Obtaining Cntrlled Drugs In Primary Care - Supply Rutes In Exceptinal Circumstances C-rdinatrs: Lesley Thmsn Lead Pharmacist Cntrlled Drugs Team Cnsultatin Grup: Apprver: David Pfleger Cntrlled Drug Accuntable Officer Signature: Signature: Identifier: NHSG_CDExceptC/ MGPG874 Review Date: May 2020 Date Apprved: May 2017 Uncntrlled When Printed Versin 2
Obtaining Cntrlled Drugs In Primary Care- Supply Rutes In Exceptinal Circumstances Backgrund This guidance is intended fr use by registered nursing/medical/pharmacy staff acrss NHS Grampian and describes hw cntrlled drugs (CDs) (Schedule 2/3) may be btained fr patients in Primary Care in exceptinal circumstances. This includes patients in their wn hme, care hmes and sheltered/very sheltered husing. This guidance des nt relate t ward transfer f cntrlled drugs. NHS Grampian Plicy and Prcedure fr the Safe Management f Cntrlled Drugs in Hspitals sectin 13 Transfer f Stck Cntrlled Drugs Between Wards/Departments must be referred t and fllwed in these circumstances. It is in the interest f patient care t ensure that supplies f medicines, including CDs, are available in a timely manner and there is minimal delay when initiating/increasing treatment. This is particularly the case in palliative care. It is als necessary t ensure that rutes f supply cmply with legislatin and there is a clear audit trail. Only when nrmal and emergency supply rutes have been cnsidered and excluded shuld supply rutes in exceptinal circumstances be utilised. The Medicines Act 1968 prhibits the supply f any cntrlled drugs in schedules 2/3 frm hspital wards and departments t ther parties. This is acknwledged in Safer Management f Cntrlled Drugs: A guide t gd practice in secndary care ; CEL 7 (2008) which states that lcal arrangements fr exceptinal supply f cntrlled drugs shuld be discussed with the pharmacy and lcal SOPs shuld be develped. The Central Legal Office have stated that the supply rutes fr use in exceptinal circumstances and the assciated guidance in this dcument are sufficiently rbust t meet the criteria set dwn in the legislatin/guidance, prviding all steps utlined are fllwed including clear dcumentatin f all actins. Medical/nursing staff btaining cntrlled drugs using supply rutes in exceptinal circumstances must clearly dcument, in the patient recrd, the circumstances leading t the decisin t supply in exceptinal circumstances and be able t justify this rute f access. Supply rutes in nrmal circumstances: Under nrmal circumstances rutes f supply fr cntrlled drugs (schedule 2/3) shuld be via the patient s dctr/independent prescriber n a GP10/GP10N prescriptin dispensed via cmmunity pharmacy. Regular review f patients regarding their ptential requirements fr palliative care and prvisin f Just in Case medicatin supplies will aid in apprpriate access t CDs and minimise the need t utilise emergency r exceptinal supply rutes. GP10/GP10(N) prescriptin supplied by patient s wn dctr/independent prescriber, e.g. palliative specialist nurse. Dispensed at cmmunity pharmacy r directed t a palliative care netwrk pharmacy shuld their nrmal pharmacy nt have the required stck. UNCONTROLLED WHEN PRINTED Review Date: May 2020 Identifier: NHSG_CDExceptC/MGPG874-1 - Obtaining Cntrlled Drugs In Primary Care - Supply Rutes In Exceptinal Circumstances Versin 2
and/r Patient has just in case bx with supply f palliative care medicatin Supply Rutes in Emergency Circumstances: Out with nrmal surgery/cmmunity pharmacy hurs it may be necessary t access supply rutes in emergency circumstances t btain cntrlled drugs in liaisn with GMED/NHS 24. GMED/NHS 24 t be cntacted t issue a GP10/GP10N prescriptin. GMED/NHS24 cntact cmmunity pharmacy t access emergency dispensing f cntrlled drugs. r GMED/GP visit t patient t administer/supply cntrlled drug medicatin as necessary Supply Rutes in Exceptinal Circumstances: This prcess is nly fr use by registered nursing staff in discussin with medical r pharmacy staff in exceptinal circumstances, when all ther rutes have been cnsidered and excluded. It is acknwledged that there can be times when the supply rutes in nrmal and emergency circumstances may nt be accessible r able t prvide the required strength, quantities r type f medicatin. In these cases supply rutes in exceptinal circumstances may be cnsidered in rder t prevent delay in initiatin/cntinuatin f treatment. In exceptinal circumstances, when all ther nrmal and emergency rutes f supply have been exhausted the fllwing prcess shuld be fllwed: Aberdeen City: Nursing staff shuld cntact GMED fr advice n patient management and supply rutes fr cntrlled drugs. GMED will discuss the patient, cnfirm that the supply is urgent and that supply under exceptinal circumstances needs t be cnsidered. GMED will determine if they have the drug(s) available frm GMED supplies cnsidering the drug, frm, strength and quantity required. The quantity requested shuld be the minimum required fr immediate treatment with future supplies being btained thrugh nrmal/emergency rutes. GMED must verify that emergency circumstances have been cnsidered and are nt apprpriate. UNCONTROLLED WHEN PRINTED Review Date: May 2020 Identifier: NHSG_CDExceptC/MGPG874-2 - Obtaining Cntrlled Drugs In Primary Care - Supply Rutes In Exceptinal Circumstances Versin 2
If the drug(s) required are nt available frm GMED then: GMED will cntact the Hspital n-call pharmacist via the hspital switchbard. GMED will write a CD rder fr the agreed drug(s), strength and quantity. The n-call pharmacist will attend the pharmacy at ARI t supply and arrange cllectin r deliver t GMED. On receipt f the drug(s) GMED will enter the receipt int GMED Cntrlled Drug Recrd Bk. GMED will arrange a hme visit t the patient, administratin f the drug(s) dcumenting dse(s) given and any drug(s) left with the patient in GMED Cntrlled Drug Recrd Bk. Out With Aberdeen: Nursing staff shuld cntact GMED fr advice n patient management and supply rutes fr cntrlled drugs. GMED will discuss the patient, cnfirm that the supply is urgent and that supply under exceptinal circumstances needs t be cnsidered. GMED must verify that emergency circumstances have been cnsidered and are nt apprpriate. If exceptinal circumstances apply GMED/nursing staff shuld cntact the Nurse in Charge f the nearest Cmmunity Hspital/Dr Grays Hspital t discuss supply f the required item(s). Supply t be cllected by Registered Cmmunity/Marie Curie/Care Hme Nurse GMED t cnfirm that the ward has the apprpriate drug, frm, strength and quantity required. The quantity requested shuld be the minimum required fr immediate treatment with future supplies being btained thrugh nrmal/emergency rutes. If the Nurse in Charge is able t supply the item(s) required the patient s drug prescriptins sheet/syringe driver sheet must be taken/faxed t the ward area. The staff cllecting the drugs must present their NHSG/Marie Curie/Care Hme identificatin badge. The Nurse in Charge must make an entry in the apprpriate page (i.e. crrespnding t the drug, frm and strength) f the ward Cntrlled Drug Recrd Bk stating: Date and time Name and designatin f staff member cllecting the drugs Statement Exceptinal Supply fr patient in cmmunity Name and address f patient fr whm supply is being given Quantity supplied The running balance must be dcumented and checked The entry must be signed by the Nurse in Charge and the staff member cllecting the drugs. UNCONTROLLED WHEN PRINTED Review Date: May 2020 Identifier: NHSG_CDExceptC/MGPG874-3 - Obtaining Cntrlled Drugs In Primary Care - Supply Rutes In Exceptinal Circumstances Versin 2
Details f any nn schedule 2 cntrlled drugs, e.g. midazlam which are supplied shuld be dcumented n the reverse f the patient s drug prescriptin sheet/syringe driver sheet cpy stating: Drug supplied: name, strength, frm and quantity Name and designatin f staff member cllecting the drugs Signed and dated by the Nurse in Charge and the staff member cllecting the drugs. A cpy f the patient s drug prescriptin sheet/syringe driver sheet shuld be taken and stred in the back f the ward Cntrlled Drug Recrd Bk. This must be held fr a minimum f 2 years frm the date f supply. Supply directly t GP/GMED Dctr/Nurse Practitiner In circumstances where drugs are supplied directly t a dctr/nurse practitiner these must be transferred int the dctr s/gmed/np Cntrlled Drug Register/Recrd Bk. The dctr/nurse practitiner is then taking persnal pssessin f the cntrlled drug(s) and must recrd any administratin/supply t patients in their wn/gmed Cntrlled Drug Register/Recrd Bk. Cnfirm the ward has the apprpriate drug, frm, strength and quantity required. The quantity requested shuld be the minimum required fr immediate treatment with future supplies being btained thrugh nrmal/emergency rutes. The dctr/nurse practitiner cllecting the drugs must present their NHSG identificatin badge/prf f identity. The Nurse in Charge must make an entry in the apprpriate page (i.e. crrespnding t the drug, frm and strength) f the ward Cntrlled Drug Recrd Bk stating: Date and time Name and designatin f the dctr/nurse practitiner cllecting the drugs Statement Exceptinal Supply fr GMED/GP/NP Quantity supplied The running balance must be dcumented and checked The entry must be signed by the Nurse in Charge and the dctr/nurse practitiner cllecting the drugs. The dctr/nurse practitiner must make an entry in their persnal/gmed Cntrlled Drug Register/Recrd Bk, in the apprpriate drug/strength/frm sectin stating: Date and time Statement Exceptinal Supply stating the ward area, hspital the drugs have been supplied frm Quantity supplied The running balance must be dcumented and checked UNCONTROLLED WHEN PRINTED Review Date: May 2020 Identifier: NHSG_CDExceptC/MGPG874-4 - Obtaining Cntrlled Drugs In Primary Care - Supply Rutes In Exceptinal Circumstances Versin 2
The entry must be signed by the Nurse in Charge and the dctr/nurse practitiner cllecting the drugs. Care Hme Residents Additinal Cntrlled Drug Recrd Keeping Requirements It is a requirement that care hmes maintain Cntrlled Drug Registers fr all cntrlled drugs received and subsequently administered, frm this supply, t their residents. If cntrlled drugs are btained fr a care hme resident the supply must be entered in the care hme Cntrlled Drug Register n a page fr this resident which specifies the residents name, drug name, strength and frm. If a GP/nurse practitiner administers cntrlled drugs t a resident f a care hme frm their wn/gmed/np stcks then this must be recrded in their persnal/gmed/np Cntrlled Drug Register/Recrd Bk. In these circumstances this administratin des nt need t be recrded in the care hmes Cntrlled Drug Register. This episde f care shuld be dcumented in the patient s medical ntes. Hwever, if GMED dctr/nurse practitiner transfers cntrlled drugs frm their wn/gmed/np stck t the care hme fr subsequent administratin t a resident, these drugs must be written ut f the GP/GMED/NP Cntrlled Drug Register/Recrd Bk and signed by the dctr/nurse practitiner and care hme staff member. These drugs must then be entered in the care hme Cntrlled Drug Register n a page fr this resident which specifies the residents name, drug name, strength and frm. Subsequent administratin f these cntrlled drugs will be recrded in the care hmes Cntrlled Drug Register. Cntrlled drugs btained frm a GP/nurse practitiner by this exceptinal supply rute must be clearly marked with the patients name t indicate t which care hme resident they relate. Skillets (medicines bxes) have been supplied t GMED and any cntrlled drug shuld be placed in a skillet marked with the patients name and the medicine name, frm and strength it cntains. Cntrlled drugs n lnger required Cntrlled drugs btained fr patients via any rute, nce in the pssessin f the patient becme their prperty. If these drugs are n lnger required they shuld be delivered, by the patient r their representative, t a cmmunity pharmacy fr apprpriate dispsal. There is n requirement t replace CDs supplied by exceptinal circumstances rute frm future prescriptin supplies. UNCONTROLLED WHEN PRINTED Review Date: May 2020 Identifier: NHSG_CDExceptC/MGPG874-5 - Obtaining Cntrlled Drugs In Primary Care - Supply Rutes In Exceptinal Circumstances Versin 2
Cnsultatin Grup Update 2017 Gerge Antrbus Eunice Chishlm Jennifer Clarke Linda Harper Sandra Jamiesn Susan Reid Anne Taylr Pharmacy Technician, Mray Head f Nursing, Aberdeenshire Pharmacist, GMED Assciate Nurse Directr Primary Care, Lead Nurse GMED Inspectin Officer, CD team Pharmacy Technician, Aberdeenshire Pharmacist, CD team UNCONTROLLED WHEN PRINTED Review Date: May 2020 Identifier: NHSG_CDExceptC/MGPG874-6 - Obtaining Cntrlled Drugs In Primary Care - Supply Rutes In Exceptinal Circumstances Versin 2