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Receipt

When controlled drugs are delivered to the ward they must be handed to an appropriate individual and not left unattended. A registered nurse in charge should check the order against the requisition, including the number ordered and received, and if all is correct they should sign the ‘received by’ section of the order book (Figure 13.2).

Figure 13.2 Controlled drugs order book.

The controlled drug should be entered in the controlled drug register, recording the following information: date, number of requisition, quantity, name, formulation and strength of drug, name and signature of person making the entry, name and signature of witness and the balance in stock. The updated balance should be checked against the controlled drugs physically present and that these are the same. The number of units received should be written in words not figures. The controlled drugs will then be placed in the controlled drug cupboard.

Storage

Controlled drugs should be stored in controlled drug cupboards that conform to British Standard BS2881. If the amount of controlled drugs that are stored is large or in areas where there is not a 24-hour staff presence, a security cabinet that has been evaluated against the SOLD SECURE standard SS304 should be used.

Cupboards should be locked when not in use. The lock must not be common to any other lock in the hospital. Keys must only be available to authorized members of staff and at any time the key holder should be readily identifiable. The cupboard must be dedicated to the storage of controlled drugs. Controlled drugs must be locked away when not in use. There must be arrangements for keeping keys secure, especially in areas that are not operational at all times.

Key holding and access

The nurse in charge is responsible for the controlled drug keys. Key holding may be delegated but the legal responsibility lies with the nurse in charge. The controlled drug keys should be returned to the nurse in charge immediately after use.

For the purpose of stock checking, the key may be handed to an authorized member of pharmacy staff. If keys are lost, the senior nurse, the pharmacy manager and accountable officer must be contacted. Spare keys can be issued to ensure that patient care is not impeded.

Record keeping

Each ward that holds controlled drugs should keep a record of received and administered controlled drugs in a controlled drug record book. The nurse in charge is responsible for keeping the controlled drug record book up to date and in good order.

The controlled drug record book should have sequentially numbered pages, have a separate page for each drug and strength, entries should be in chronological order and in ink. The entries in the controlled drug record book should be signed by a registered nurse and then witnessed by a second registered nurse. If a second nurse is unavailable, the transaction can be witnessed by another practitioner such as a doctor, pharmacist or pharmacy technician.

When the end of a page is reached, the balance should be transferred to another page. The new number should be written on the bottom of the finished page and as a matter of good practice the transfer should be witnessed. If a mistake is made in the record book, the mistake should be bracketed so that the original entry is still clear and then signed, dated and witnessed by another nurse or registered professional who will also do the same for the correction.

Stock checks and discrepancies

The stock balance entered in the controlled drug record book should be checked against the amounts in the cupboard. In addition, regular stock checks should be carried out by pharmacy. The nurse in charge is responsible for ensuring that the stock checks are carried out. The stock checks should be carried out by two registered nurses. When checking the balance, the record book should be checked against the contents of the cupboard, not the reverse. Packs with unopened tamper-evident seals do not need to be opened during the check and liquid