8.11.1. Controlled Drugs in GP Practice

Each GP Practice has their own SOP, within which they must follow the procedures listed therein. The SOP has been developed in conjunction with NHS Tayside Controlled Drugs Accountable Officer and Team.

GP Practices are contracted to the local Health Board to provide general medical services to NHS patients.

CDs are used in the treatment of a number of conditions. Most notably for severe pain, anxiety and sleeping disorders but also for the management of substance misuse. Many patients in the community are prescribed these drugs by their GP. Non-medical prescribers may also work in clinics, often within GP practices.

There are a number of extra legal requirements for a prescription for Schedule 2 & 3 CD to be valid (see Section 8.4.1.). Prescriptions for CDs in Schedules 2, 3 and 4 are valid for only 28 days compared to six months for non CDs. Government advice is that the quantities of these drugs that may be prescribed should be limited to 30 days supply except in exceptional circumstances. CDs are regularly prescribed in instalments, often for the management of substance misuse, but also for inclusion in monitored dosage systems and in these circumstances, specific prescription requirements must be met for Schedule 2 & 3 CDs.

GPs that keep CD stock for administration to patients during house visits or emergencies must be ordered on GP10A stock order forms. Schedule 2 and certain schedule 3 CDs should be stored either in a secure central location with restricted access within their practice or in a locked bag or other locked receptacle, which should be kept in the GP’s possession. Controlled Stationary should also be stored securely as it can be used fraudulently to obtain CDs.

GPs can supply Schedule 2 CDs to other GPs provided there is a record of the transaction on their CD Register, however, cannot destroy their own stock. Any Schedule 2 CDs in their possession must be destroyed by an Authorised Witness.

Please refer to:

·         A Guide to Good Practice in the Management of Controlled Drugs in Primary Care – Scotland

·         Controlled Drugs Governance – Standards for GP Practices (applies to all Schedules of CDs)

·          Information on how to complete a Primary Care CD Register appropriately

 
8.11.2. Controlled Drug Management for Use in Car Bags

When the GP is ready to leave in the car to attend home visits they should obtain CD Keys from their secure location in the base.

Once the keys have been obtained the GP should go to the Controlled Drug Cabinet and remove the corresponding “Attractive Drug Pouch” and CD Register to the car which they are in.

Video - taking drugs out to car.mp4

The “Attractive Drug” pouch should be opened and for those drugs which the Out of Hours Service Register, the registered quantity should be checked against the physical quantity in the pouch.

The drugs which are currently registered by the Out of Hours Service are:

·         Morphine Sulphate 10mg/ml Injection

·         Midazolam 10mg/2ml Injection

·         Midazolam 10mg/ml Buccal Liquid

·         Morphine Sulphate Oral Solution 10mg/5ml

If there is an intact yellow seal on any boxes of liquid medicines, it can be assumed the bottle is full. If there is no yellow seal on the box or if the seal appears to be broken, then a visual check of the bottle will be sufficient.

If all quantities in the pouch match the stated quantities in the Register then the GP should record on the stock check page that a stock check has been undertaken.

The stock check pages can be found at the back of the CD Register. Required information is:

·         Date

·         Time

·         Words “stock correct”

·         GP Name and Signature

If there is any discrepancy noted then this should be highlighted to the Nurse in Charge or Team Leader on shift. The discrepancy should be noted in the CD Register and a DATIX completed.

Once completed, the GP should return the Controlled Drug keys to their secure location. 

Video - bringing drugs back from car.MP4   

All medicines and prescription pads should then be placed back in the “Attractive Drug” pouch and locked in the Controlled Drug Cabinet, along with the Controlled Drug register.

The GP should then secure the Controlled Drug Cabinet and return the keys to their secure location.

8.11.3. Administration of CDs on Home Visits whilst undertaking NHS Tayside Duties

Controlled Drugs must be prescribed and administered in accordance with local policies.

The practitioner administering the CD must verify that the appropriate prescription requirements are in place and check appropriate details on opening the CD receptacle. Where possible, this should be independently* checked (see below) by a second practitioner. Checks relate to:

·         The drug name.

·         The correct dose. Where the prescribed dose is higher than the usual starting dose, check the patient's previous dose and formulation.  Where an increase in dose is intended, the prescribed dose should not usually be more than 50% higher than the  patient's previous dose.

·         Volume of bolus/infusion (additive, diluents/infusion).

·         Route and rate of administration.

·         Expiry date/time.

·         Reconciling balance of stock against the Register balance after removing required quantity of drug.

Packaging is not discarded until the patient check has been completed.

The practitioner must check appropriate details of the patient.  Where possible, this should be independently* checked (see below) by a second practitioner.  Checks relate to:

·         The patient's name and date of birth corresponds with the details on the prescription.  Where this is not practical (e.g. patients with cognitive impairment), the patient may be identified via other means in accordance with local procedures.

·         Confirm the patient is not allergic to the drug.

·         The drug name.

·         The dose administered is correct in relation to the prescription and is safe for the patient.

·         The drug details on the original ampoule.

·         Volume of bolus/infusion.

·         Route and rate of administration.

·         Expiry date/time.

*independently is defined as an individual undertaking the above process on their own without verbal or other communication during the checking process.

This is a two step process, step one is the check when opening the controlled drug receptacle, step two is the check on administration to the patient.

The CD Register in the GP home visit bag should be completed with the following details:

·         Date and time when dose administered.

·         Name of patient.

·         Quantity administered.

·         Form (name, formulation and strength) administered.

·         Name/signature and printed name of practitioner administering the dose

·         Name/signature and printed name of witness to the administration, where applicable.

·         Balance in stock

·         An appropriate record of administration must also be entered on the electronic patient record.

Where only part of an ampoule containing a CD is used please refer to Section 8.8. Controlled Drug Destruciton for disposal of the unused quantity.