1 Ordering and Receipt of Controlled and Recorded Drugs and Controlled Drug Prescription Pads

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1 All staff using the Fluid & Medication Management policies must first familiarise themselves with the contents of: Roles & Responsibilities Policy, Basic Infection Prevention & Control Principles related to Fluid & Medication Patient Identification Policy (Volume 11) Ordering of Controlled and Recorded Drugs Area specific requirements Receipt of Controlled or Recorded/C5 Drugs... 4 Purpose To ensure the ordering of Controlled Drugs and/or Recorded Drugs is performed in an appropriate and standardised manner. Scope All CDHB Hospital Sites (excludes Rural Health) Nurses/Midwives/designated Anaesthetic Technicians and other designated Staff/Approved Persons/Medical Officers/Medical Radiation Therapists (MRT s)/ward Pharmacists/Security staff Associated Documents Controlled Drug Register (Black) Recorded Drug Register (Blue) Site Specific Controlled Drug Order Form Site Specific Recorded Drug Order Form/C5 Drug Order Form Security Log Book (Christchurch Hospital Campus only) Ref: 4740 Page 1 of 5

2 1.1 Ordering of Controlled and Recorded Drugs Area specific requirements Christchurch Hospital (except for Day Surgery and Emergency) Same Day Delivery Requests to arrive in Pharmacy before 1000 hours. Next Routine Delivery Day Requests received after 1000 hours will be delivered on the next routine delivery day as below Parkside East and West Monday and Thursday Riverside Tuesday and Friday Urgent Orders after 1000 hours If urgent orders (same day) are required after 1000 hours, a Registered Nurse must: Fax order to Pharmacy filling in urgent box Ring Pharmacy to alert them Pharmacy will call ward when order is ready: Registered Nurse (carrying personal hospital ID) collects blue satchel and signs the receipt of delivery/collection book form Day Surgery Areas Requests to be faxed to Pharmacy by 1200 hours Monday. Deliveries 0900 hours Wednesday. Emergency Department Requests to faxed to Pharmacy by 1200 hours Tuesday. Deliveries 0830 hours Wednesday Christchurch Women s Hospital Requests to arrive in Pharmacy by 1100 hours on Mondays. Delivered on Wednesday mornings. The Princess Margaret Hospital Routine orders Requests to arrive in Pharmacy by 1200 hours Mondays to Thursdays. Deliveries made by Pharmacist the following day. Ref: 4740 Page 2 of 5

3 Urgent orders Fax order indicating it is needed for same day. Pharmacist will deliver. Burwood Hospital Routine orders Requests to arrive in Pharmacy before 1200 hours on Mondays and Thursdays. Deliveries are made by the pharmacist to areas on Tuesdays and Fridays. Urgent orders Fax request to Pharmacy. Once Pharmacy ready: Registered Nurse takes appropriate Register(s) to Pharmacy to collect the drugs. Ashburton Hospital Pharmacy staff check Controlled Drug Register weekly and ascertain needs and replenish stock as required. Hillmorton Hospital Fax requests to Pharmacy before 1200 hours Monday to Friday. Recorded Drug deliveries are sent out at 1215 and 1600 hours daily. Pharmacists will deliver Controlled Drugs. Urgent orders (New admissions and chartings) Contact Pharmacy on phone Pharmacists will deliver Ref: 4740 Page 3 of 5

4 1.2 Receipt of Controlled or Recorded/C5 Drugs When checking Controlled or Recorded Drugs and Controlled Drug prescription pads received from Pharmacy into the ward/unit/department safe, two appropriate staff (one being a Registered nurse/midwife/transitioned EN (preferred practice) with a second RN/M/Transitioned EN or approved person) must Check items and quantities match packing slip Check the sealed containers are intact. (Broken packs may be sent occasionally. Quantities will be indicated on boxes and have Broken Pack stickers on them. Document in the register the receipt of the drugs From Pharmacy In and Balance Confirm that the balance is correct For any unsealed containers, document this in the register. Recount and reseal the container if the count is correct. Date and sign the sealed container to indicate correct amount. If count is incorrect, complete a incident form and notify CNM/NIC and a Duty Nurse Manager out of hours See local policy for areas who do not have registered staff available to check in drugs/prescription pads Specific Requirements for receiving or collecting Controlled or Recorded Drugs (In the transfer and receipt of Controlled or Recorded Drugs and prescription pads for Christchurch Hospital Campus (Med Surg and Womens and Child Health) Pharmacy staff are to identify a registered nurse/midwife/transitioned EN (preferred practice as able)to take receipt of the drugs in the area (identified by their personal identification card) This staff member is to sign their name and document their personal ID number on the security log to acknowledge receipt of drugs Ref: 4740 Page 4 of 5

5 References Misuse of Drugs Act, 1975 and its Amendments, 1981 Misuse of Drugs Regulations, 1977 and Amendments Medicines Act, 1981 and Regulations 1984 Hospitals Regulations, 1933 Health Practitioner s Competence Assurance Act, 2003 Health Act, 1956 Guidelines for Nurses on the Administration of Medicines (NZNO 2007) Health and Disability Sector Standards (Standards NZ, NZS8134:2008) Policy Owner Date: July 2013 Pharmacy Services and Directors of Nursing Ref: 4740 Page 5 of 5