Dispensing of Controlled Drugs: A controlled substance is a drug or chemical which ownership, manufacture, or use is regulated by a respective government of countries such as illegally used drugs or prescription medications. These laws enforcement leads to prevention in the unauthorized use of such substances/drugs such as central analgesics (opioids), anesthetics, steroids, etc. These controlled substances are listed under the following schedules.
Schedules:
- Schedule 1: The drugs under this schedule have a high potential for abuse and have no accepted medical use in treatment (e.g. Marijuana, raw opium).
- Schedule 2: The drugs under this schedule have high potentials for abuse but are accepted for medical use (e.g. Cocaine, morphine).
- Schedule 3-5: The drugs under these schedules have less as compared to the above potentials for abuse, are accepted for medical treatment, and have less physical dependence and psychological dependence (e.g. benzodiazepine and painkiller, phenobarbitone, low strength codeine, steroids, etc.).
Hospital Control Procedures
The following procedure and person/department are responsible for maintenance and record of controlled substances in the hospital.
- Pharmacist in chief: Responsible for the purchase, storage, accountability, and appropriate dispensing of the controlled substances in the hospital.
- Head nurse: Responsible for the record of proper storage.
- Administration head: Responsible for the proper safeguarding and handling of controlled substances.
Role and Responsibility of Administration
During handling of control substances, the following duties should be performed administration department.
The head nurse should use the control drug form while ordering the drug from the pharmacy. The head nurse should enter the information of control substance administration within 24 hours in a daily basis administration form.
Each nursing unit should maintain the monthly dispensing record of controlled substances. This is called as storage record of a nursing unit.
Policies and Procedures for Ordering of Controlled Substances
- Preparation of orders: Order of the control substance should be made by using Ink or indelible pencil, typing, and duly signed by the respective doctor.
- Doctor’s orders for the administration of controlled drugs: Order of controlled substances for Ward stock must write on the physician order sheet or patient chart. If the control substances are not in ward stock, then a complete prescription is written on a blank hospital prescription along with the complete name and signature by the doctor.
- Pro Re Nata orders (PRN Order): This type of order must be discouraged except under special circumstances.
- Telephone orders: Doctor may give telephonic orders of control substances in certain cases while it is necessary to take such order by a nurse on doctor order sheet by mentioning the complete name of the doctor along with initial of nurse and later such order sheet must be signed by doctors within 24 hours.
- Verbal orders: In emergency cases, a doctor may give a verbal order of control substances and the nurse may write such order on the doctor order sheet and later duly sign by a doctor within 24 hours.
- Ordering non-ward stock-controlled drugs from the pharmacy: Ordering of the controlled substances for non-ward stock done by doctor sign and if more substances are again needed then the doctor may sign again.
- Ordering ward stock-controlled substances from the pharmacy: Ordering of controlled substances from the pharmacy must be taken on the ward stock form which is completed by placing a check mark opposite the name, and strength. This order form must be duly signed by the doctor. While before issuing new controlled substances, there is a need to mention the account of previous supply (24 hr record, record losses, and errors).
- The nurse in charge must prepare a special form in duplicate entries to cover the incidence of every dose of control substance given/administered to patient or drug is lost or wasted onward. Such accountability of controlled substances needs to furnish to the pharmacy department while a request for a new supply of drugs. Original is filled in pharmacy and a duplicate copy is kept for the record to nursing office.
Documentation
Pharmacists need to maintain the records of the receipt and return of controlled drugs for disposal. Documentation/recording of the return of controlled drugs for demolition by the pharmacist from the respective ward of the hospital is considered a good practice of record.
Procedure for Dispensing of Controlled Substances for In-Patients
Doctor’s order for the administration
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Ordering of ward stock from a pharmacy
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Narcotics delivery to the ward
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Narcotics and controlled drugs on wards by a nurse
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Charges for narcotics to the patients
Telephone Order
In certain cases, a doctor may give telephonic orders of control substances to the nursing unit. While it is necessary to take such order by a nurse on doctor order sheet by stating it is a telephone order along with mention of the complete name of the doctor with initial of a nurse. Such type of order must be signed by doctors within 24 hours.
Verbal Order
In emergency cases such as when the dose of time does not permit wait then a doctor may give verbal order. While the nurse must write such verbal order on the doctor’s order sheet and later on duly sign by a doctor within 24 hours.
Ordering Non-Ward Substances from Pharmacy
Drugs that are not needed to be stocked in the nursing station may be ordered from the pharmacy unit on the written prescription only by mentioning the total quantity along with duly sign of the doctor. If there need for more drugs then a new signed prescription must be obtained. The prescription must have the following details;
- Date.
- Details of patients.
- Patient’s hospital number.
- Amount of drug ordered.
- Strength.
- Name of the prescriber and their signature
Prescribing of Control Drugs in Out Patient Department (OPD)
Dispensing of controlled drugs for outpatient from pharmacy must be made on the prescription-only by clearly mentioning the strength and the quantity with duly sign of the doctor. The information for such order includes:
- Date.
- Details of patients.
- Patient’s hospital number.
- Amount of drug ordered.
- Strength.
- Name of the prescriber and their signature.
Dispensing of Control Drugs for House use when Pharmacy is closed
When the patients are discharged from the hospital or emergency ward at the time of closing of pharmacy. Occasionally such patients require drugs for use at home and in such cases dispensing of drugs can be done only on a prescription which must be signed by the staff who is a registered medical practitioner and also authorized to prescribe controlled substances for this purpose.
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