. A 5% accuracy gap — the difference between a 94% count and a 99% count — represents $40,000 to $100,000 in unaccounted medication value. Some of that is shrinkage. Some of it is documentation error. Some of it is recoverable through reverse distribution. But none of it is recoverable if you do not know it is missing.

The facilities that take inventory accuracy seriously are not doing it because they enjoy the process. They are doing it because they have seen what happens to their budget when they do not.

I started this piece by saying that technology is only as good as the person holding it. I want to end there too, because I think it is the most important thing I can share after fifty years in this business.

The best scanning technology in the world cannot replace a technician who knows what they are looking at. It cannot replace the experience of recognizing that a medication has been miscategorized, or that a bin count does not match what the system shows, or that a particular storage area in this particular hospital has a history of discrepancies that need extra attention.

That knowledge is not in any software. It lives in the people who have spent their careers on pharmacy floors, learning the patterns, building the protocols, and caring enough about the outcome to get it right.

That is what we bring to every count. And after fifty years, I am more convinced than ever that it is what makes the difference.

Michael Samojla is the CEO of IMC Pharma, a national pharmaceutical inventory and reverse distribution company serving hospitals, health systems, and pharmacies across all 50 states since 1976. For questions about your facility's inventory program, contact IMC Pharma at (630) 520-2150.