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Pre-Reg Competency > Controlled Drugs > Flashcards

Controlled Drugs Flashcards

1
Q

Purchase & Receipt of CD

Fill in the blanks:
1. Purchasing CD requires both (A) order and (B) order to be emailed to (C) when placing an order.
2. Upon receiving stocks, receiving pharmacist has to ensure correct amount stated on (D) is received by (E) every tablet or ampoule.
3. Every tablet or ampoule is checked to ensure that it is (F).
4. The invoice is then stamped & signed to confirm receipt of stocks. The (G) copy of the signed order is to be given to the delivery personnel and a (H) should be retained by receiving pharmacist.

NUH-SOP-PHA-GEN-004 Rev 18

A

A) purchase
B) signed
C) supplier
D) invoice
E) checking
F) intact, not damaged or broken, not discoloured or expired
G) original
H) duplicate

NUH-SOP-PHA-GEN-004 Rev 18

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2
Q

Maintenance of CD

Fill in the blanks:
1. (A) invoice is to be submitted to Finance for payment processing. (B) copy of invoice is filed in CD Room for (C).
2. Enter the receipt of stocks in (D) in Parts I and II. Part II entry is in (E) ink only.
3. CD can be issued via prescription or (F).
4. All records pertaining to CD have to be kept for (G) as required by (H).

C) For how long?

NUH-SOP-PHA-GEN-004 Rev 18

A

A) Original
B) Duplicate
C) 3 years
D) CD register book
E) RED
F) CD requisition form
G) 3 years as of last entry
H) Misuse of Drugs Regulations r17

NUH-SOP-PHA-GEN-004 Rev 18

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3
Q

Destruction/Disposal of CD

True or False:
Any damaged/broken or wasted controlled drug should be documented in the completely filled wastage report form, and can be disposed immediately in appropriate waste containers without needing to return to Pharmacy Store.

NUH-SOP-PHA-GEN-004 Rev 18

A

False.

Any damaged/broken or wasted controlled drugs has to be returned Pharmacy Store together with the completely filled wastage report form, including those returned by patients.
- An additional “Recording Form for Returned CD” is required for CDs returned by patients
- Wastage is consolidated periodically before request is sent to inspectorate

NUH-SOP-PHA-GEN-004 Rev 18

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4
Q

Destruction/Disposal of CD

How should CD wastages be properly disposed of?

NUH-SOP-PHA-GEN-004 Rev 18

A
  • Wastage is consolidated periodically to bring from respective location to Store before request is sent to inspectorate.
  • An appointment is then fixed with inspector to authorise & witness destruction of CD.
  • CD administration book has to be retrieved from wards, Omnicell and department for inspector to endorse on book with regards to CD wastage.
  • After actual destriction of CDs, wastage will then be thrown into a biohazard container.

NUH-SOP-PHA-GEN-004 Rev 18

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5
Q

Procedures for sending CD for analysis

Fill in the blanks:
1. CD sample must be send personally by a (A) to the (B).
2. (C) is to be recorded in (D), indicating that drug is sent for analysis.
3. The receipt from (B) stating (C) is to be (E). A copy of analysis results is filed for reference

NUH-SOP-PHA-GEN-004 Rev 18

A

A) pharmacist
B) Department of Scientific Services, Health Sciences Authority
C) quantity issued for analysis
D) CD register book
E) kept as proof of delivery

NUH-SOP-PHA-GEN-004 Rev 18

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6
Q

Loss of CD

True or False:
Any loss of CD unaccounted for should be reported to police directly and need not be reported to HSA.

NUH-SOP-PHA-GEN-004 Rev 18

A

False.
* Any loss of CD unaccounted for should be first reported to CD Store Pharmacist, who will then notify HSA.
* A police report will only be made if advised by HSA.
* Once internal investigation has concluded, HSA Wastage form & incident report must be submitted to CD Store Pharmacist for forwarding to HSA for investigation.

NUH-SOP-PHA-GEN-004 Rev 18

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7
Q

Legality of CD Rx

According to Misuse of Drugs Regulations, under what conditions can CD be dispensed when provided with a prescription?

Misuse of Drugs Regulations

A
  1. Written in ink or otherwise indelible and be signed by prescriber issuing it with its usual signature and dated by him
  2. Written by prescriber’s own handwritting
  3. If issued by dentist, the words “For dental treatment only” should be written
  4. If issued by veterinary, the words “For animal treatment only” should be written
  5. Name & address of patient whose treatment it is issued or pet’s owner whom CD prescribed is to be delivered to
  6. Name & address of practice of prescriber
  7. Specify dose to be taken with both strength & total quantity / duration written out in both words and figures to be supplied
  8. Prescriber’s name verified against the government gazette for registered doctors in Singapore or through MOH website
  9. In the case of CD Rx whose total quantity intended to be dispensed by instalments, Rx should contain directions specifying amount of instalments of the total amount which may be dispensed & intervals to be observed when dispensing.

Misuse of Drugs Regulations

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8
Q

Dispensing of CD

In the event of receiving a CD prescription issued by non-NUH doctors at the pharmacy, what should you do to establish the authenticity of the Rx?

NUH-SOP-PHA-GEN-004 Rev 18

A
  1. Prescriber’s name verified against the government gazette for registered doctors in Singapore or through MOH website
  2. Prescriber’s signature verified against NUH “Doctor’s Authorised Signature for Prescriptions” file
  3. If the signature don’t match or doesn’t have specimen signature, call prescriber to verbally verify authenticity.
  4. Obtain his/her specimen signature on th “Authorised Signature for Prescription” Form & forward to pharmacy manager.
  5. A copy of the signature will be subsequently uploaded into NUH “Doctor’s Authorised Signature for Prescriptions” file.

NUH-SOP-PHA-GEN-004 Rev 18

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9
Q

Legality of CD Rx

What should you check to determine the legality of a hardcopy CD prescription?

NUH-SOP-PHA-GEN-004 Rev 18

A
  • Written by prescriber in his/her own handwriting
  • Written in ink or otherwise so as to be indelible
  • Contain the following information:
    1. Name of patient
    2. Address of patient
    3. Controlled drug name, formulation and strength
    4. Exact amount of CD to be dispensed with strength & total quantity / duration dispensed in both words & figures
    5. Date of issue
    6. Prescriber’s name & address of practice (may be printed)
    7. Prescriber’s signature

NUH-SOP-PHA-GEN-004 Rev 18

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10
Q

Legality of CD Rx

What should you check to determine the legality of a electronic CD prescription?

NUH-SOP-PHA-GEN-004 Rev 18

A

1) MUST contain the following:
- Controlled drug name, formulation and strength
- Dosage, frequency
- Duration of supply
- Quantity to be supplied
2) Validity of CD e-Rx = 30 days from date of prescribing
3) Amendment of CD e-RX is NOT allowed; advise to cancel current order & make a new entry with correct order.

NUH-SOP-PHA-GEN-004 Rev 18

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11
Q

Legality of CD Rx

True or False:
Failed translation of electronic CD order from electronic Rx to iPharm which resulted in manual amendments in iPharm is prohibited. Dr must make a new entry with the correct order to be considered as a legal e-Rx.

NUH-SOP-PHA-GEN-004 Rev 18

A

False.
Failed translation of electronic CD order from electronic Rx to iPharm which resulted in manual amendments in iPharm is permitted as long as:

  • CD name, strength, formulation, dosage, frequency, duration and quantity to be supplied are present
  • Prescriber’s intention is clear and not ambiguous. If ambiguous, Dr is to reorder.
  • CD e-Rx must always remain in ORG status.
  • ALL manual translations in iPharm for CDs should be double-checked by a pharmacist before dispensing.

NUH-SOP-PHA-GEN-004 Rev 18

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12
Q

Dispensing of CD

True or False:
If other medications are ordered on the same electronic order with CD, partial collection of non-CD drugs is permitted.

NUH-SOP-PHA-GEN-004 Rev 18

A

True.

NUH-SOP-PHA-GEN-004 Rev 18

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13
Q

Dispensing of CD

True or False:
When dispensing CDs, there is no need to check if the system computed quantity on iPharm matches against the total quantity that is prescribed.

NUH-SOP-PHA-GEN-004 Rev 18

A

False.
When dispensing CDs, ALL pharmacists should check if the system computed quantity on iPharm matches against the total quantity that is prescribed.
- If they do not match, pharmacists will need to modify the “to-be-dispense” quantity to be that of “prescribed” and not utilise the quantity that is computed by system.

NUH-SOP-PHA-GEN-004 Rev 18

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14
Q

Dispensing of CD

True or False:
For both paper & electronic Rx of CD, CD partial collection and repeat orders are allowed in NUH.

NUH-SOP-PHA-GEN-004 Rev 18

A

False.
For both paper & electronic Rx of CD, CD partial collection and repeat orders are prohibited in NUH.

NUH-SOP-PHA-GEN-004 Rev 18

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15
Q

Legality of CD Rx

How long is the validity of a Rx containing CD(s), other the a drug specified in the First Schedule of the Misuse of Drugs Regulations?

NUH-SOP-PHA-GEN-004 Rev 18

A
  • From the date specified in Rx till
  • 30 days after date of Rx

NUH-SOP-PHA-GEN-004 Rev 18

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16
Q

Legality of CD Rx

Can a patient collect a CD prescribed to him/her before the date specified in the Rx?

NUH-SOP-PHA-GEN-004 Rev 18

A

No

NUH-SOP-PHA-GEN-004 Rev 18

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17
Q

Verification of Doctor’s Signature of CD Rx

What should you do if you suspect the prescriber’s signature on a paper Rx containing CD(s) has been forged?

NUH-SOP-PHA-GEN-004 Rev 18

A
  1. Retain forged CD Rx
  2. Immediately contact pharmacy manager, police & investigate further

NUH-SOP-PHA-GEN-004 Rev 18

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18
Q

Packing of CD

What are the operational procedures you should do when packing a CD Rx? Fill in the blanks:
1. Check (A) of Rx under Misuse of Drugs Regulations r11 & (B) is correctly typed.
2. Check the (C) of CD for the Rx & ensure it tallies with (D) in CD register book. Discrepancies must be investigated & appropriate actions taken immediately.
3. (E) & (F) the quantity of CD required for Rx.
4. Discard empty containers. (G) all empty containers of CD before discarding.
5. (H) details of Rx in (I) of CD register book under the correct item using (J) ink. Details required are (K), (L), (M), (N), (O) & (P).
6. Pharmacist to enter his name & (Q) against the entry in the CD register.
7. Check the (C) of CD left in the cupboard & countercheck against (D) in CD register book. Discrepancies must be investigated & appropriate actions taken immediately.
8. (R) the CD cupboard.
9. Indicate (L) & (S) of the receiving party (e.g. ambulance staff, staff nurse, patient’s family/guardian) in the discharge prescription (under iPharm counselling).

NUH-SOP-PHA-GEN-004 Rev 18

A

(A) legality
(B) label
(C) physical stock
(D) balance
(E) Count
(F) pack
(G) Visually inspect
(H) Record
(I) Part II
(J) Blue / black
(K) Date of prescription
(L) Patient’s name
(M) Patient’s address
(N) Prescription number
(O) Quantity of CD dispensed
(P) Balance of CD
(Q) sign
(R) Lock
(S) last 3 digits & alphabet of NRIC / passport number

NUH-SOP-PHA-GEN-004 Rev 18

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19
Q

Packing of CD

What are the required fields to populate in Part II of CD register book when packing CDs?

NUH-SOP-PHA-GEN-004 Rev 18

A
  • Date of prescription
  • Patient’s name
  • Patient’s address
  • Prescription number
  • Quantity of CD dispensed
  • Balance of CD

NUH-SOP-PHA-GEN-004 Rev 18

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20
Q

Checking of CD Rx

What is the usual operational workflow when processing Rx with CD?

Operational procedures

NUH-SOP-PHA-GEN-004 Rev 18

A
  1. Check Rx for compliance with Misuse of Drugs Act & Misuse of Drugs Regulation.
  2. Ensure that prescriber’s practice address specified on Rx is a valid address in SIngapore.
  3. Ensure date of dispensing of CD is no later than 30 days after date of Rx.
  4. Ensure date of supply of CD is no earlier than date specified on CD Rx.
  5. For e-Rx of CD, double-check PMR (patient medication record) to ensure medication was not dispensed at other sections.
  6. Check item packed matches prescription & label.
  7. Open all containers of CD & count tablets packed. Ensure quantity & item matches that of Rx.
  8. Check label against Rx & ensure name of drug, strength, directions of use, patient’s name, prescription number & quantity of item are correct.
  9. For paper Rx, ensure prescriber’s signature has been verified.
  10. For e-Rx, print dispensing summary label & paste on a blank piece of paper. This is to be retained at the pharmacy for 3 years.

NUH-SOP-PHA-GEN-004 Rev 18

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21
Q

Cancellation of CD Rx

Fill in the blanks:
1. Cancel Rx in computer system.
2. (A) label on the container.
3. (B) CD to CD cupboard.
4. (C) by the entry in CD register book that the prescription is cancelled.
5. (D) the return of stocks under Part(s) (E) of CD register book. Use (F) ink pen ONLY only for this entry in Part (G) of the CD register book.
6. (H) the cancelled Rx in the CD cupboard. DO NOT (I) prescription.
7. Count the (J) of returned CD for the Rx in the CD cupboard.
8. Countercheck (K) of physical stock with that in CD register book.
9. (L) to countercheck (J) & (K) in the CD register book. Then, (L) to countersign against entry of returned CD in Part (G) of CD register book. This is done (M) if not immediately.

NUH-SOP-PHA-GEN-004 Rev 18

A

(A) Remove
(B) Return
(C) Make a remark
(D) Record
(E) I & II
(F) RED
(G) II
(H) Keep
(I) destroy
(J) physical stock
(K) balance
(L) Second pharmacist
(M) within the day of return

NUH-SOP-PHA-GEN-004 Rev 18

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22
Q

Methadone Workflow

Name two indications you should identify on receiving of new order for methadone prior to dispensing it.

NUH-SOP-PHA-GEN-004 Rev 18

A

1) Detox addiction program
2) Oncology use (for pain management)

NUH-SOP-PHA-GEN-004 Rev 18

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23
Q

Methadone Workflow - Detox Addiction Program

Fill in the blanks:
1. Check methadone order in EPIC followed by retrieving patient history via iPharm to identify (A).
2. If patient was previously from (B), check for (C), (D).
3. Confirm with (A) on methadone (E) throughout (F) & (G).
4. (H) methadone order in the (I).
5. Perform (J) and confirm (K) with patient.
6. (L) methadone quantity required should patient require continuation of methadone throughout admission & for discharge.
7. If patient has sufficient methadone stock, (M).
8. Communicate (M) with nurse manager & staff nurse concerned & (N) in EPIC.
9. Patient’s balance methadone stock must be (O), stored in Ward CD cabinet and dispensed as per SOP.
10. (P) methadone balance stock from Ward CD cabinet upon discharge & supply the balance as per prescription.
11. If patient do not have balance stock, pharmacist to liaise with (Q) pharmacist, consultant & NUH consultant on agreement of methadone (R) upon patient admission and discharge.
12. Ensure all communication is (S) in EPIC.
13. Inform (A) of estimated lead time of (T) for methadone stock supply.
14. Liaise with (U) on the methadone quantity required.
15. During office hours, (U) will prepare authorisation letter and arrange for loan from IMH or other hospital according to urgency of stock.
16. Transportation fee will be charged to (V) upon getting the stock.
17. Once stock arrived, stock to be issued to patient as CD.
18. Alternatively, arrangement for collection of methadone can be made by patient caregivers or relatives with Rx issued to IMH.
19. If NUH pharmacy has ex-stock, arrange with (W).

NUH-SOP-PHA-GEN-004 Rev 18

A

(A) prescriber
(B) Institute of Mental Health (IMH)
(C) stock balance
(D) last date, dose and quantity of methadone dispensed
(E) dose, frequency and duration required
(F) admission
(G) upon discharge
(H) Document
(I) patient medical record
(J) medication reconciliation
(K) physical balance stock
(L) Estimate
(M) use patient’s own medicine
(O) treated as CD
(P) Withdraw
(Q) National Addiction Management Service (NAMS)
(R) dose, quantity & estimated duration required
(S) documented
(T) 8 weeks
(U) Purchasing pharmacist
(V) patient
(W) CD Store pharmacist

NUH-SOP-PHA-GEN-004 Rev 18

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24
Q

Methadone Workflow - Oncology Use (for Pain Management)

Fill in the blanks:
1. Inform (A) of estimated lead time of (B) for methadone stock supply.
2. Inform (C) on the quantity needed.
3. (C) to process relevant documents and arrange for methadone stock.
4. (C) to inform (D) once stock arrived.
5. Arrange with (E) to requisite methadone as Ward CD for patient’s use.

NUH-SOP-PHA-GEN-004 Rev 18

A

(A) prescriber
(B) 8 weeks
(C) Purchasing pharmacist
(D) Ward pharmacist
(E) Ward nurse manager

NUH-SOP-PHA-GEN-004 Rev 18

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25
Q

Routine Stock Count of CD

How frequent should we do a stock count of CDs kept in storage?

NUH-SOP-PHA-GEN-004 Rev 18

A

Once a month

NUH-SOP-PHA-GEN-004 Rev 18

26
Q

Routine Stock Count of CD

After a routine stock count of CD, what are the follow-up actions you should do thereafter?

NUH-SOP-PHA-GEN-004 Rev 18

A

1) Enter in Part II of CD register book in RED ink, under the correct item, the following: “Pharmacy balance checked and found correct.
2) Pharmacist conducting the count to sign & date the entry.
3) Follow up promptly on any detected discrepancy or wastage.

NUH-SOP-PHA-GEN-004 Rev 18

27
Q

Definitions of CD Wastage

What type of CD wastage is this?

Wastage of the full amount of drug prepared by registered nurse / doctor (none of the CD was administered to patient), excluding spillage or breakage.

NUH-HAP-PHA-029 Rev 03

A

Complete wastage

NUH-HAP-PHA-029 Rev 03

28
Q

Definitions of CD Wastage

What type of CD wastage is this?

Wastage of the partial amount of drug prepared by registered nurse / doctor (partial amount of the CD was administered to patient), excluding spillage or breakage.

NUH-HAP-PHA-029 Rev 03

A

Partial wastage

NUH-HAP-PHA-029 Rev 03

29
Q

Definitions of CD Wastage

What type of CD wastage is this?

Amount of CD discarded during preparation in accordance to a CD prescription/order.

NUH-HAP-PHA-029 Rev 03

A

Preparation wastage

NUH-HAP-PHA-029 Rev 03

30
Q

Definitions of CD Wastage

What type of CD wastage is this?

Wastage resulting from spillage or breakage of any form of CD. Supersedes other definitions of wastage.

NUH-HAP-PHA-029 Rev 03

A

Spillage / breakage

NUH-HAP-PHA-029 Rev 03

31
Q

Definitions of CD Wastage

What type of CD amount is this?

Quantity of prepared amount that was administered to patient.

NUH-HAP-PHA-029 Rev 03

A

Administered amount

NUH-HAP-PHA-029 Rev 03

32
Q

Definitions of CD Wastage

What type of CD amount is this?

Quantity of prepared amount that was not administered to patient.

NUH-HAP-PHA-029 Rev 03

A

Residual amount

NUH-HAP-PHA-029 Rev 03

33
Q

Definitions of CD Wastage

What type of CD amount is this?

Quantity that was submitted to Pharmacy for HSA-witnessed disposal.

NUH-HAP-PHA-029 Rev 03

A

Wastage submission amount

NUH-HAP-PHA-029 Rev 03

34
Q

Authorised CD Personnel

Who are the authorised personnel that are allowed to handle, witness and sign for CD-related activities?

NUH-HAP-PHA-029 Rev 03

A
  • Doctors registered with Singapore Medical Council (SMC)
  • Pharmacists registered with Singapore Pharmacy Council (SPC)
  • Registered Nurses (RN) with Singapore Nursing Board (SNB)

NUH-HAP-PHA-029 Rev 03

35
Q

Authorised CD Personnel

True or False:
Enrolled nurses are allowed to handle, witness and sign for CD-related activities.

NUH-HAP-PHA-029 Rev 03

A

False!
* ONLY Registered Nurses (RN) with Singapore Nursing Board (SNB) are allowed to handle, witness and sign for CD-related activities.

NUH-HAP-PHA-029 Rev 03

36
Q

Authorised CD Personnel

True or False:
The retrieval, preparation handling, administration and disposal of CD must be performed in the presence of a witness. The witness can either be a doctor, pharmacist, a registered nurse or an enrolled nurse.

NUH-HAP-PHA-029 Rev 03

A

False!
* Enrolled nurses are NOT allowed to handle, witness and sign for CD-related activities.

NUH-HAP-PHA-029 Rev 03

37
Q

CD Register Documentation

How long should all hardcopy registers (e.g. pharmacy CD registers, ward CD registers, non-ADC location registers) be preserved before disposal?

NUH-HAP-PHA-029 Rev 03

A

3 years from date of last entry

NUH-HAP-PHA-029 Rev 03

38
Q

CD Register Documentation

True or False:
CD registers can be disposed immediately after 3 years from last entry.

NUH-HAP-PHA-029 Rev 03

A

False!
* CD registers shall not be disposed until all the CD wastage entries have been stamped and endorsed by HSA.

NUH-HAP-PHA-029 Rev 03

39
Q

CD Register Documentation

True or False:
Name stamps are not allowed if they are not accompanied by signatures.

NUH-HAP-PHA-029 Rev 03

A

True

NUH-HAP-PHA-029 Rev 03

40
Q

CD Register Documentation

True or False:
Cancellation, obliteration or alteration of any entries are permissible.

NUH-HAP-PHA-029 Rev 03

A

False!

Follow the standard recording format regardless of reasons for wrong entries.
* Indicate at respective wrong entry with RED asterisks on left of “Date” and on left/right of “Stock balance”.
* Under the “Remarks” column or last column of entry, write *wrong entry, date of correction in RED ink
* DO NOT explain reasons for wrong entries!

NUH-HAP-PHA-029 Rev 03

41
Q

CD Register Documentation

How should you record CD wastage on hardcopy CD registers in pharmacy locations?

NUH-HAP-PHA-029 Rev 03

A

Follow the standard recording format regardless of reasons for wastage.
* E.g. ---Wastage---
Date and signature
* Do not include * as it will confuse people as wrong entries!

NUH-HAP-PHA-029 Rev 03

42
Q

CD Register Documentation

For automated dispensing cabinets (ADC), if there is a need to use patient’s own CD or CD that are not available in ADC, what documents should be used to record all CD transactions?

NUH-HAP-PHA-029 Rev 03

A

Hardcopy CD registers

NUH-HAP-PHA-029 Rev 03

43
Q

CD Register Documentation

How should you transfer the recording from a completely filled hardcopy CD register to a new hardcopy CD register?

NUH-HAP-PHA-029 Rev 03

A

Transfer of the recording to a new register shall be performed in the presence of two authorised personnel.
* Write Balance brought forward from previous CD Register dated _ to _
and the transferred quantity in the “Balance” column in RED ink.
* Both authorised personnel will need to sign on “Dispensed by” and “Checked by” column.

NUH-HAP-PHA-029 Rev 03

44
Q

CD Requisition Voucher

Fill in the blanks:

  1. The (A) making the CD request shall complete the (B) section in the CD requisition voucher, specifying the (C), (D), (E) & (F).
  2. The (G) supplying the CD shall complete the (H) section in the CD requisition voucher. The (C), (D), (E) & (F) are to be clearly stated.
  3. Each requistion voucher shall be signed by (A) & (G), with the (I), (J), (K) & (L) clearly stated.
  4. Name stamps are allowed in place of information mentioned above as long as these are accompanied by a (M).
  5. The (N) copy of the requisition voucher will be filed in the (O) CD location as evidence of transaction.
  6. RN shall witness the replenishment of supply by pharmacist. The quantity restocked must be (P) against the requisition voucher & documented in (Q).
  7. Supplier will retain the (R) copy of the requisition voucher, while requestor will retain the (S) copy.
  8. The CD requisition voucher shall be kept in a (T) after the completion of CD re-stock.

NUH-HAP-PHA-029 Rev 03

A

(A) requestor - pharmacist / RN
(B) “Requisition from Ward”
(C) drug name
(D) dosage form
(E) strength
(F) quantity supplied
(G) supplier - pharmacist / RN
(H) “Supply”
(I) full name (of requestor / supplier)
(J) employee number / professional registration number
(K) CD storage location
(L) date of requisition
(M) signature
(N) original
(O) supplying
(P) verified
(Q) ADC or CD register
(R) white
(S) pink
(T) locked cupboard

NUH-HAP-PHA-029 Rev 03

45
Q

After Office Hours / Urgent CD Requistion

True or False:

Transfer of CDs between non-ADC storage locations in the absence of pharmacist cannot be performed after office hours or under urgent circumstances.

NUH-HAP-PHA-029 Rev 03

A

False.

Transfer of CDs between non-ADC storage locations in the absence of pharmacist should only be performed after office hours or under urgent circumstances. However, this is permitted only for non-ADC locations.

NUH-HAP-PHA-029 Rev 03

46
Q

After Office Hours / Urgent CD Requistion

True or False:

For after office hour requisition of CDs not stocked in any ADCs, requsition can be made to obtain from non-ADC locations in the absence of pharmacists.

NUH-HAP-PHA-029 Rev 03

A

True, but with a caveat.

  1. Availability of CD in other ADCs must be checked first by accessing ADC global list function. If this is available, obtain the CD from other ADCs first.
  2. If this CD is not available in other ADC, initiate requisition from non-ADC location as per SOP, but to inform on-call pharmacist before requisition.
  3. Obtain physical CD register from on-call pharmacist & complete CD requisition form as per SOP.

NUH-HAP-PHA-029 Rev 03

47
Q

CD Requisition at Clinics / Centres

Fill in the blanks:

  1. For clinics that do not store CD regularly, requisitions from clinics to Pharmacy must only be made (A) by (B) only.
  2. RN obtains (C) & (D) and proceeds to assigned pharmacy to collect CD.
  3. Supplying pharmacist records supply & must record any (E) in CD register.
  4. Any unused CD or CD wastage intended for HSA-witnessed disposal must be returned to Pharmacy (F).

NUH-HAP-PHA-029 Rev 03

A

(A) on the day of administration
(B) registered nurse (RN)
(C) CD register
(D) requisition voucher
(E) administration or wastage
(F) within the same day

NUH-HAP-PHA-029 Rev 03

48
Q

CD Requisition under Life-threatening Emergencies

Fill in the blanks:

  1. For life-threatening emergencies, (A) may request for supply of CD (B) issuing a valid CD order.
  2. (C) supplying the CD will assess the (D) of request.
  3. If (C) disagrees with (D), he/she will request (A) to issue a CD order.
  4. If (A) refuses, the (C) will supply the CD first, then (E) to nursing officer(s) in charge of CD storage location.
  5. (F) of the CD order must performed (G) after the emergency.
  6. If the justifications for emergency CD supply is determined to be (H) by nursing officer(s), the (I) & (J) must be notified to be part of the investigation.

NUH-HAP-PHA-029 Rev 03

A

(A) doctor
(B) before / prior to
(C) registered nurse (RN)
(D) urgency
(E) escalate
(F) Documentation
(G) immediately
(H) invalid
(I) head of department of requesting doctor
(J) pharmacist(s)

NUH-HAP-PHA-029 Rev 03

49
Q

After Office Hours / Urgent CD Requistion

True or False:

  1. CD withdrawn from storage location need not be administered immediately to patient.
  2. CD can be left unattended under Code Blue.
  3. Supply of CD must be based on a doctor’s prescription / order.

NUH-HAP-PHA-029 Rev 03

A
  1. False. ALL CD withdrawn from the storage location shall be administered immediately to the patient. Exceptions are for CDs prepared in accordance to ordered medical procedures.
  2. False! Under no circumstances should CD be left unattended.
  3. True.

NUH-HAP-PHA-029 Rev 03

50
Q

Loss of CD / Managing CD Discrepancy

If loss of CD is ascertained in the ward, what are the subsequent steps we should follow up on?

NUH-HAP-PHA-029 Rev 03

A
  1. Nursing Reporting Officer shall notify relevant pharmacist (e.g. ward or on-call) STAT.
  2. Ward / on-call pharmacist will report to CD Store Pharmacist, who will subsequently report loss to HSA & then advise the need to file a police report.
  3. Report to Police (if required).
  4. Once all necessary investigations have concluded, submit completed HSA wastage form & incident report to CD Store Pharmacist.
  5. CD Pharmacist will forward incident report & HSA wastage form to HSA for incident reporting.
  6. Nursing Reporting Officer to raise an eHOR (electronic Hospital Occurrence Report).

NUH-HAP-PHA-029 Rev 03

51
Q

Loss of CD / Managing CD Discrepancy

For any CD discrepancy that is resolved after preliminary investigation in a ward, what are the subsequent steps RN should follow up on?

NUH-HAP-PHA-029 Rev 03

A

Appropriate reason shall be documented in ADC or through a written incident memo to be filled in the ward.

NUH-HAP-PHA-029 Rev 03

52
Q

Handling CD Wastage

Fill in the blanks:
1. For all forms of CD spillage / breakage, (A) must be made by staffs involved to (B) and within reasonable limits. (C) should not be compromised. This includes (D) and any (E).
2. Method of collecting debris may include (F), (G) & (H) which can safely contain the debris.
3. All debris collected must be submitted with the necessary document (e.g. (I)) to the (J) for HSA inspector-witness destruction.
4. In situations where complete collection/retrieval of debris cannot be performed despite best efforts, attempt must be (K).
5. For ADC locations, document the wastage in the ADC by keying in the counted quantity of (L) CD ((M)), then clicking on the “(N)” button and enter the appropriate remarks.

NUH-HAP-PHA-029 Rev 03

A

(A) attempts
(B) collect/retrieve as much debris as possible
(C) Safety
(D) glass ampoules/vials
(E) liquid CD
(F) syringing of liquid CD
(G) soaking liquid CD with adsorbent material (e.g. gauze or paper towel)
(H) storing in a sealable plastic container/bag
(I) HSA wastage form & incident report
(J) pharmacist
(K) documented
(L) intact
(M) excluding the broken CD
(N) Discrepancy

NUH-HAP-PHA-029 Rev 03

53
Q

Handling CD Wastage

Fill in the blanks:
1. All CD spillages / breakages & wastages to be submitted to HSA-witnessed disposal shall be reported to the pharmacist within (A) hours
2. All relevant details must be provided to (B) leading to the wastage
3. CD liquid wastages in syringes for submission to Pharmacy are required to be labelled using (C) with (D), (E), (F), (G) & (H) stated. Label has to (I) by staff involved.

(C) Including the colour

NUH-HAP-PHA-029 Rev 03

A

(A) 24
(B) allow clear understanding of the circumstances
(C) the blue CD drug label
(D) patient identity (name, NRIC) (if applicable)
(E) drug name, strength, formulation
(F) dilutions (if any)
(G) final volume
(H) date & time of wastage
(I) signed

NUH-HAP-PHA-029 Rev 03

54
Q

Handling CD Wastage

Which types of CD wastage will require submission for HSA-witnessed disposal?

Clue:
1. Wastage type: complete, partial, preparation
2. Route of administration: oral, parenteral, transdermal patches

NUH-HAP-PHA-029 Rev 03

A

Requires submission (in zip-lock bag, syringes & infusion affixed with blue CD label):
* All oral CD wastages (complete, partial & preparation)
* Complete parenteral wastages
* Complete transdermal patch wastages

Not required for submission:
* Partial parenteral wastages
* Preparation parenteral wastages
* Partial transdermal patch wastages

NUH-HAP-PHA-029 Rev 03

55
Q

Handling CD Wastage

Which types of CD wastage will not require submission for HSA-witnessed disposal?

Clue:
1. Wastage type: complete, partial, preparation
2. Route of administration: oral, parenteral, transdermal patches

NUH-HAP-PHA-029 Rev 03

A

Requires submission (in zip-lock bag, syringes & infusion affixed with blue CD label):
* All oral CD wastages (complete, partial & preparation)
* Complete parenteral wastages
* Complete transdermal patch wastages

Not required for submission:
* Partial parenteral wastages
* Preparation parenteral wastages
* Partial transdermal patch wastages

NUH-HAP-PHA-029 Rev 03

56
Q

Handling CD Wastage

  • What details are required when filling up the HSA Wastage form?
  • Under what conditions will the HSA Wastage form be required?

NUH-HAP-PHA-029 Rev 03

A

Mandatory for all CD wastages requiring submission to pharmacy for CD destruction witnessed by HSA inspectors.

Form to be signed by staff involved, witness, and reporting officer; endorsed by pharmacist & submitted with physical wastage to CD store. Details of incidents must clearly document:
* Name, NRIC of patient (if applicable)
* Dose ordered, dilutions (if applicable)
* Preparation wastage (amount discarded during preparation in accordance to CD order/Rx, if applicable)
* Administered amount (quantity of prepared amount administered to patient, if applicable)
* Residual amount (quantity of prepared amount not administered to patient, if applicable)
* Wastage submission amount (quantity submitted to Pharmacy for HSA-witnessed disposal, if applicable)
* Any attempts to retrieve wasted CD for submission for spillage/breakage incidents

NUH-HAP-PHA-029 Rev 03

57
Q

Handling CD Wastage

  • Under what conditions will an incident report be required for CD wastage?
  • Any additional details required?

NUH-HAP-PHA-029 Rev 03

A

Necessary only for wastage incidents involving:
* Loss of CD
* Accidental disposal
* Non-compliance to SOP
* Discrepancies between physical wastage which was submitted & quantity that should be submitted rightfully
* Any other situtations deemed necessary by CD pharmacist(s)

All details needed for reporting & investigation of incident will need to be clearly stated.
* Separate reports by each staff involved & endorsed respectively by their reporting officers, before submission to pharmacists
* Reporting officer to provide corrective actions needed to prevent future incidents

NUH-HAP-PHA-029 Rev 03

58
Q

Handling CD Wastage

Fill in the blanks:
1. For all partial parenteral wastage, (A) out any remaining liquid in (B) and empty the (A) fully into the (C).
2. Volume of partial parenteral liquid CD wastage must be (D) by an authorised personnel before disposal.
3. For patient-controlled analgesia (PCA) partial wastage, document both (E) & (F) in respective CD registers/ADC.
4. For CD in PCA deltec cassette, if the cassette has been topped-up before discontinuation, handle as per (G) if remaining volume exceeds the (H).
5. For partial transdermal patch wastage, in the presence of an authorised witness, (I) & discard directly into (C). Document the wastage in ADC or CD register as per SOP.

NUH-HAP-PHA-029 Rev 03

A

(A) syringe
(B) container (ampoule, vial, deltec cassette)
(C) yellow biohazard sharp box containing Virex II
(D) verified
(E) last recorded volume in PCA pump
(F) syringed out volume
(G) complete wastage
(H) topped-up volume
(I) fold patch into half by sticking adhesive surface together

NUH-HAP-PHA-029 Rev 03

59
Q

Handling CD Wastage

True or False:

Disposal of parenteral preparation CD wastage into the Virex II sharps bin is permitted in the absence of HSA inspector, without the need of a second authorised personnel to serve as witness.

NUH-HAP-PHA-029 Rev 03

A

False!

Disposal of parenteral preparation CD wastage into the Virex II sharps bin is permitted in the absence of HSA inspector, but require the witness of at least 2 authorised personnel (inclusive of staff disposing CD).
* Staff involved (including witness) must ascertain the correct amount is withdrawn BEFORE disposing preparation wastage in Virex II sharps bin.
* Preparation wastage appropriately discarded are not required to be submitted to Pharamcy for HSA-witnessed disposal.

NUH-HAP-PHA-029 Rev 03

60
Q

Handling CD Wastage

Under what condition will you need to return esketamine nasal spray back to store as a CD wastage?

NUH-HAP-PHA-029 Rev 03

A

Failure to administer full dose of esketamine

NUH-HAP-PHA-029 Rev 03

61
Q

Legal CD Compounding Limits

Fill in the blank:

Pharmacists shall keep every invoice issued when supplying a preparation containing a total of not more than (A) of codeine / pholcodine per dosage unit, with a total concentration of not more than (B) (calculated as base) in undivided preparations.

Misuse of Drugs Regulations r18 & First Schedule

A

(A) 100mg
(B) 2.5%

62
Q

Legal CD Compounding Limits

Fill in the blank:

Pharmacists shall keep every invoice issued when supplying any preparation containing, per dosage unit, not more than (A) of diphenoxylate calculated as base, and a quantity of atropine sulphate equivalent to at least (B) of the dose of diphenoxylate.

Misuse of Drugs Regulations r18 & First Schedule

A

(A) 2.5mg
(B) 1%

Pre-Reg Competency (1 decks)

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