Controlled drugs Flashcards

Question

Exceptions of prescription requirements

Answer 1

Prescribing methadone requires a special exemption Provincial pharmacy standards do require that in the case of repeats, the interval between repeats is also stately clearly Ex. 3 repeats (every 30 days) No repeats allowed for narcotics

Answer 2

Should be a reasonable attempt to limit access to unnecessary drug – Intent of the law Limiting quantity of Schedule I drugs dispensed at a time to 1 month Limiting quantity of Schedule IV drugs used for maintenance of chronic conditions to 3 months (ex. phenobarbital for epilepsy control)

Answer 3

A practitioner shall (a) Furnish to the minister on request such information respecting (i) the receipt and use by the practitioner of (including the administering and furnishing thereof to a person), and (ii) the prescriptions for narcotics issued by the practitioner, as the minister may requirement

Answer 4

At any time the Minister (of Health) can request documentation of a practitioner’s receipt of narcotics AND their use by the practitioner. Usually inspection of records is delegated to the provincial regulatory and licensing bodies I.e., SVMA It is felt these organizations are better suited to monitoring compliance of their members.

Answer 5

(2) a practitioner who is required by this section to keep a record shall keep the record in a place, form and manner that will permit an inspector to readily examine and obtain information from it. Federally, only amounts more than 3 days needed to be recorded in a separate registry. It is allowed to review medical and surgical records in order to generate the needed information for less than 3-day quantities. As per SVMA Practice Standards, every dispensing act should be logged into a dispensing registry. Triplicate Prescription Program (TPP) - Alberta

Answer 6

Practice Standards 7g Medical Records (Major) Requires a controlled log with 2 major components Registers can be physically separate (in 2 different binders) or they can be combined Cannot be combined with other logs (i.e. part of an anesthesia log or general prescription log) Must be filed in chronological sequence

Answer 7

AKA Acquisition Log Tracks purchase Records total inventory

Answer 8

Tracks use of the inventory List of individual transactions (administered, dispensed, wastage, discard)

Answer 9

Controlled drug log for a large multi-use bottle -Euthanasia solutions -Ketamine -Hydromorphone Controlled drug log for individual-use vials or small vials -Fentanyl -Hydromorphone (10 ml) -Valium vials (2 ml)

Answer 10

Weekly reconciliation is recommended Daily, weekly, monthly depending on size of practice

Answer 11

The logs must be kept separate from the actual drugs Minimizes ability to alter logs or remove logs completely Ambulatory (ANY) practice CANNOT keep logs with the drug bottle – can have temporary then transfer to clinic log.

Answer 12

Cupboard, refrigerator, a drawer in a steel cabinet, or an equivalent may be used for this level of security provided it is located in a locked room and fastened to the room's floor or wall. The device used to store the inventory is to be secured with an approved padlock or its equivalent. Located in an area to which the public does not have access. List of people with access is maintained and available to inspectors

Answer 13

When reconciling, the hub of a needle holds 0.05 mls of solution Errors are crossed out with a single stroke correction made initialed Must be in blue or black pen

Answer 14

Steel cabinet, refrigerator or equivalent provided it is located in a locked room and fastened to a wall or floor in such a manner that it is not moveable. The cabinet or refrigerator must be locked with an approved padlock Located in an area to which the public does not have access. Alarm system is required. Minimum of local horn if unauthorized access. List of people with access is maintained and available to inspectors

Answer 15

7e Procedure © Narcotic and controlled drugs are stored in a locked secure location. An immovable safe is used as per federal legislation. Rationale: The Narcotic Control Regulations and the Controlled Drugs and Substances Act state that a practitioner must take adequate steps to protect such drugs in his possession from loss or theft. Guidelines: All narcotic and controlled drugs should be kept in a safe. For ambulatory work, small amounts of these drugs can be kept in a locked vehicle. The drugs should be in a container (e.g., medical kit, drug box) and not loose on the seat or dash. If drugs are kept in kits, and the kits are brought into the clinic when not in use, they should be stored in a secure location (e.g., locked storage room) and not left in areas where they could be accessed by members of the public. Similarly, small amounts of these drugs that are used in clinic should be stored either in the safe or in a locked area (e.g., locked drawer in the treatment room) when not in use.

Answer 16

Typically smaller amounts of drugs consistent with Security Level 1 Drugs can be locked in an automated dispensing cabinets (security-based patient dispensing centre, e.g., Pyxis) Ideally locked cabinet inside locked room (2 separate keys) Locked containers and carts are also acceptable, but must be attended at all times, or secured and locked to a wall or placed in a locked room when not in use. Access must be controlled - pass cards, keys, pass codes should never be shared Who has access to the room (practitioner, nurse, student, other staff is determined by the facility)

Answer 17

Discarding unused, assigned amounts that were originally prescribed for a patient. Must be recorded and witnessed (see section on records). Referred to as “wastage” e.g. giving drug to effect and the entire dose is not used. Spills and breakage. Must be recorded as “spill or breakage” in the dispensing log, dated, signed by DVM and witness Expired drug. Must be disposed of in the presence of a witness (legally another practitioner; but RVT or other staff person is acceptable when there is no other practitioner available) and recorded in the dispensing log. Referred to as “discard”

Answer 18

Can either destroy in-hospital or return to licensed dealer No regulations related to method of destruction or discarding of controlled substances Drug must be altered or denatured to such an extent that its composition has been rendered impossible or improbable SVMA recommends squirting volumes into cat litter before discarding into biohazard waste container All waste and discard must be recorded and witnessed by a health care professional (DVM; if not available, then an RVT)

Answer 19

Theft is easier to detect Loss is difficult to detect Must be reported within 10 days of discovery of the theft Report to the Office of Controlled Substances, Health Canada List of missing drugs, amounts, the date of (discovery of) loss Also requires a post-loss review and risk mitigation plan to prevent future loss/theft

Answer 20

Entering a quantity of drugs into inventory that is different from quantity received Pilfering and reporting a missing dose Replacing package contents with look-alike drug Replacing prepared syringe contents with saline Removing controlled drugs without an order Falsifying a verbal or electronic order Documenting administration of drugs without doing so Removing and documenting administration of a full dose, but administering a partial dose Removing a higher dose than ordered and not wasting the excess Pilfering from drug waste, sharps containers, or patches removed from patients Pilfering patient-supplied drugs or not returning them at discharge Removing drugs for a discharged or nonexistent/ deceased patient

Answer 21

missing purchase order or packing slip compromised packaging (watch for excessive “accidents” and check rubber stoppers for punctures) verbal orders created but not verified by prescriber numerous unresolved discrepancies numerous corrected transactions removing drugs for more patients than are generally assigned to a single practitioner failing to document waste failing to discard wastage or render it unusable frequent breakage or waste of entire doses controlled drugs disposed of in regular trash; staff member frequently volunteering to take out the trash patient or family complaints of inadequate pain management

Controlled drugs Flashcards

(46 cards)