Nurses should not routinely transport Controlled Drugs in the course of their practice.  This must only be undertaken in circumstances where there is no other reasonable mechanism available. During transport all drugs must be kept out of sight. On arrival at the patient’s home, the nurse must sign and check the stock in the Patient Drug Record Card, and it should be witnessed that the CD has been received by the patient.  Where a second nurse is not available another competent person may witness receipt e.g. a family member.

The person collecting the medicine from the dispensing pharmacy will be required to sign the back of the prescription form when collecting Schedule 2 or 3 CDs. Legislation states that the pharmacist must ascertain whether the person collecting is the patient, patient’s representative or healthcare professional. If the person collecting the Schedule 2 controlled drug is a healthcare professional acting in their professional capacity on behalf of the patient, the pharmacist must also obtain the name and address of the healthcare professional and evidence of identity (unless he/she is acquainted with that person).

If Controlled Drugs have to be delivered by a taxi driver they must be packaged within a tamper evident container. The taxi driver must be requested to sign for the package at the point of collection, and get a signature at the point of delivery. This forms a robust audit trail protecting the supplier, courier and patient.

Nurses must also advise patients regarding the safe storage of their medication in accordance with the patient information leaflet, and with any instructions on the label.  

A Registered Nurse or doctor in the community may administer, without witness, a Controlled Drug which has been obtained on prescription by the patient. A GP may administer a controlled drug from stock.  In this case, an entry must be made in the appropriate CD register. A prescriber may complete a controlled drug record form, authorising the community nurse to administer a particular controlled drug. A record of that administration must also be made on the accompanying form. 

The following process must be followed:

• Check the identity of the patient. The patient's name and date of birth corresponds with the prescription and wherever possible is confirmed by the patient.
• Check the patient is not allergic to the medicine prior to administration.
• Ensure that the intended drug and dose for the patient is correct.
• Know the therapeutic uses of the medicine to be administered, its normal dosage, side effects, precautions and contra-indications.
• Check the prescription and/or the label on the medicine dispensed is clearly written and unambiguous.
• Check the expiry date of the medicine.
• Check the strength, dosage, weight, where appropriate method of administration, route and timing, frequency, start and finish dates.
• Contact the prescriber or another authorised prescriber without delay where contra-indications to the prescribed medicine are discovered, where the patient develops a reaction to the medicine, or where assessment of the patient indicates that the medicine is no longer suitable.
• Where a nurse is administering a Controlled Drug that has already been prescribed and dispensed for that patient, obtaining a witness and second signature must be based on the local risk assessment.  (Proactive Risk Management: Assessing Risk in NHS Tayside. March 2007) (Health & Safety General Risk Assessment Policy. April 2007).
• Although normally the second signatory should be another registered health care professional, in the interest of patient care, where this is not possible a second suitable person who has been assessed as competent may sign e.g. Student Nurse or family member.
• A stock check of Controlled Drugs must be taken and recorded as part of the administration procedure.

Entries made in error must not be obliterated or crossed out; the words “entered in error” must be written on the same or next line. The entry must be signed and dated by the person who made the error.

Where only part of an ampoule containing a Controlled Drug is used, the aunused drug should be disposed of down a sink and the amount used and the amount destroyed must be recorded. Where there is a witness to the administration, this person must also witness the destruction of the unused drug.

Where a discrepancy has occurred the practitioner must refer to the NHS Tayside Adverse Incident Management Policy.  Any errors or incidents in relation to the administration of controlled drugs must be recorded and reported via the relevant manager and an Adverse Incident Management (AIM)/Datix report and detailed in the patient’s record. Refer to guidance in Section 8.3.

Any discrepancy identified within a GP practice, whether in the GPs bag or within the stock cupboard must be investigated in accordance with Section 8.2.

If a practitioner becomes aware that Controlled Drugs are missing from a patient’s home this must be discussed with the senior nurse as soon as possible and reported to the manager as soon as practical with discussion with the Head of Controlled Drugs Governance and police as appropriate.  Any incident of this nature should be recorded as an adverse incident using the Adverse Incident Management/Datix system.

It should not normally be the responsibility of nurses to become involved in the disposal of unwanted CDs. However, there may be occasions when it is appropriate for nursing staff to become involved in removal / disposal of CDs.  A staged approach should be:

• If return by relatives / next of kin is not practical or possible then the following action could be taken - 
  Registered Nurse with another member of the nursing team acting as a witness disposes of CD in an appropriate and safe manner within the patient's home. This must be within an agreed local SOP and must include appropriate record keeping in patients notes.

OR

• Registered Nurse could take CDs to local community pharmacy who would be asked to countersign patient nursing record.