Dispensaries should regularly monitor and audit arrangements for controlled drugs in the lower schedules, the Care Quality Commission has recommended. It would like to see better control of Schedule 4 and 5 medicines “to identify and take swift action on diversion.”
The recommendation is made in the CQC’s report, ‘The safer management of controlled drugs: annual update 2017’. In its review of prescribing issues identified in inspections over the past year, it has found nationally there is a “general naivety” of diversion issues.
It advises: “It is important to minimise the quantity of a controlled drug prescribed and to regularly review the patient’s ongoing need. It is particularly important to consider the quantity issued in an emergency and for temporary residents until checks are carried out.
“We expect the standard operating procedures to cover all aspects of controlled drug management and for these to be kept under review with supporting audits.”
In addition, the CQC says it has found “insufficient monitoring and audit,” and is aware of thefts and diversion of CDs, “particularly those in lower schedules where there is less control, for example dihydrocodeine or morphine sulphate solution 10mg/5ml.
“We expect organisations to risk-assess their controlled drug arrangements, with regular monitoring according to their organisational needs, to keep losses to a minimum.”
It has also recommended:
- health commissioners should include the governance and reporting of concerns around CDs as part of the commissioning and contracting arrangements;
- healthcare professionals should keep their personal identification badges and passwords secure and report any losses as soon as possible to enable organisations to take the necessary action;
- a prescriber who is not the patient’s GP should ask about existing prescriptions and medicines when prescribing CDs, and where possible make the patient’s GP aware.
Among governance matters is the concern that not all organisations separate high and low strength preparations or those intended for different routes such as epidurals and intravenous injections. This can increase the risk of selecting and administering the wrong preparation, it says.
“We expect organisations to carry out their own risk assessment and incorporate relevant guidance into their processes.”