8.10.1. Management
of Controlled Drugs in operating theatres -
Accountability
and responsibility
The Registered Nurse or Midwife
in charge of an operating theatre or theatre suit is responsible for the
safe keeping and management of CDs. Even if the theatre or theatre
suit is managed by an Operating Department Practitioner (ODP), the most
senior Registered Nurse or Midwife present is responsible for the CDs.
The
Registered Nurse or Midwife in charge can delegate key holding to the CD
cupboard to a Registered Nurse of an ODP. A nurse or ODP can then remove
CDs from the cupboard and/or remove them from the cupboard on the
specific authority of either the Registered Nurse or Midwife in charge
or doctor. However legal responsibility remains with the Registered
Nurse or Midwife in charge.
8.10.2.
Management
of Controlled Drugs in operating theatres - Requisitioning
of Controlled Drugs
The
Registered Nurse or Midwife in charge of an operating theatre or theatre
suite is responsible for the requisitioning of Controlled Drugs for use
in the theatre. The task of preparing the requisition can be delegated
to another Registered Nurse or ODP, however legal responsibility remains
with the Registered Nurse or Midwife in charge.
The
requisition must comply with the requirements set in out
in
Section 8.3.
8.10.3.
Management
of Controlled Drugs in operating theatres -
Receipt
of Controlled Drugs
When
CDs are delivered to a theatre or theatre suite they should be handed to
an appropriate individual. On no account should they be left unattended.
At the point of delivery, the
contents of the container must be checked immediately by a Registered
Nurse or ODP and witnessed by a second Registered Nurse or ODP, Student
Nurse, Pharmacist or Doctor. Where possible, the person ordering the
medicine should be different to the person receiving the medicine into
stock. Any discrepancy must be reported to the
Specialist Pharmacy Technician or Senior Pharmacist in the dispensary
immediately.
The
receipt of CDs must conform to the provisions set out in
Section
8.3.
8.10.4.
Management
of Controlled Drugs in operating theatres -
Storage of Controlled Drugs
The
storage requirements for CDs must conform to the requirements detailed
for wards and departments in
Section 8.2.
8.10.5.
Management
of Controlled Drugs in operating theatres -
Record
keeping
The
records for CDs must conform to the requirements in
Section
8.3. There must be a separate CD register for each theatre.
8.10.6.
Management
of Controlled Drugs in operating theatres -
Controlled
drug stock checks
Within
NHS Tayside all areas possessing stocks of
Controlled Drugs must carry out a stock balance reconciliation every 24
hours. This should be recorded. Any discrepancy must be investigated in
accordance with
Section
8.5.
A
check of all CDs stocked within wards and departments, must be completed
every 3 months by Pharmacy (either a pharmacist or a senior pharmacy
technician). This
includes a check of documentation relating to CDs in the preceding three
months and a check of CDs currently stocked in the CD cupboard. The
nurse in charge or deputy must also be present for the final stock
balance check. The pharmacy
technician may act as a deputy when working with a pharmacist.
The
procedure for CD stock checks must conform to the requirements detailed
in
Section
8.5.
8.10.7.
Management
of Controlled Drugs in operating theatres -
Prescribing
of Controlled Drugs
Where
separate charts are used e.g. epidural, anaesthetic or
patient-controlled analgesia charts, these should be cross-referenced on
the patient’s main prescription chart.
Prescribing
of CDs should follow the general provisions set out below and should
include:
- Drug
name and form
- Route
- Dose
and frequency (with time interval stated if prescribed when
required, indication for which prescribed and maximum dose)
- Start
date and if appropriate, finish date
- Signature
of authorised prescriber
There
requires to be a record kept of:
- All
CDs issued
- CDs
administered to named patients
- CDs
returned to stock
8.10.8.
Management
of Controlled Drugs in operating theatres -
Administration
of Controlled Drugs
The
practice of issuing “active stock” to the anaesthetist and then
returning the unused portion to stock, recording both issues and returns
in the theatre CD register should be avoided. An amount should be
issued to the anaesthetist for a specific patient and any surplus drug
should be destroyed and witnessed.
The
person who administered the CD should make a record of administration on
the appropriate chart immediately after administration.
This should include the identity of the person, the dose
administered and the time of administration.
8.10.9.
Management
of Controlled Drugs in operating theatres -
Management
of CDs when patients are transferred to/from theatre
There
should be documentation in place to ensure records are maintained when
patients are transferred with CDs physically attached to them e.g. PCA,
epidural. The receiving nurse or doctor and transferring nurse or doctor
should check the patient identity, infusion and prescription and
annotate the appropriate chart at the point of transfer to document that
this check has been made.
8.10.10.
Management
of Controlled Drugs in operating theatres -
Destruction
and disposal
The
disposal of CDs in theatre should conform to the general provisions set
out in
Section 8.8.
Unused
part doses should be destroyed promptly and witnessed by a Registered
Nurse or registered ODP. The CD to be discarded should be rendered
irretrievable by emptying the contents of the ampoule/vial, into a
sharps bin suitable for pharmaceutical waste. |