8.6.1. Procedure for Administering, Witnessing Administration and Recording Administration of CDs

Before dispensing the Controlled Drug check the patient’s drug administration chart and check allergy status. If the CD to be administered is an opioid, the registered Nurse administering the drug should confirm any recent opioid dose, formulation, frequency of administration and any other analgesic medicines prescribed for the patient.

Two Registered Nurses, midwives or registered healthcare professionals obtain the CD Cabinet keys and go to the CD Cabinet with the patient’s drug administration chart. The CD Cabinet keys and CD Register must be held until the procedure is completed. Student nurses /midwives can check and administer controlled drugs under direct supervision from a registered Nurse/midwife once they have successfully completed the administration of Medicines theory and simulated practice within their educational programme. Responsibility for the delegation of the task is retained by the registered healthcare professional (NMC 2007). All aspects of administration must be in line with relevant policies.

All checks are to be carried out independently, with all aspects being checked by both parties.

At the CD Cabinet, the correct page in the Ward CD Register relating to the drug, form, and strength to be administered is found. Drug (name, formulation and strength) should be recorded on the header of the sheet used to record the administration.

The correct stock is identified and selected from the CD Cabinet. Labels should be read very carefully, as different strengths and forms (e.g. Modified Release) of medicines and their packaging can look very similar. Check the stock balance against the CD Register is correct.

The following information is recorded in the Ward CD Register:

·         The date must be stated. Ditto marks or arrows to indicate the same day or time is NOT acceptable.

·         Patient’s full name i.e. first name and surname

·         Remove amount required, returning the remaining stock to the CD Cabinet. The new stock balance is calculated, physically checked by both healthcare professionals and this is recorded in the Ward CD Register

The dose to be given is then prepared against the prescription, carefully checking ALL details on the prescription chart.

Any excess medicines when preparing a dose must be disposed of correctly witnessed and recorded in the Controlled Drug Register at the time of destruction (see Section 8.8.)

Both staff attend the patient’s bedside, taking the prescription and the CD Register with them, for the administration of the dose and independently confirm the patient’s identity and date of birth, verbally where possible, with that on the prescription chart. The patient’s wristband or photograph (if used) must also be checked against the prescription chart, and re-check allergy status.

An explanation about the process should ideally be given to the patient, where possible, depending on the patient’s condition (this may not be possible, for example, palliative care) thus gaining implied consent.

The CD is then administered by one of the nurses or registered healthcare professionals whilst the other registered healthcare professional or student nurse witnesses the administration.

If only part of the CD is given, the amount administered and the amount discarded must be witnessed and fully documented in the Ward CD Register. This might be the case, for example, when titrating analgesia and part of the prepared medication is not required.

If the patient refuses the medication (see Section 8.8.9.), document in the CD Register and on the administration chart.

Individual doses of CDs prepared but not administered should be destroyed by two healthcare professionals (see Section 8.8.), where one must be a Pharmacist or Pharmacy Technician, or a registered healthcare professional and a suitably trained competent witness if available. It is recognised that there may only be one registered professional available and therefore, local policies must be referred to. Complete the CD Register and annotate clearly.

Both members of staff then complete the entry in the CD Register, including “administered by”, “witnessed by” and “time of administration”. The prescription record chart must also be signed. Sign the Ward CD Register and return it to the CD Cabinet.

CD Cabinet Keys are then returned to the Senior Charge Nurse / Midwife / Operating Department Practitioner of the Ward / Department or Theatre.

When administering an oral liquid dose, the bottle must be fitted with an appropriate sized ‘bung’ and an oral syringe suitable(for example, do not use a 50mL syringe for a 2mL dose) to the dose being measured must be used.

When administering parenteral doses of less than 1mL in volume, the healthcare professional must use a graduated 1mL syringe.

Where larger volumes are to be administered for example, methadone a Home Office approved measuring cylinder must be used.

Example of how the CD Register must be completed following CD administration:

·         Date and time the dose was administered

·         Patient name

·         Quantity administered (for example, 1 x 10mg MST Tablet)

·         Signature of Nurse

·         Signature of witness

·         Balance in stock updated