CONTROLLED DRUG GUIDE FOR CARE HOMES Controlled drugs are prescription drugs controlled under the misuse of drugs legislation and subsequent amendments. These are drugs, substances or chemicals whose manufacture, possession, or use is regulated by the government. Controlled drugs have additional safety and legal requirements for supply, receipt, storage, administration and disposal. These additional requirements must be incorporated into the care homes medicines policy. Controlled drugs are divided into five schedules depending on their potential for abuse if misused. The schedule a CD is in determines the requirements for safe custody and recording. Access to controlled drugs Controlled drugs are usually individually prescribed for residents in care homes. All controlled drugs in care homes must be prescribed for individual patients by an appropriately qualified healthcare professional and dispensed by a pharmacy or dispensing practice. Receipt of controlled drugs CDs should be delivered separate to the main delivery of medicines and the package clearly marked that it contains a CD. CDs should be checked on receipt preferably before signing for it. If there is any discrepancy between the product and the label, or what was ordered and the CD received, there should be a documented procedure for handling such an occurrence. The CDs must be checked against any paperwork received or other relevant document, e.g. copy of prescription. The receipt of CDs by the care home should be recorded in a CD register. The entry should be witnessed by a second suitably trained and competent member of staff. Storage of controlled drugs A CD cupboard must be made of steel, have a specified locking mechanism and be permanently fixed to a solid wall with rag or rawl bolts. CD cupboards should only be used for the storage of CDs and no other medication or valuables should be stored in the cupboard. If medication is provided in a monitored dosage system (MDS), the MDS should be stored in the CD cabinet. Access to the CD cupboard should be controlled. The CD cupboard keys should be kept under the control of an authorised, designated person and there should be a clear audit trail of the holders of the key
Administration of controlled drugs If the resident is not able to self-administer the control drug: In Nursing homes a medical practitioner or a registered nurse should administer the CDs. In accordance with the Nursing and Midwifery Council (NMC) standards for medicines management (standard 8) the registered nurse should obtain a secondary signatory from a witness who has been assessed as competent in relation to CDs. In a care home without nursing CDs should be administered by appropriately trained and competent care home staff, and this should be witnessed by another appropriately trained care home staff member. The use of a witness is intended to reduce the possibility of an error occurring. Therefore to be effective the witness must have the same level of training as the person administering the controlled drug. It is good practice that the second signatory witnesses the whole administration process. Documentation of Controlled drugs; Controlled drug register (CDR) A CDR must be a hard bound book with pages clearly numbered and should not be used for any other purpose The CDR should be used to record the receipt, administration, disposal and transfer (eg. when a patient goes into hospital) of CDs and a running balance and audit must be kept All entries in the CDR must be written in indelible ink. Entries must be signed and witnessed by two appropriately trained members of staff. Staff should sign and print their name. Errors must not be crossed out. Errors should be marked as entered in error signed, witnessed and dated. The correct entry should then be made using a new line. Each drug, for each resident should be recorded on a separate page, with the name, form, dose and strength of the drug written clearly at the top of the page When transferring the drug record to a new page in the CDR, the amount remaining should be identified with carried forward from page x written clearly on the new page. It is good practice to write balance transferred to page x on the old page. When CDs are sent for disposal a record must be made in the CDR and in the returns book. Deduction and entries should be made in a timely manner, and running balance should always reflect quantities left in CD cupboard at all any point in time. An audit of the CD register and drugs cupboard should be carried out routinely. This should be done weekly, fortnightly or monthly at the discretion of the care home manager. Audits should be carried out by two authorised members of staff and recorded in RED pen. Any discrepancies must be reported to the manager immediately. It is good practice to carry out a balance check at the end of each shift. It is a legal requirement to keep the CDR for two years from the last entry. It is good practice to retain the CDR for longer as cases can take several years to come to light and go to court.
Medication Administration Record (MAR) charts Administration of the CD should be documented on the medicines administration record (MAR) chart and the CD register The care home staff responsible for administering the CD and an appropriately trained witness should sign the CD register. The staff member administering the CD should also sign the MAR (A witness signature on MAR is optional, but good practice). The records should be completed immediately after the CD has been administered and not before. If the controlled drug has been administered by a visiting healthcare professional i.e. district nurses giving controlled drug injections in residential homes; If the CD is stored by the care home, appropriate records should be made in the CD register if it is then given to a visiting healthcare professional to administer. A second trained member of staff should witness the transfer. The care home staff should ask visiting healthcare professionals to make their record of administration available to the care home. The healthcare professional should also consider seeing the resident in the presence of care home staff responsible for administering medicines to the resident Care home staff should keep a record of medicines administered by visiting health professionals on the resident s MAR. This can be annotated with Administered by district nurse and the Visiting healthcare MAR kept at home and available when requested. If the controlled drug is transferred out of the care home e.g. when the resident is away from the home for a short period of time or is transferred to another care home, a record should be made in the CD register and witnessed by a second trained member of staff. Residents that self-administer their medications Where a resident is wholly responsible for their medicines (i.e. requesting and collecting the CDs personally) no record is required in the CDR. If staff are ordering and collecting on behalf of the resident then a record of the receipt from the pharmacy, the supply to the person and any disposal should be made. Individual doses do not need to be recorded. CDs if stored in residents room should be in a locked, non-portable receptacle in the resident s room. Disposal of Control drugs Type of care home Arrangements Records Care home without nursing (Residential homes) CDs should be returned to the relevant pharmacist at the earliest opportunity for appropriate destruction. Care homes should record the forms and quantities of CDs they are returning, and the pharmacist should sign for
Care home with nursing (Nursing home) The care home will need to make arrangements for the collection of waste medication with a Waste Management Regulations licensed waste disposal company. CDs must be denatured before being handed to the waste disposal company, e.g. in specially designed denaturing kits. A T28 exemption will be needed in order to comply with the legislation that is overseen by the Environment Agency. them on receipt. If pharmacy staff collects the CDs, they should sign for them in the CD register at the time of collection. Relevant details of any such transfer for disposal should be entered into the CD register and signed by a trained and competent member of staff, returning the drug For stock CDs, a registered nurse and an authorised witness for destruction should sign the CD register. For CDs supplied to individual residents, a registered nurse and a suitably trained witness should sign the CD register. A record of the waste transfer note needs to be made by the appropriate nursing care home staff. Discrepancies - supply Always enter the stock received in to the CDR. Segregate the stock received in the CD cabinet until the discrepancy can be resolved. Contact the supplier of the CD to resolve the discrepancy. If stock is deemed unfit for use and is picked up by the supplier obtain a signed receipt and keep a copy. Discrepancies - running balance Check back over the CDR entries to ensure that there has not been a bookkeeping or numerical error. Check the MAR chart and records of medicine disposal. If the discrepancy can be identified the outcome should be recorded and the CD register should be corrected with a retrospective entry referencing how the discrepancy was resolved.
If the discrepancy cannot be explained then the Care Quality Commission (CQC), the Area Team Controlled Drugs Accountable Officer and the police should be informed. CD incident reporting Incidents involving CDs must be reported to the Care Quality Commission (CQC). In addition to CQC there is also a legal requirement for Care Homes to report all CD related incidents in a timely manner to the local NHS England Accountable Officer for Controlled Drugs. If you have queries please get in touch by emailing england.ea-cdao@nhs.net. Please report drug concerns/incidents in Essex, Norfolk, Suffolk, Cambridgeshire and Peterborough at https://www.cdreporting.co.uk REFERENCE; Adapted from Presquipp bulletin 75/ December 2014.
Example of how to fill in the CD register for a patient in a care home. Name of Drug Diamorphine 10mg injection Mini Mouse AMOUNT(S) OBTAINED AMOUNT ADMINISTERED/DISCHARGED Amount Date Received Date Time Patients Name Amount Given Amount Discarded Given By (Signature) Witnessed By (Signature) Balance In Stock 10 ampoules received from Bloggs Pharmacy, Anytown, SS1 2AB 01/02/2017 11:00 Mini Mouse 04/02/2017 14:00 Mini Mouse B. Mouse D.Duck 10 1x10amp None B. Mouse D.Duck 9 10/02/2017 Stock checked and correct B.Mouse Duck 9 14/02/2017 9 ampoules returned to Bloggs Pharmacy, Anytown SS1 2AB B. Mouse B Brown (Driver) NIL