Canberra sexual health organisation's accidental distribution of probe covers as condoms caused by online ordering error
Chekmate lubricated probe covers were mistakenly handed out as condoms by Sexual Health and Family Planning ACT, including in the organisation's Condom Box Packs. (ABC News: Luke Stephenson)
In short:
An independent review into the accidental distribution of ultrasound probe covers as condoms by Sexual Health and Family Planning ACT has revealed the mistake was likely caused by an online ordering error.
The review found the organisation had no procedures to confirm it ordered the correct product, and made recommendations to prevent similar errors in future.
What's next?
Sexual Health and Family Planning ACT has committed to implementing all of the review's recommendations, including creating an ordering catalogue that includes a product number.
A Canberra sexual health education organisation's accidental distribution of more than 4,000 ultrasound probe covers as condoms was likely caused by an online ordering error, an independent review has revealed.
In early August, Sexual Health and Family Planning ACT (SHFPACT) issued a product withdraw for all condoms it had supplied since the beginning of 2024.
SHFPACT said the approximately 4,200 probe covers were distributed at numerous public events, five public colleges, and up to 20 community health organisations, including all of the territory's walk-in centres.
The organisation engaged PFK Integrity Services (PFK) to undertake an independent review to determine the cause of the mistake and provide recommendations to prevent similar errors in future.
SHFPACT incorrectly issued these ultrasound probe covers instead of condoms. (Supplied: SHFPACT)
The review indicated the probe covers were likely mistakenly ordered due to a keyword search for "condoms" on the supplier's website, where the ultrasound equipment covers were incorrectly listed under the product category "condoms".
The probe covers have blue packaging of a similar shape and size to standard condom packaging, with the words "Chekmate lubricated probe cover" on the front.
Inside the packaging the probe covers also appear physically similar to a condom, but do not offer the same level of protection from pregnancy or sexually transmitted infections as the barrier contraceptive.
SHFPACT commits to implementing all review recommendations
The independent review's major finding was SHFPACT had no procedures in place to cross-check it had ordered the correct product.
It said the organisation had no formalised purchase-making procedure, no mechanism to verify order accuracy when placed, shipped or delivered, and no central register for stock items.
The review also noted there were no stocktakes for items – including condoms – the organisation had not yet distributed to the public, which it said may have identified the probe covers as having been added to the condom inventory.
PKF made a number of recommendations to improve SHFPACT's procurement and inventory controls in its review, all of which the organisation has committed to fully implementing.
Sexual Health and Family Planning ACT has committed to implementing all the review's recommendations. (ABC News: Luke Stephenson)
On PKF's recommendation the organisation will develop an ordering catalogue for regularly purchased products, including their product number, and will only order products using that product number.
SHFPACT will also assign a single person to oversee its purchasing portfolio, introduce a two-factor authorisation for all purchases, and establish training for all staff involved in procurement to outline the new procedures.
In a statement SHFPACT said it knew community trust and confidence were prerequisites for the successfully delivery of their health promotion and clinical services.
"We remain committed to providing sexual and reproductive health education and clinical services to the Canberra community,"SHFPACT said.
"These enhanced processes will support our ability to continue to distribute condoms to prevent sexually transmissible infections and as a contraceptive method to prevent pregnancy as part of our approach."