The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [535]
If a discrepancy is found it should be checked that all requisitions have been entered, that all drugs administered have been entered, that items have not been recorded in the wrong place in the record book, that the drugs have not been placed in the wrong cupboard and that the balances have been added correctly. If an error is found, the nurse in charge should make an entry to correct the balance which should be witnessed. If the error cannot be found, the chief pharmacist and the accountable officer should be contacted immediately.
Archiving
Controlled drug record books should be stored for a minimum of 2 years from the date the last entry was made/date of use.
Administration
Any registered practitioner can administer any drug specified as Schedule 2, 3 and 4 provided they are acting in accordance with the directions of an appropriately qualified prescriber (see Prescribing).
Two practitioners must be involved in the administration of controlled drugs, and both practitioners should be present during the whole administration procedure (NMC 2008a). The two practitioners should have clearly defined roles. One should be the checker and the other should take responsibility for taking the drug out of the cupboard, preparing and administering the drug. These roles should not be interchangeable during the procedure as this can result in errors. They should both witness the preparation, the controlled drug being administered and the destruction of any surplus drug. An entry should be made in the controlled drug record book recording the following information:
the date and time the dose was administered
the name of the patient
quantity administered
the name
formulation
the strength being administered
the name and signature of the person administering
the name and signature of the witness
the balance in stock (see procedure).
Return and disposal including part vials
Unused controlled drug stock should be returned to pharmacy. Controlled drugs that are expired should also be returned to pharmacy for safe destruction. An entry should be made in the relevant page of the record book recording the following information:
date
reason for return
name and signature of registered nurse
name and signature of witness
quantity removed
name, form and strength
the balance remaining.
Disposal of controlled drugs can take place on the ward if a part vial is administered to the patient or if individual doses of controlled drugs were prepared and not administered. If destroying a part vial, the registered nurse should record the amount given and the amount wasted under the administration entry in the record book. The entry and destruction should be witnessed by a registered nurse or other registered professional. If destroying an unused prepared controlled drug, this should also be recorded in the record book and the entry and destruction witnessed by another registered professional.
Stationery
Controlled drug stationery should be stored in a locked cupboard or drawer. Controlled drug stationery will be issued from pharmacy against a written requisition signed by an appropriate member of staff. Only one requisition book should be in use by a ward. If a new record book is started, the stock balance transfer should be witnessed by a registered nurse.
Transport
Controlled drugs should be transferred in a secure, locked or sealed, tamper-evident container.
A person collecting controlled drugs should be aware of safe storage and security and the importance of handing over to an authorized person to obtain a signature. They must also have a valid ID badge.
Supply under PGD
Registered nurses in accident and emergency departments and coronary care units can supply or administer diamorphine for the treatment of cardiac pain in accordance with a PGD.
They can also supply or administer any Schedule 3 or 4 controlled