The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [533]
The detail and format of the record may vary according to the patient’s needs and performance status the complexity of treatment, and local circumstances and policy (NMC 2008a, NMC 2008b, NMC 2009).
Controlled drugs
Definition
Controlled drugs are those drugs that are classified under the Misuse of Drugs Act 1971 and have controls around certain activities related to them, for example diamorphine, morphine, amphetamines, benzodiazepines. The use of controlled drugs in medicine is permitted by the Misuse of Drugs Regulations and related regulations, as detailed in the next section.
Legal and professional issues
Legislation
Medicines Act 1968
The Act and the regulations under it allow midwives to supply and/or administer diamorphine, morphine, pethidine and pentazocine. A number of healthcare professionals are also permitted to supply and/or administer controlled drugs in accordance with a PGD.
Misuse of Drugs Act 1971
For reasons of public safety, the Misuse of Drugs Act (1971) controls the import, export, production, supply, possession and manufacture of controlled drugs to prevent abuse as most are potentially addictive or habit forming. Other regulations of the Act govern safe storage, destruction and supply to known addicts.
Misuse of Drugs (Safe Custody) Regulations 1973
These regulations controlled the storage of controlled drugs. The level of control of storage depends on the premises in which they are being stored.
Misuse of Drugs Regulations 2001
Under these regulations, controlled drugs are classified into five schedules, each representing a different level of control (Table 13.6).
Table 13.6 Legal requirements for the schedules of controlled drugs (CDs)
The requirements of the Act as they apply to nurses working in a hospital with a pharmacy department are described in Table 13.7.
Table 13.7 Summary of legal requirements for handling of controlled drugs (CDs) as they apply to nurses in hospitals with a pharmacy
Controlled Drugs (Supervision of Management and Use) Regulations 2006
These regulations set out the requirements for certain NHS bodies and independent hospitals to appoint an accountable officer. The duties and responsibilities of the accountable officer are to improve the management and use of controlled drugs. These regulations also allow the periodic inspection of premises.
Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007
These regulations give accountable officers authority to nominate persons to witness the destruction of controlled drugs within their organization. They also allow operating department practitioners to order, possess and supply controlled drugs.
In addition, they set out changes to the record keeping for controlled drugs, with requirements for recording in the controlled drug register the person (the patient, patient’s representative or a healthcare professional) collecting the Schedule 2 controlled drug. If it is a healthcare professional, there is a requirement for the name and address of that person. Records need to be kept regarding whether proof of identity was requested of the patient or the patient’s representative and whether this proof of identity was provided. These requirements also changed midazolam from Schedule 4 to Schedule 3.
Implications of the regulations for nursing practice
Accountability and responsibility
The nurse in charge of an area is responsible for the safe and appropriate management of controlled drugs in that area. Certain tasks such as holding of the keys can be delegated to a registered nurse but the overall responsibility remains with the nurse in charge.
Requisition
The nurse in charge of an area is responsible for the requisition of controlled drugs for that area. This task can be delegated to a registered nurse but the overall responsibility remains with that nurse in charge. Orders should be written on suitable stationery and must be signed by an authorized signatory. All those who are authorized to order should