SAFE AND SECURE HANDLING OF MEDICINES

Section 8.1: Prescribing of Controlled Drugs (Refer to Section 8.7 and Section 19 for prescribing on TPAR)

8.1.1 Controlled Drugs - general prescribing information:
Prescribing of Controlled Drugs
To meet legal requirements, the following details must be present (in indelible ink) on the Controlled Drug prescription (unless the drug is specified in schedule 4 or 5 or temazepam).  These requirements do not apply where controlled drugs are prescribed on the TPAR for administration to inpatients (see section 8.7.11 and section 19 for these). If any are missing, the script is invalid and must be returned by the pharmacist:
  • The name and address of the patient
  • The name, form and strength of the preparation
  • The dose to be taken, (NHS Tayside enforce the view of the Home Office, in that a dose of  “as directed” or “when required” is not acceptable, but “one to be taken as directed/when required” is acceptable
  • The number (in both words and figures) of dosage units to be supplied. In any other case, the total quantity (in both words and figures) of the Controlled Drug to be supplied
  • The handwritten signature of the prescriber
  • The date
  • Have written on it, if issued by a dentist “for dental treatment only”
  • The address of the prescriber must be stated on the prescription

See Appendix 4 for guidance on how to write a discharge or outpatient controlled drug prescription.

Regulations allow for the use of computer generated Controlled Drug prescriptions, however it is essential that prescriptions are checked by the prescriber after printing, to minimise the risk of error.

Professional Regulatory bodies may impose restrictions on healthcare professionals in relation to prescribing of CDs.  Any practitioner subject to such restrictions must ensure that any organisations or practices for whom they provide services are aware of all terms of restrictions imposed.

Practitioners should not prescribe CDs for themselves, their family or friends except in an emergency.


8.1.2
Controlled Drugs - general prescribing information:
Checking the dose
When opioid medicines are prescribed in anything other than acute emergencies, the healthcare practitioner concerned should:
  • Confirm any recent opioid dose, formulation, frequency of administration and any other analgesic medicines prescribed for the patient. This may be done for example through discussion with the patient or their representative (although not in the case of treatment for addiction), the prescriber or through medication records.
  • Ensure where a dose increase is intended, that the calculated dose is safe for the patient (e.g. for oral morphine or oxycodone in adult patients, not normally more than 50% higher than the previous dose).
  • Ensure they are familiar with the following characteristics of that medicine and formulation: usual starting dose, frequency of administration, standard dosing increments, symptoms of overdose, common side effects.
8.1.3 Controlled Drugs - general prescribing information:
Electronic Discharge Document (EDD)

Where a supply of controlled drugs is required on an EDD prescription, a paper copy should be printed off and signed by the prescriber.  This paper copy should be sent to pharmacy for dispensing.
 
8.1.4 Controlled Drugs - general prescribing information:
Quantity prescribed
Prescribing of schedule 2, 3 and 4 Controlled Drugs should be restricted to a maximum of 30-day supply. In those circumstances where it is deemed appropriate to supply more than a 30-day quantity, and this does not pose a significant risk to patient safety, the patient's notes should be annotated. Prescribers will have to justify their decision.
8.1.5 Controlled Drugs - general prescribing information:
Monitoring
Patients prescribed controlled drugs should be monitored in accordance with relevant local and national guidance.
8.1.6 Controlled Drugs - general prescribing information:
Validity of prescriptions
 Prescriptions for schedule 2, 3 and 4 Controlled Drugs are only valid for 28 days from the date signed by the prescriber or from a start date specified by the prescriber on the prescription.

8.1.7
Controlled Drugs - general prescribing information:
Technical errors on Controlled Drug prescriptions
If a prescription for a controlled drug other than a drug specified in schedule 4 or 5 or temazepam contains a minor typographical error or spelling mistake the pharmacist may still supply. A pharmacist can make a supply if the prescription does not comply with the requirement for the total quantity of the preparation or the number of dosage units to be specified in either words and figures, but not both, provided that;
  • They are satisfied that the prescription is genuine
  • They are satisfied that the drug is being supplied in accordance with the intention of the prescriber
  • The prescription is amended so as to be indelible to correct the minor typographical or spelling mistake, so the prescription complies with the stated requirement detailed under Section 8.1 above
  • The prescription is endorsed with the initials of the person making the amendment

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