storage, recording & disposal of schedule 2 controlled drugs
TRANSCRIPT
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Storage, recording & disposal of Schedule 2 Controlled Drugs
Dr. Jo Murrell
BVSc. (hons), PhD, DiplECVAA, MRCVS
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All Controlled Drugs are listed in one of the five Schedules in the Misuse of
Drugs Regulations 2001 (MDR) and the Misuse of Drugs Regulations
(Northern Ireland) 2002 (MDR (NI))
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• Schedule 2 drugs have therapeutic value but are highly addictive. Their use is strictly controlled with requirements for:
– special prescription
– storage
– record keeping
– destruction
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Opioid Drug Schedule
Methadone 2
Fentanyl 2
Pethidine 2
Morphine 2
Buprenorphine 3
Butorphanol Not Controlled
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Legal Requirement
Schedule 2 e.g.
methadone, fentanyl, pethidine
Schedule 3 e.g.
buprenorphine
Schedule 4 e.g.
midazolam, ketamine
Safe custody in a Controlled Drugs cabinet
✔ ✔ The RCVS recommends keeping ketamine in a CDs cabinet
Record in a Controlled Drug Register
✔ It is good practice to record buprenorphine use
The VMD recommends that ketamine use is recorded
Witnessed destruction
✔ No legal requirement
The VMD recommends that destruction of ketamine is witnessed & recorded
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Storage requirements (Schedule 2&3)
• Kept in a locked container that conforms to British Standards & is attached to the fabric of the building
• Clients should not normally have access to the room where CDs are stored
• Access should be restricted with a key (s) kept by a responsible individual at all times
– it is not acceptable to have a communal key
It is good practice to keep CDs separate to other medicines
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Record Keeping
• CD Register must be a bound book or computerized record
• Within the Register each DRUG, FORM and STRENGTH must have a separate section – e.g. separate page for methadone, parenteral
fentanyl and transdermal fentanyl solution
• Entries in the Register must be made in chronological order
• The Register must be completed within 24 hours • Responsibility for correct completion of the
Register lies with the prescribing veterinary surgeon
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Controlled Drugs Register
• Controlled Drugs received
– date
– name & address of supplier
– amount received (volume ml e.g. Comfortan or no. of vials e.g. buprenorphine 1 ml ampoules)
– running total (mls or no. of vials)
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Controlled Drugs Register
• Controlled Drugs supplied
– date supplied
– patient ID e.g. “Bruno” Smith
– amount supplied e.g. volume mls or no. of vials
– amount discarded
– legible signature of the veterinary surgeon (a counter signature is recommended “witness”)
– running total
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Dechra CD Register
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Destruction of Controlled Drugs
• Out of date CDs cannot be simply disposed of – CDs awaiting destruction must be separated from
current stock in the CD cabinet & labelled appropriately
• Who can dispose of OOD CDs? – independent veterinary surgeon – member of the VMD or RCVS inspection team – police officer
• The majority of practices will easily use a 10 ml bottle of Comfortan with the 28 dds of broaching a vial! – no need for disposal of OOD stock
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Destruction of Controlled Drugs
• An entry must be made in the Register detailing the items destroyed and the running total of the drug must be updated
• This must be signed by the authorized witness (e.g. independent veterinary surgeon)
• CDs must be rendered irretrievable before disposal e.g. by using a commercially available denaturing kit
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Top 10 tips for recording methadone use in practice
1. Develop a practice SOP for CDs based on the CD legislation & ensure all staff are trained in the SOP!
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2. Don’t let people talk to you while drawing up CDs: concentrate on accurate recording in the Register
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3. Use a calculator to keep a running total of methadone volume (mls)
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4. Only have one open bottle of methadone at any one time
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5. Before drawing up methadone confirm with a visual check that the running total in the Register is correct
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6. Allow a discard volume of 0.05 ml for each syringe of methadone drawn up
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7. “Square” off the running total at the end of each bottle as recommended by the VMD
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8. Stock check daily (visually) to confirm running total is correct
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9. Adopt a logical approach to discrepancies in the Register
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10. Don’t view keeping Schedule 2 CDs as a “hassle” the benefits in terms of analgesia provision outweigh the “costs”