Drug diversion & palliative care Indian perspective 2/22/2016
Essential steps to preventing diversion Security of stock Maintenance of records Judicious prescribing 2/22/2016www.palliumindia.org
Security of stocking Safe room; safe cupboard One person responsible Daily stock verification Weekly verification by supervisor 2/22/2016www.palliumindia.org
Documentation Name and age of patient Registration number Dose, strength, frequency, duration Signature of doctor (legible) 2/22/2016www.palliumindia.org
Verification at review Quantity dispensed Understanding of dose regime Quantity left over Any returned morphine is entered in stock and used again 2/22/2016www.palliumindia.org
Periodic verification Matching stock on hand with documented balance Investigating every discrepancy and accounting for it Ensuring that minimum balance is always maintained 2/22/2016www.palliumindia.org
Study in Kerala 1723 patients over 2 year period No reports of thefts or unreasonable unsanctioned dose escalations Every discrepancy in stock investigated Lancet: 2001; 358: /22/2016www.palliumindia.org