AFAMS EO Maintaining Undercontrol Medication Inventory (Dari) 01/09/2013

AFAMS Importance of Lesson (Dari) In the previous lecture you learned that Undercontrol/ Controlled Medications require stringent controls due to the potential for their misuse (e.g. diversion and abuse). These more stringent controls include increased steps when: –Storing; –Ordering; –Receiving; –Accounting; and –Dispensing. AFAMS Insert Dari

AFAMS Importance of Lesson (Dari) The purpose of this lecture is to teach the processes for the proper management of these medications. AFAMS Insert Dari

AFAMS Overview EO (Dari) Identify the prescription requirements for an under control medication prescription. Process for performing physical counts under Pharmacist’s supervision Maintain and update records Procedure to address under control drug discrepancies Review Scenarios (not graded) AFAMS Insert Dari

AFAMS Under Control Prescriptions Inpatient: –Require form 58 prescription Outpatient: –Outpatient prescription written by physician

AFAMS Form 58

AFAMS Form 58 Patient Total of Each Drug Required Drug Strength Amount of Drug Required for Each Patient

AFAMS Outpatient Prescription Example Dari The date should be within 3-7 days of today’s date Only dispense if you are aware of the prescriber and recognize their signature. If not, call the prescriber. An exact quantity should be written.  All prescriptions for Under control medications require a pharmacist to review

AFAMS Signs of Counterfeit Prescriptions Dari Under control medication prescriptions are commonly counterfeited. Look for: –Use of two colours of ink. This may indicate changes made after it was written. –Unknown prescriber. –Incorrect registration number –Drug names misspelled –Quantity does not match direction requirements –Not written on an official prescription form. –No Sig Code –Quantities changed by crossing out In all these instances the Pharmacist will have to investigate.

AFAMS Learning Check What are some common signs of a counterfeit Under control medication prescription?

AFAMS Learning Check What are some common signs of a counterfeit Under control medication prescription? –Use of two colours of ink. This may indicate changes made after it was written. –Unknown prescriber. –Incorrect registration number –Drug names misspelled –Quantity does not match direction requirements –Not written on an official prescription form. –No Sig Code –Quantities changed by crossing out

AFAMS Authority to Order Controlled Drugs Dari OTSG Policy 18

AFAMS Authority to Order Controlled Drugs Dari OTSG Policy 18

AFAMS Authority to Order Controlled Drugs Dari OTSG Policy 18

AFAMS Uncontrolled Access OTSG Policy 18

AFAMS Uncontrolled Access Unaccompanied access to controlled medical substances will be denied until a satisfactory local security check is completed. (Appendix A to OTSG Policy 18) The Medical Commander reviews the security check and determines if the individual meets the requirements to have unaccompanied access to controlled substances. Appendix B to OTSG is completed authorizing unaccompanied access to controlled substances –provided to the employee, the immediate supervisor, and the unit Security Officer.

AFAMS Appendix A

AFAMS Appendix B

AFAMS Uncontrolled Access OTSG Policy 18:

AFAMS Uncontrolled Access OTSG Policy 18:

AFAMS Uncontrolled Access OTSG Policy 18:

AFAMS Physical Count Requirements Dari OTSG Policy 18

AFAMS Physical Count Requirements Dari OTSG Policy 18

AFAMS Physical Count Requirements Dari OTSG Policy 18 Requirement for a perpetual log

AFAMS Physical Count Requirements Dari ANA 6-81:

AFAMS Physical Count Requirements Dari OTSG Policy 18:

AFAMS Pharmacy Depot Requirements Dari  Stock cards and MoD Form 1 will be discussed in future lectures Policies and Procedures of Pharmacy Department ANA

AFAMS Pharmacy Depot Requirements Dari Policies and Procedures of Pharmacy Department ANA

AFAMS Pharmacy Dispensary Requirements Dari Policies and Procedures of Pharmacy Department ANA

AFAMS Pharmacy Dispensary Requirements Dari Policies and Procedures of Pharmacy Department ANA

AFAMS Pharmacy Dispensary Requirements Dari Policies and Procedures of Pharmacy Department ANA

AFAMS Pharmacy Dispensary Requirements Dari Policies and Procedures of Pharmacy Department ANA

AFAMS Documentation: Each time a controlled substance is administered, record: –day –hour –patient’s name –initial and last name of the prescriber –signature of the individual administering the medication –amount of the substance administered –new balance recorded Dari Perpetual Log Dari

AFAMS Dari Perpetual Log Dari

AFAMS Perpetual Log Example Dari

AFAMS Dari Perpetual Log Dari 20 Apr 13 Mohammad Taj Abdullah 0950 Behroz BehnamLatifa Ahmad Previous page qty Morphine 10mg tablets

AFAMS Ward Requirements Dari Policies and Procedures of Pharmacy Department ANA

AFAMS Ward Requirements Dari Policies and Procedures of Pharmacy Department ANA

AFAMS Ward Transfers/ Dari

AFAMS Updating the Perpetual Log Dari

AFAMS Return from a Ward Dari

AFAMS Dari Perpetual Log Dari 20 Apr 13 Mohammad Taj Abdullah 0950 Behroz BehnamLatifa Ahmad Previous page qty Morphine 10mg tablets Apr Pharmacy Behroz Behnam1587

AFAMS Error in Recording Dari

AFAMS Dari Perpetual Log Dari 20 Apr 13 Mohammad Taj Abdullah 0950 Behroz BehnamLatifa Ahmad Previous page qty Morphine 10mg tablets Apr Pharmacy Behroz Behnam Apr Rm 5430Behroz Behnam Mohammad Taj Abdullah Apr Rm 5415Behroz Behnam Mohammad Taj Abdullah signature

AFAMS Recording Accidental Destruction (Broken, Unserviceable) Dari

AFAMS OTSG Policy 18

AFAMS Dari Perpetual Log Dari 20 Apr 13 Mohammad Taj Abdullah 0950 Behroz BehnamLatifa Ahmad Previous page qty Morphine 10mg tablets Apr Pharmacy Behroz Behnam Apr Rm 5430Behroz Behnam Mohammad Taj Abdullah Apr Rm 5415Behroz Behnam Mohammad Taj Abdullah signature 21 Apr PharmacyBehroz Behnam Destroyed 15 Destroyed

AFAMS Returning Expired to QM Dari

AFAMS Dari Perpetual Log Dari 20 Apr 13 Mohammad Taj Abdullah 0950 Behroz BehnamLatifa Ahmad Previous page qty Morphine 10mg tablets Apr Pharmacy Behroz Behnam Apr Rm 5430Behroz Behnam Mohammad Taj Abdullah Apr Rm 5415Behroz Behnam Mohammad Taj Abdullah signature 21 Apr PharmacyBehroz Behnam Destroyed 15 Destroyed Apr QuartermasterBehroz Behnam Expired x signature

AFAMS Pharmacy Depot Requirements Dari  Stock cards and MoD Form 1 will be discussed in future lectures Policies and Procedures of Pharmacy Department ANA MoD Form 1 and Stock Card indicate destruction in QM

AFAMS Under Control/ Controlled Medication Discrepancies Dari

AFAMS Reporting Discrepancies OTSG Policy 18: On Ward:

AFAMS Dispensary Responsibility Policies and Procedures of Pharmacy Department ANA

AFAMS Dispensary Responsibility OTSG Policy 18:

AFAMS Questions?

AFAMS Review Above Slides (Dari) AFAMS

Scenario (Assessment) Dari Formative Assessment: Not marked Used to assess the students understanding of lectures material. Instructors will provide a Scenario involving the updating of the Under Control/ Controlled Medications Perpetual Log. Instructor to provide students with blank Perpetual Log sheet. Instructor will provide a debrief at the end of the Scenario. Time estimate (including debrief): mins Insert Dari

AFAMS Scenario

AFAMS Scenario You are working in the Dispensary and have just received an order (next slide) from the Quartermaster. The Pharmacist (Dr Behroz) has asked you to record the order in the perpetual log. Instructor to hand out two blank perpetual log sheets to each student.

AFAMS Scenario Date: 10 September 2013 Time: 1425 The received order is as follows: tramadol 100mg tablets –100 tablets –Previous on hand quantity: 75 tablets morphine 10mg tablets –100 tablets –Previous on hand quantity: 150 tablets

AFAMS Dari Answer: Perpetual Log Dari 10 Sept Behroz BehnamPharmacy Previous page qty Tramadol 100mg tablets When starting a new page always transfer the quantity on hand to the new page. Quartermaster

AFAMS Dari Answer: Perpetual Log Dari 10 Sept Behroz BehnamPharmacy Previous page qty Morphine 10mg tablets When starting a new page always transfer the quantity on hand to the new page. Quartermaster

AFAMS Scenario Date: 10 September 2013 Time: 1545 You receive an outpatient prescription. You show the pharmacist (Dr Behroz) who tells you to record it in the perpetual log and to dispense the medication.

AFAMS Dari Answer: Perpetual Log Dari 10 Sept Behroz BehnamPharmacy Previous page qty Tramadol 100mg tablets Quartermaster 10 Sept Behroz BehnamLatifa Ahmad Dr Abdullah

AFAMS Scenario Date: 10 September 2013 Time: 1545 You receive an inpatient prescription. Signed by: Dr Hussein You show the pharmacist (Dr Behroz) who tells you to record it in the perpetual log and to dispense the medication.

AFAMS Form 58 Patient Total of Each Drug Required Tablets

AFAMS Dari Answer: Perpetual Log Dari 10 Sept Behroz BehnamPharmacy Previous page qty Morphine 10mg tablets Quartermaster 10 Sept Behroz Behnam Dr Hussein 10 Sept Behroz Behnam Dr Hussein

AFAMS Questions?

AFAMS End of Lecture Dari