Transcript Controlled Substance Orientation - Medical University of South

Internal Audit Department
Controlled Substance
Orientation
Ernest Thomas
Controlled Substance Investigator
792-4199 or Pager 11283
Available by pager 24/7
Course Objectives
We will review:
• The role of the Internal Audit Department and the Controlled Substance
Investigator at MUSC.
• The responsibilities of the professional with access to controlled substances
at MUSC.
• Wastage and discrepancy policies for controlled substances at MUSC.
• Common errors.
• The proper storage and disposition of patient prescription medications.
• Your responsibility to report drug diversions.
• Characteristics of individuals who divert controlled substances.
Internal Audit
One of Internal Audit’s responsibilities includes review of
controlled drugs used in:
• Patient units,
• Hospital pharmacies,
• Clinics, and
• Research areas.
This duty is primarily performed by the
Controlled Substance Investigator
Know the Laws and Regulations For Your
Discipline
• SC Code of Laws Section 40-33-110 [Nurse Practice Act].
Grounds for discipline of licensees.
– violated a federal, state, or local law involving alcohol or drugs…
conviction is not required to prove misconduct under this item.
– obtained, possessed, administered, or furnished prescription drugs to a
person including, but not limited to, one's self, except as directed by a
person authorized by law to prescribe drugs;
– engaged in the practice of nursing when judgment or physical ability is
impaired by alcohol, drugs, or controlled substances or has declined or
been unsuccessful in accomplishing rehabilitation;
– failed to make or keep accurate, intelligible entries in records as required
by law, policy, or standards for the practice of nursing
Know MUHA Policy Concerning
Controlled Drugs
• MUHA Policy C-168 - Management of
Automated Dispensing Machines
AcuDose
PROTECT YOURSELF!
 Run and review AcuDose activity reports for
your patients and yourself at the end of each
shift.
 Run a discrepancy report and make sure all
outstanding problems are resolved before you
leave the unit.
 Never give out your ID and password.
You are legally accountable for all transactions that occur
under your ID and password.
When You May Waste
Controlled Substances
SC Code of Regulations 61-4-911:
 A partial dose is ordered; waste the unused portion.
 The patient refuses the medication after it is
prepared; waste the entire dose.
 The practitioner discontinues the order after the
medication is prepared; waste the entire dose.
 Blood is aspirated into the syringe; waste the dose.
EVERY WASTAGE MUST BE PERFORMED AND WITNESSED
BY LICENSED PERSONNEL.
SC Code of Laws 40-33-110. Grounds for discipline of licensees.
- indicated the witnessing of wastage of narcotics or controlled
substances on record when the wastage was not witnessed or failed
to obtain a witness to the wastage of narcotics or controlled
substances
Wasting Controlled Substances –
Are You Sure?
Per policy C-168, the wastage must be
performed at the time the dose is prepared,
or as soon as possible after the
administration of the dose.
A witness should be reasonably sure the
drug that is wasted is the drug he/she is
attesting to. Delays in wasting drugs may
create doubt as to the identity of the drug
being wasted.
Two Steps to a Waste
A waste is complete when two licensed
individuals:
1. Dispose of a medication in a manner in which it is
rendered unusable or irretrievable (wash down
sink, dispose of in Sharps container, etc.) AND
2. Record the waste in an patient record system
(AcuDose, the medical record, etc.)
A witness to a wastage should ALWAYS WATCH the disposal of the
medication.
A wastage must be performed at the time the dose is prepared, or as
soon as possible after the administration of the dose.
When You May NOT Waste
Controlled Substances
SC Code of Regulations 61-4-911:
• Broken seal or Tamp-R-Tel.
• Crushed or dropped tablet.
• Spilled liquid medication. Mop up the liquid with 4x4
gauze, place the gauze in a plastic bag, and store the bag
safely.
When these situations occur, complete a
Controlled Substance Discrepancy Report and fax it to 7921204 or email it to [email protected]. Lock the
drug and the original of the form in the narcotics box.
Controlled Substance Discrepancy Report
Reportable controlled substance discrepancies must be documented
on Controlled Substance Discrepancy Report form and faxed to the
Internal Audit Department (2-1204) or emailed to
[email protected].
This form is available:
• On each unit,
• On the MUHA Forms directory:
http://academicdepartments.musc.edu/internalaudit/forms/CS%
20Discrepancy%20Form.pdf,
• On the Internal Audit webpage:
http://academicdepartments.musc.edu/internalaudit/controlled_
substances/Forms.
Common Errors
• Wastages – Know when you LEGALLY may and may not waste
controlled substances.
When You MAY Waste
When You MAY NOT Waste
All of these wastes should be documented
in AcuDose
Contaminated controlled substances should
be reported to Internal Audit on a
Controlled Substance Discrepancy Report
A partial dose is ordered
The patient refuses the medication after it
is prepared
The order is discontinued after the
medication is prepared
Blood is aspirated into the syringe
• A transaction is incomplete –
The medication is CONTAMINATED:
• Broken seal or Tamp-R-Tel
• Crushed or dropped tablet
• Spilled liquid medication (save what you
clean it up with!)
A trained individual should be able to trace a
transaction involving a controlled substance from the
physician order
dispense
waste (if necessary)
administration. One
should be able to account for the entire amount dispensed. Omitting steps
causes the transaction to be incomplete and may jeopardize patient safety or
cause compliance issues.
Storage and Disposition of Patient Prescription
Medications
When a patient presents with medications from home:
 Send the medications home with
a member of the patient’s family.
 If this is not possible:
1. Inventory the medications with a witness, seal
the medications in a security bag and store
the medications in the locked narcotics
cabinet.
2. Document the inventory and location of the
drugs in patient’s database or chart.
3. Return medications to patient upon
discharge. Note in the patient’s record that
the medications were returned.
4. If the medications are not returned to the
patient upon discharge, send a 30-day
notification letter.
5. After the 30-days has elapsed, call Internal
Audit for destruction of controlled
substances.
Diversion
Happens Here
It has been estimated that 10 to 15 percent of all nurses in the
United States are addicted to some type of illegal or controlled
substance.
http://www.nursetogether.com/nurses-and-substance-abuse
You Are Responsible for Reporting
Drug Diversions
• Drug Abuse and Diversion are serious
problems.
• SC Code of Laws, Section 44-33-110.
Grounds for discipline of licensees.
• Failed to report incompetent or
unprofessional practice of a licensed
nurse to the appropriate authorities,
including the board.
• Nurses have an ethical duty to protect patients,
colleagues, the profession, and the community.
Source: Nurse Drug Diversion and Nursing Leader's Responsibilities: Legal, Regulatory, Ethical, Humanistic, and Practical Considerations.
JONA's Healthcare Law, Ethics, & Regulation. 13(1):13-16, January/March 2011.
• If you suspect that someone is diverting
drugs, DO NOT intervene on your own.
• Contact your Nurse Manager and the
Controlled Substance Investigator in the
Internal Audit Department.
Given the increasingly
stressful environment
due to manpower
shortages in the
healthcare system in
general, substance
induced impairment
among some
healthcare professions
is anticipated to grow.
http://www.ncbi.nlm.nih.gov/pmc/arti
cles/PMC2265282/
Possible Signs of Impairment
• Personality change;
• Patient and staff complaints
about quality of care, attitude,
or behavior;
• Interpersonal relations with
colleagues, staff and patients
suffer;
• Wearing long sleeves when
inappropriate;
• Deteriorating personal
appearance;
• Increasing personal and
professional isolation.
Nurses who are chemically dependent may be successful at
disguising dependency issues because they are often stellar
employees, popular, respected, and bright.
Source: Nurse Drug Diversion and Nursing Leader's Responsibilities: Legal, Regulatory, Ethical, Humanistic, and Practical Considerations.
JONA's Healthcare Law, Ethics, & Regulation. 13(1):13-16, January/March 2011.
Possible Signs of Diversion
• Patient complaints about poor pain control;
• Inaccurate narcotics counts;
• Offers to administer medications to patients the nurse is not
assigned to;
• Frequent delays between administration and wasting drugs;
• Frequent or unexplained disappearance from the unit.
The ANA estimates approximately 6% to 8% of nurses are
practicing while impaired.
Source: Nurse Drug Diversion and Nursing Leader's Responsibilities: Legal, Regulatory, Ethical, Humanistic, and Practical Considerations.
JONA's Healthcare Law, Ethics, & Regulation. 13(1):13-16, January/March 2011.
MUSC/MUHA Employee Assistance Program
(EAP)
This confidential benefit is available to help you deal with:
• Personal and family problems such as:
– Relationship issues
– Divorce
– Drug and alcohol dependency
– Financial
• Work related problems such as
– Absenteeism
– Chronic tardiness
– Poor morale
Call 792-2848 or visit the website at www.musc.edu/eap
S.C. Recovering Professionals Program
(RPP)
RPP is a state-wide confidential referral and monitoring program
for licensees of the South Carolina Boards of Medical Examiners,
Nursing, Pharmacy, Dentistry, Podiatry Examiners, Chiropractors,
Counselors, Occupational Therapy, Optometry, Physical Therapy,
Psychology, Social Workers, Speech Therapy & Audiology, and
Veterinary.
It is for professional who are experiencing problems related to:
• alcohol and/or other drug abuse or dependence,
or from a dual diagnosis of addiction and mental
illness.
The program ensures that impaired professionals receive the help they
need at the earliest point possible. Call 1-877-349-2094 or visit their
website at http://scrpp.org/
Contact Information
Internal Audit Department
45 Bee Street
843-792-4561
Ernest Thomas
Controlled Substance
Investigator
843-792-4199
Pager ID 11283
Alternate Pager ID 12540
Available by pager 24/7