Dispensing of controlled substances

Dispensing

1. Dispensing of controlled substances: Dr.Zulcaif Ahmad [phone]

2. Controlled substances: Defination: “Controlled substances are drugs that have some potential for abuse or dependence. ” These prevent unauthorized use of analgesics, anesthetics, steroids.

3. Law of controlled substances: The drug law 1976, in schedule B has the list of such drugs. 1997 is the drug law currently used nowadays and have not changed.

4. Categorized into 5 schedules: Schedule 1: High potential for abuse and has no accepted medical use in treatement in USA. Schedule 2: High potentials for abuse but accepted for medical use in USA. Schedule 3-5: Less as compare to above potentials for abuse, accepted for medical treatment in USA and has less physical dependence and psychological dependence.

5. Schedules: Schedule 1 ( such as e.g marijuana) Schedule 2 ( such as e.g cocaine) Schedule 3 ( such as e.g steroids) Schedule 4 ( such as e.g valium) Schedule 5 ( such as e.g opium)

6. Hospital control procedures: Assigning of responsibility of control: To check the control is joint responsibility of administration, pharmacist and nurses. Administration head: Proper safeguarding & handling of Controlled Substances.

7. Hospital control procedures: Pharmacist in chief: For purchase, storage, accountability, & proper dispensing of control substances. Head nurse: Responsible for proper storage.

8. Role and responsibility of Administration: Administration execute responsibilities for drug control by formulating proper policies regarding: Ordering Dispensing Prescription Documentation of controlled drugs

9. Role and responsibility of Administration: Controlled drugs form to be used by head nurse to order drugs from pharmacy. A daily basis administration form of controlled drugs to have 24 hours administration record, this form is also used as review of errors (form record). Monthly controlled drugs serves as a monthly dispensing record for each nursing unit. (Storage record)

10. Policies & procedures for ordering of controlled substances: Preparation of orders: Ink or indelible pencil sign and typing. Doctor’s orders for administration of controlled drugs: Ward stock orders must written on Dr order sheet or patient chart & if it is not in ward stock a complete priscription is written on hospital prescription blank and a complete name signature is done by the Dr.

11. Policies & procedures for ordering of controlled substances: Pro Re Nata orders: Must be discouraged except under special circumstances. Telephone orders: Dr may give the orders, in necessity nurse may also take and orders are written on dr order sheet by nurse by dr name and her initials, later on dr must sign by his name or initials within 24 hours.

12. Policies & procedures for ordering of controlled substances: Verbal orders: A doctor may give a verbal order in emergency cases and the nurse may write order on order sheet and later on Dr may sign within 24 hours. Ordering non ward stock controlled drugs from pharmacy: It is also covered by Dr sign if more is needed then Dr may sign again.

13. Policies & procedures for ordering of controlled substances: Ordering ward stock controlled substances from pharmacy: The ward stock form is completed by placing a check mark opposite the name, and strength. Before issuing new controlled substances, previous supply is to be accounted.( 24 hr record, record losses and errors)

14. When ever dose or drug is lost or wasted on ward, nurse in charge must prepare a special report on form to cover incidence so report is prepared in duplicate and sent it to pharmacy (request for new supply of drugs). Orignal is filled in pharmacy and duplicate is sent to nursing office.

15. Prescribing: Prescription for personal use: Physician may not prescribe any drug for his personal use. No refilling: Prescribing controlled drugs to outpatients: yes, it can be prescribed and route of administration and frequency info is added.

16. Dispensing of controlled substances: Dispensing of ward supply to patients for home use: No Dispensing to employees: No Dispensing of controlled drugs for home use during pharmacy off-hours: yes can be given from ward stock.

17. Why they are not used as other medications (in terms of safety): It may cause levels of addiction. They have maximum adverse effects and very harmful then other drugs. Once a person is addicted to it its very difficult to come back to normal condition and may need rehabilitation centre.

18. Precautions: Do not share facilities NoTransfer to another container

19. Control and Security: Provide effective controls to guard against theft, prevent illegal drug use, and protect public from harm.

20. Administration Administered By Nurse The nurse should use Proper number of tablets /ampules Record the number used Dose given Controlled drugs administration sheet: Date Amount given Patient's full name Patient's hospital number Number of tablets administered Filling out invetory column

21. Administration of medication may include some or all of the following: Selecting and preparing medicines for immediate administration Applying creams and ointments Inserting drops to ear, nose or eye Assisting with the administration of inhaled medicines . Where possible, a second designated member of staff should witness the preparation and administration of a controlled drug and should sign the record of medicines administered. Administration

22. Procedure in case of wastage: Aliquot part of drug solution: It should be expelled into sink. Dose refusal by patient or Dose cancellation by doctor: In such cases drug prepared should be expelled into sink. Accidental destruction: In this case the incident and reasons are to be recorded on a specified form. Administration

23. Delivery To Nursing Stations Reliable person must be assigned for this purpose. Due to Maintenance of adequate record illegal use can be Immediately detected If happen so appropriate measures are necessary for Recovery

24. Roles and Responsibilities of Pharmacy Department Various systems include: Controlled drug loss report Drug Delivery system for nursing stations protocol for drug abuse and diversion Documentation

25. Controlled Drug Loss Report System for reporting of a drug loss in an institution. Drug Delivery System For Nursing Drug Delivery system for nursing stations requires re liable person

26. Protocol for drug abuse and diversion requires Collaborative effort Requirements: Define products included in it. Scope is extended to employes,patients and visitors. Procedure for reporting File the report in pharmacy or in some cases in personnel department Outside agencies involvement like local police if diversion is suspected by pharmacy or abuse is reportes by personnel department. Record must be maintained to detect any illegal use Documentation provides basis for measures to be taken in this case. Protocol For Drug Abuse and Diversion

27. Documentation is u seful in Maintaining proper control Periodic audits Basis for appropriate measures Documentation Documentation

28. Records of the receipt and return of controlled drugs to the pharmacist for disposal must be maintained. It is considered good practice for records of the return of controlled drugs to be signed by the pharmacist receiving them for destruction. Documentation

29. Roles And Responsibilities Of Nurses Auditing of nursing inventory Physical count of narcotics Mentioning on audit record Forwarding loss report to pharmacy department

30. Charges To Patients Charge of each dose received: Some hospitals charge for each dose administered to patient Flat charge to cover all controlled drugs: In some hospitals, this is done by charging a flat charge to cover all controlled drugs Charges in per diem charge Sometimes cost is added in per day expenditures. Without specific charge: In some hospitals no specific charge is made to patients .In some larger hospitals these are available at no charge. Split charging: There is no carge for routinely used drugs but those obtained on special order are charged.

31. Use Of Controlled Drugs In Research Notification to Pharmacy and Therapeutics Committee No one can conduct research without authorization of Pharmacy and theraputics committe Documentation Maintaining records

32. Records: Name and address Maintenance of inventory accounting for Each controlled substance Awaiting disposal Held for quality control purposes Maintained for extemporaneous compounding Maintaining receipts Dispensing records Documentation

33. DEA The Drug Enforcement Administration (DEA) is a United States federal law enforcement agency under the U.S. Department of Justice, tasked with combating drug smuggling and use within the United States. International Presence - DEA has 86 offices in 67 countries around the world. Among government agencies, DEA has sole responsibility for coordinating and pursuing drug investigations abroad and works in partnership with foreign law enforcement agencies.

34. DEA DEA Employees: DEA employs more than 9,200 men and women, including over 4,600 Special Agents, over 600 Diversion Investigators, nearly 800 Intelligence Research Specialists, and close to 300 Chemists How it works? Using unique operational and intelligence capabilities, the men and women of DEA identify, investigate, disrupt, and dismantle major drug trafficking organizations and those who facilitate them, remove drugs and violent criminals from our neighborhoods, and fight the diversion of licit drugs.

35. CSA The Controlled Substances Act (CSA) is the federal U.S. drug policy under which the manufacture, importation, possession, use and distribution of certain substances is regulated. Two federal agencies, the Drug Enforcement Administration and the Food and Drug Administration, determine which substances are added to or removed from the various schedules