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Shipman 4 & Implications for
Pharmacy: Controlled Medicines
Implications for Hospital Pharmacy
Liz Kay
Head of Pharmacy Services
What should hospital
pharmacists be considering?
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What do you mean by a ‘controlled drug’?
How do you balance access to CD’s?
CLINICAL NEEDS OF PATIENTS
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SECURITY OF STOCK FROM THEFTS
Have you reviewed prescribing practices?
How will you engage multidisciplinary teams?
Do you need to train staff to undertake
investigations?
What are the workload implications?
What is a ‘controlled drug’?
Confusion exists in hospitals
 Schedules 2 – 5 of Misuse of Drugs
Regulations
 Products liable to clinical error
potassium chloride injection
 Products liable to misuse
ketamine
 Others?
Balancing Access to CDs
Policy and procedures
- where are the stock holding units?
- are they appropriate?
* cupboards / locks / keys
* authorised product lists
* authorised staff with access
* accountable staff for stock
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Balancing Access to CDs
How do you undertake proactive audit?
* Within Pharmacy – how and when
* All other stock locations – how and
when
* Use of product issue data and register
* Electronic tools – record audits, identify
potential misuse
Reviewing Prescribing Practice
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Regular opioids – choice, dose,
frequency, legal requirements
‘PRN’ opioids – avoiding errors and
incidents, dosing, frequency
Self administration – supporting pain
management
Patients’ own medicines
AS REQUIRED PRESCRIPTIONS
surname (block letters)
Unit no.
Check for allergy status on inside page
First name
DOB
Use addressograph
1 Drug
Dose
MORPHINE
Route
IV / IM
Freq and max dose
Start Date
Signature Print name
Date
10 mg
Pharm.
Time
4 - 6 HOURLY PRN
Dose
Stop Date
Bleep
2 Drug
Given
Dose
DIAMORPHINE
Route
IV
Freq and max dose
Start Date
Signature Print name
Date
2.5 mg
Pharm.
Time
When required for pain
Dose
Stop Date
Bleep
3 Drug
Given
Dose
PETHIDINE
Route
IM
Freq and max dose
Start Date
Signature Print name
Date
50 - 100
mg
Pharm.
Time
Stop Date
Dose
2 - 4 hourly PRN
Bleep
Given
Engaging Multi Disciplinary
Teams
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Accountability, responsibility, authority
Standards for Better Health – medicines
safe and secure handling – declaration
Accountable officer – leadership
CDs in context of clinical quality
Relative importance
Positive & Negative
Implications of ‘Shipman 4’
Positive
 Improve patient care - patient record
card
 Review, audit, investigate use of CDs
 Improve safe handling (especially
parenterals)
 Leadership
Positive & Negative
Implications of ‘Shipman 4’
Negative
 Workload implications (LTH examples)
Proactive monitoring
Reactive investigation
Patient record card
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Questions?