Controlled Drug Process. Khoa Vo Masters candidate University of Canterbury

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1 Controlled Drug Process Khoa Vo Masters candidate University of Canterbury

2 Bachelor of Pharmacy (VN) PG Diploma in Palliative Care (NZ)

3 Cancer Patients in Vietnam 250,000 of 89 million Increased by 150,000 per year

4 China Burma Vietnam Laos Thailand Cambodia

5 Purpose Standard of Service Provision in Palliative Care Standard 12: Quality improvement Controlled drugs: - Extensively used - Easily abused Addiction

6 Purpose In view of pharmaceutical management, Misuse of Drug Act 1975 (reprinted Jul.2014) Misuse of Drug Regulation 1977 (reprinted Jul.2014) Pharmacy Standard Operating Procedures C09 and C11. Hospice Controlled Drug Policy.

7 Audit Planning Key activities: Visit of facilities Review of source documents, including those from: Pharmacy: Controlled Drug Register, Controlled Drug Destruction Report, Prescriptions, Storage and Temperature monitoring log. Hospice: Stock Controlled Medication Register, Ward Medication Register, Patient-Only Medication Register, Handover record or minute, Medication Treatment Chart, Staff Delegation and Signature log. Controlled drug accountability. Meeting with the Quality Manager, the Charge Pharmacist before, during and after the audit for reporting purposes.

8 Audit Conduct & Findings

9 Hospice Audit (1) Register Stock Register Daily Stock

10 Hospice Audit (2) Delivery from pharmacy to hospice: Bulk supply order Preparation Delivery Stock Register Prescribing practice: - Days: Inpatient drug chart - Nights: Verbal and

11 Hospice Audit (3) Prescription: Morphine 60mg IV Q1H PRN Drug chart: 4 x Morphine 60mg at 3.10am, 11.55am, 6.15pm and 10.40pm (240mg) Register: 4 x Morphine 120mg/1.5ml taken (480mg) What is the issue? Drug Loss 240mg

12 Hospice Audit (4) Prescription: Morphine 10mg IV PRN Register: Morphine 10mg amp. taken (2) Drug chart: no record Morphine elixir Oxycodone injection // some patients Systematic potential Drug loss

13 Hospice Audit (5) Methadone suspension 10mg/ml Date Patient In Out Balance 9/8/15 Pt A.C /8/15 Pt R.B /8/15 Daily count 180

14 Hospice Audit (6) Methadone suspension 10mg/ml Date Patient In Out Balance 9/8/15 Pt A.C /8/15 Pt R.B /8/15 Daily count /8/15 Pt /8/15 Pt /8/15 Pt /8/15 Stock transfer /8/15 Page check

15 Hospice Audit (7) Signature log Date Name Signature 10/12/2013 2/3/ /3/2015 R.O. ## 12/11/2015 B.C. LLLLLL - Missing staff signatures - Cross-out without explanation - Discrepancy between log and register - No delegation or training log

16 Hospice Audit (8) Findings: 33 grouped under 5 categories - Suspected drug loss - Signature log to be up-to-date - Correction for entry errors - Destruction process: unclear - Documentation issues

17 Pharmacy Audit (1) Standard Operating Procedures, Controlled Drug Register (old and new ones), Methadone Register, Supply orders, Copied drug charts, Controlled Drug Prescriptions and Destruction records. 22 Controlled Drug Prescriptions reviewed. 18 Bulk Supply Orders were reviewed. Controlled Drug accountability and inventory.

18 Pharmacy Audit (2) Findings: 15 grouped under 5 categories - Expired SOPs C09 and C11 - Delegation, Training and Signature logs - Policy gap in dispensing between pharmacy and hospice - Incorrect correction method in Registers - Calibration of temperature device

19 Recommendations Action plans for each finding (CA-PA) General recommendations: - Retraining site staff - Updating policy for destruction record, signature log - Updating policy for verbal / e-prescription - Involving pharmacists in the entire process

20 References [name withheld] Pharmacy. (2012a). Dispensary Procedures General Dispensing. C09 Controlled Drug Dispensing (pp ) [name withheld] Pharmacy. (2012a). Dispensary Procedures General Dispensing. C11 Controlled Drug Storage, Records and Destruction (pp ) Hospice New Zealand. (2012a). Standards for Palliative Care, Quality Review Program and Guide The national standards. Wellington: Hospice New Zealand. Hospice New Zealand. (2012a). Standards for Palliative Care, Quality Review Program and Guide The quality review program. Wellington: Hospice New Zealand. Misuse of Drugs Act (1975). Misuse of Drugs Regulations (1977). [name withheld] Hospice. (2011). Controlled Drugs in the In-patient Setting. Section C Hospital and Hospice.

21 Thank you Lớp học chữ BV Ung Bướu TpHCM

Guidance on Bulk Prescribing for Care Home Patients

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