Accident and emergency departments and minor injuries units:
Medicines coming into the Department with the Patient

One of the following procedures shall be observed and all actions recorded: -

• The medicines may be stored until returned to the patient at time of discharge or transfer to another ward.  Responsibility and security of storage is the same as for ward/dept stocks of medicines.

• Where a patient has brought their medication with them into hospital and it is desired to use these, they must be recorded and assessed in accordance with Section 6.

• The medicines may be returned home via an identified adult.  Responsibility for security is transferred to that adult.

• If the patient or the patient's agent agrees, the medicines must be sent to the pharmacy for destruction.  Responsibility and security is the same as for ward/dept stocks of medicines.

• Where patient's own medicines are to be used for the continued treatment of that patient in the ward/dept, the responsibility and security is the same as for ward/dept stocks of medicines.

If the Controlled Drug is no longer required by the patient, the patient's agreement must be sought for destruction. The pharmacist may then be requested to destroy it in the department. An entry to that effect shall be recorded in the Controlled Drug Register.

If the Controlled Drug is to be used to treat the patient on the ward, the Controlled Drug will be entered in the Controlled Drug Register as described above and an entry made in the register in the normal manner for patient's own Controlled Drugs (see Section 6.3)

16.2

In the Department, the responsibility for the safekeeping of the medicines rests with the Nurse with continuing responsibility.

Where there is perceived to be an extra risk, the advice of security specialists or Crime Prevention officers, in consultation with the Pharmacist with responsibility for the department, must be sought.

The Nurse with continuing responsibility shall be responsible for controlling access (by keys or other means) to the medicines cupboards and trolley.

For good practice the stock balance of Controlled Drugs must be reconciled at least once every 24 hours.  This check shall be carried out by two nurses, one of whom will be the Nurse in Charge.  The check shall be recorded with both nurses identified.

For clinical emergencies (e.g. cardiac arrest) all departments must have access to a source of appropriate emergency medicines.  These must be held in boxes clearly marked 'for emergency use'.  These boxes shall be tamper-evident and must not be held in a locked cupboard, but at strategically placed and accessible sites. Once a box has been opened, a replacement must be obtained from Pharmacy during working hours or from the Emergency Cupboard at other times and the opened box returned to pharmacy.

Accident and emergency departments and minor injuries units:
Medicines for Issue to Out-patients

These are variously known as Out-patient Packs (OP) or To Take Out packs (TTO). In order for a pre-dispensed pack to be issued to a patient a doctor or other practitioner with authority to prescribe these items must write a prescription as usual or the relevant PGD be implemented by an approved practitioner. A signed and dated Casualty Sheet is acceptable. In order to make packs available where dosage may be decided by the doctor for the patient, the packs may not carry full dosage instructions. Before issue, any required dosage instructions, the patient’s name and the date must be written on the label and checked against a written prescription with another practitioner.