Medication cart security: a key is no longer enough

On July 3, 2026, the Italian Ministry of Health sent the Regions and professional bodies a memo on the fentanyl emergency.
It states that Section A narcotic medications must be kept “in a cabinet locked with a key, separate from other substances.” Section A is the part of the medications table in Italy’s narcotics law that includes, among others, opioid painkillers such as morphine and fentanyl. The quantity in stock must match the quantity written in the stock register. And “it would be advisable for the single person responsible for stock control and storage to be the same person who holds the keys”.

So in the memo, the key does two jobs: it keeps the cabinet locked, and it shows who is responsible for what’s inside. The second job works as long as one person holds the key. But on a ward that runs several shifts, the key can change hands. When the stock doesn’t match the register, the register shows what is missing. Only a lock that records each opening can show who opened the drawer, and at what time.

The medication cart takes medications from the ward cabinet to the patient’s bedside, and the same question applies to it.

This article covers the four levels of control a closure can provide, what the rules require in Italy, France, and the United States, and the questions to ask before writing a tender.

In France, the ministerial order (arrêté) of April 6, 2011, still in force, says medications must be kept in rooms, cabinets, or other storage units “fermés à clef ou disposant d’un mode de fermeture assurant la même sécurité“: locked with a key, or with a closure that gives the same security. The unit’s nurse manager agrees with the pharmacist on the rules for access to the keys.
For narcotics, the order of March 12, 2013 requires a dedicated cabinet or compartment, with the same wording on the closure.

The Italian and French rules agree on one point: both focus on the person who controls access. They differ on another.
The French text explicitly allows a closure other than a key, as long as it’s just as secure, and that leaves room for an electronic lock.
The Italian circular mentions a key and no alternative. Anyone preparing a tender in Italy should check with the hospital pharmacy whether hospital policy allows an electronic lock.

In the United States, the federal rule for hospitals that take part in Medicare and Medicaid, the public health insurance programs, is just as short. Medications must be kept in a secure area and “locked when appropriate.”
Controlled substances, the U.S. legal category that includes narcotics, must always be locked within that area (42 CFR 482.25).
The ASHP guidelines go into more detail. ASHP is the American Society of Health-System Pharmacists, and it updated these guidelines in 2022 to prevent the theft of controlled substances in hospitals. They ask that cabinets and carts holding controlled substances have a personal electronic lock, opened with a fingerprint, a code, or a card. Every opening must be recorded. Where keys are still used, they ask for a procedure to track the keys, store them securely after hours, and change the lock if a key is lost.

In practice, according to the 2023 ASHP national survey, 86% of U.S. hospitals distribute ward medications mainly through automated dispensing cabinets, which open with personal identification and record each time a medication is taken out.

Frequently asked questions

How should narcotics be stored on a ward?
In Italy, the Ministry of Health memo of July 3, 2026, states that Section A narcotics must be kept in a cabinet locked with a key, separate from other substances. The quantity in stock must match the register, and every movement must be recorded within 48 hours. In France, the order of March 12, 2013, requires a dedicated cabinet or compartment, locked with a key or with a closure that gives the same security.

What happens if the electronic lock runs out of battery?
It opens with a physical backup key, which works without power. The tender can ask for a lock that has one.

Does a crash cart need the same closure as a medication cart?
The priorities are opposite. A crash cart must open in a single movement, without a key or a code, and the seal guarantees its contents. A medication cart must open only for authorized staff. We covered this in Crash cart specifications: closure, seal, quick access.

To control who opens the cart, there are two electronic locks: Digicode, with a 10-key keypad and a 4-digit code, and a keycard lock. Both unlock all the drawers at once. Both can be fitted to Preciso and Presto carts with drawers, and to Preciso carts with a rolling shutter. In an emergency, or when the battery is dead, the cart opens with the backup key. If a keycard is lost, the master code is used to enable a new one, and the lock no longer recognizes the old one.

If you’re preparing a tender or reviewing how medications are managed on your wards, write to us through our contact page. And if now isn’t the right time, you can sign up for our newsletter: we send only a few emails a year on these topics.