Controlled Drugs (CDs) Flashcards
When can Schedule 1 CDs be administered or prescribed?
Under a Home office licence
Who can administer Schedule 2, 3, 4 CDs to patients?
- A doctor, dentist, independent prescriber or independent nurse prescriber
- A supplementary prescriber acting in accordance with clinical management plan
- A person acting in accordance with the direction of a prescriber entitled to prescribe CDs (e.g. pharmacists)
1) What is needed for a pharmacy to import or export Schedule 1, 2, 3, 4 Part I CDs?
2) What about Schedule 4 Part II?
1) A licence
2) Licence also needed, UNLESS it is for self-administration
Would a person travelling with < 3 months supply of a CD need a personal licence?
No - but it would be advised to carry a signed letter from the prescriber, highlighting the indication, patient name, travel plans, doses and quantities
What are the legal requirements for a CD requisition form?
1) Signature of recipient
2) Name of recipient
3) Address of recipient
4) Profession/occupation
5) Total quantity of drug
6) Purpose of requisition
Can supply be made against a faxed/photocopied requisition form?
No
1) Must a written requisition form be obtained BEFORE delivery of any Sch 2 or 3 CDs?
2) Are there any premises where this is NOT a requirement?
3) Are there any circumstances where this is NOT a requirement?
1) Yes
2) Yes - GPhC registered pharmacies, although Home Office advised the sending of a written form when one pharmacy is supplying another
3) In an emergency, provided form is sent within 24h. Failure to do so would be an offence by the doctor etc
Can midwifes obtain CDs? which CDs?
Yes - registered midwifes can use a Midwife Supply Order to obtain the following:
- Diamorphine
- Morphine
- Pethidine
What information MUST a Midwife Supply Order contain?
1) Midwife name and occupation
2) Name of person the CD is supplied for
3) Purpose for which CD is required
4) Total quantity of CD
5) Signature of appropriate medical officer - a Doctor or person responsible for supervising midwifes in the area
What are the Safe Custody Regulations?
Refers to physical security of certain CDs. Requires HCPs to keep them in a ‘locked safe’, cabinet or room
Examples of CDs requiring Safe Custody?
- Sch 1
- Sch 2, except some liquid formulations and Quinalbarbitone
- Sch 3, except the following: Gabapentin, Mazindol, Meprobamate, Midazolam, Pentazocine, Phentermine, Phenobarbital, Pregabalin, Tramadol
What must be ensured when CDs requiring Safe Custody storage are not in the CD cabinet?
They require the ‘direct personal supervision’ of a registered pharmacist
Does Safe Custody still apply to patient-returned CDs?
Yes - they should be segregated from the other stock in the cabinet to avoid supply to future patients
When disposing of returned/ expired/ obsolete stock, Which CDs require denaturing?
Schedule 2, 3 or 4 (Part I)
1) When patients return CDs, is an authorised witness required for denaturation?
2) What record must be kept?
1) No, however it is preferable for it to be witnessed by another member of staff familiar with CDs
2) Record should NOT be made in the CD register, but patient-returned Sch 2 drugs and their destruction should be recorded in a separate record
How should solid dosage forms be denatured?
- Grind or crush before adding to denaturing kit, using small amount of water to avoid release of particles into air
- Where a denature kit is not available, crushed drug is added to warm soapy water and mixed to dissolve. Mixture is poured into a suitable product and placed in pharma waste container and sent for incineration
1) When expired/ obsolete/ unwanted stock is denatured, is a witness required?
2) What record must be kept?
1) Yes, IF Sch 2. For Sch 3, it would be GOOD PRACTICE to have another member of staff witness denaturing
2) Entry should be made in CD register for Sch 2 CDs
How should liquid dosage forms be denatured?
- Pour into an appropriately sized denaturing kit
- Where one is not available, pour liquid into a suitable product (diluent) and pour into an appropriate waste disposal bin
- Bottles can be rinsed using denaturing kit liquid and then recycled appropriately
How should ampoules or vials be denatured?
- For liquid containing ampoules- open ampoule and pour into denaturing kit and then same as a liquid formulation
- For powder containing ampoules- open ampoule and add water to dissolve powder inside. Resulting mixture can be poured into denaturing kit
How should patches be denatured?
- Remove backing and fold the patch over itself
- Place into waste disposal bin or denaturing kit
Prescription requirements for CD Rx?
1) Patient details - name and address
2) CD drug details - name, form strength, dose, quantity (in WORDS AND FIGURES)
3) Date (Valid for 28 days)
4) Prescriber signature and details - address
Who may collect Sch 2 CDs from the pharmacy?
- Patient or patient’s representative
