1. Training guide Recording and handling of Schedule 8 drugs in hospital wards ( including healthcare services and other patient care settings)

2. Contents page  Objectives Objectives  Introduction Introduction  2011 changes to the Register 2011 changes to the Register  Reasons for 2011 changes to the Register Reasons for 2011 changes to the Register  When and how to make entries in the Register When and how to make entries in the Register  What is in the Register Drugs of Addiction What is in the Register Drugs of Addiction  Explanatory notes Explanatory notes  Using the index page Using the index page  General notes on the record of drugs received administered or supplied page General notes on the record of drugs received administered or supplied page  Using the record of drugs received administered and supplied page Using the record of drugs received administered and supplied page  Amount discarded column Amount discarded column  General notes on the record of drugs destroyed page General notes on the record of drugs destroyed page  Using the record of drugs destroyed page Using the record of drugs destroyed page  Who can destroy and who can witness the destruction of a Schedule 8 (S8) drug Who can destroy and who can witness the destruction of a Schedule 8 (S8) drug  S8 balance checks S8 balance checks  Reporting discrepancies in the Register Reporting discrepancies in the Register  General information on S8 drugs General information on S8 drugs  Related Information and further enquiries Related Information and further enquiries

3. Objectives The objectives of this PowerPoint presentation are to provide information on:  records which are required to be maintained in the Register Drugs of Addiction HA 14  how to use the Register Drugs of Addiction HA 14 how to use the Register Drugs of Addiction HA 14  2011 changes to the Register Drugs of Addiction HA 14 2011 changes to the Register Drugs of Addiction HA 14  reporting discrepancies in the Register reporting discrepancies in the Register  other other Return to previous slide

4. Introduction  S8 requirements are detailed in the Poisons Act 1964 and the Poisons Regulations 1965.Poisons Act 1964Poisons Regulations 1965  WA Health is responsible for administering the Poisons Act 1964 and its Regulations which includes the monitoring of S8 drugs.  S8 drugs are also referred to as drugs of addiction or drugs of dependence. S8 drugs  S8 drugs are addictive and can be abused and diverted.  To manage the use of S8 drugs in WA there are controls over the prescribing and record keeping of S8 drugs that are supplied or used.  A Register must be maintained when a S8 drug is supplied, obtained stored or used (Regulation 44).  The Register Drugs of Addiction HA 14 is the Register which is used in hospital wards, healthcare services and other patient care settings to record S8 drugs transactions. Return to previous slide

5. 2011 changes to the Register HA 14  more detailed explanatory notesexplanatory notes  revised index pageindex page  inclusion of an “amount discarded” column in the record of drugs received administered or supplied page  signature columns requiring authorised persons to sign and print their names in the record of drugs received administered or supplied page  addition of a record of drugs destroyed pagerecord of drugs destroyed page Return to previous slide

6. Reasons for 2011 changes to Register  improve ease of use  enhance accountability  minimise the risk of errors Return to previous slide

7. When and how to make entries in the Register  An entry is to be made in the Register when a S8 drug is used, received, supplied or stored.  An entry is to be made when the transaction occurs.  Person recording an entry in the Register must sign and print their name.  Entries made in the Register must be in ink. Correction fluid is not to be used.  Entries in the Register are not to be obliterated, deleted or altered.  Incorrect entries or errors should be corrected with a marginal or footnote which is initialled and dated.  An entry can be corrected by making an entry on a subsequent line. Return to previous slide

8. What is in the Register drugs of addiction HA 14 ?  explanatory notes explanatory notes (located on the inside cover page)  index page index page (located on the first two pages of the Register)  record of drugs received administered or supplied page record of drugs received administered or supplied page (located after the index pages)  record of drugs destroyed page record of drugs destroyed page (located on the last two pages of the Register) Return to previous slide

9. Explanatory notes Revised explanatory notes 2011 Return to previous slide

10. Item 8 is new in the explanatory notes to highlight:  the record of drugs destroyed page  who can destroy an S8 drug  who can witness the destruction of an S8 drug Explanatory notes

11. Worked example of index page revised index page 2011 Return to previous slide

12. Using the index page continued Record:  drug name +  brand name to minimise the risk of confusion and error

13. Using the index page continued  Record  Release type: immediate release sustained release controlled release etc  Form: tablets injections capsules suppositories etc  Strength: mg, mg/mL, microgram etc

14. Using the index page continued Record  page number This is the page number of the record of drugs received administered or supplied page where the drug’s transactions details will be entered. When a record of drugs received administered or supplied page recording an individual drug’s transaction is full a new page is to be commenced. In the Index page a line is put through the completed page number and the new page number is recorded.

15. General notes on the record of drugs received administered or supplied page  Record one drug per page (ensure that an entry for the drug has been made in the index page).  Recording one drug per page ensures that there is a running balance of the stock on hand of that drug.  Date is the day the transaction occurred and should be recorded at the time the transaction occurred.  Actual destruction transactions of S8 drugs should not be entered in this part of the Register. Return to previous slide

16. Worked example of a record of drugs received administered or supplied page Revised record of drugs received, administered or supplied page 2011 Return to previous slide

17. Using the record of drugs received, administered or supplied Page Record:  drug details as recorded in the index page

18. Using the record of drugs received administered or supplied page For incoming stock record:  amount (number of capsules/tablets/injections, volume of oral liquid etc)  requisition number (located on top left hand side of requisition form)

19. Using the record of drugs received administered or supplied page continued Identifying details is a description of the transaction where you record:  Supplier (if stock received ie “ex pharmacy” or  Patient name in full (if dose administered or supplied). or  DD check (if safe check undertaken) or  Stock to be destroyed (stock should be labelled ‘to be destroyed’ and placed to the side in the safe to await destruction by authorised person).

20. Administration of S8 drugs For patient administration Record:  time dose given  dose administered (record in mg, microgram, mL etc)  amount discarded (record in mg, microgram, mL etc)  amount issued from stock (record in mg, microgram, mL etc) ‘Amount discarded’ column new in 2011

21. Amount discarded column Amount issued from stock – Dose administered = Amount discarded Return to previous slide  Amount discarded only relates to products such as injections and infusions where the sterility of the product is compromised  All other formulations where only part of a product is used the remainder is to be accounted for in the balance.  If the remainder of the product for example half a tablet is unusable, then it should be recorded in the record of drugs received, administered or supplied page that it is to be destroyed. It should then be labelled and put aside in the safe to await destruction.  See record of drugs destroyed section for further information on destroying of S8 drugs.record of drugs destroyed

22. Supply of S8 drugs Supply of S8 drugs:  must only be done by an authorised person such as a medical practitioner or pharmacist  must be recorded in the Register  may be done when the pharmacy is closed  must be appropriately packaged and labelled in accordance with the Poisons Regulations 1965 Note: supply = handing the appropriately packaged and labelled S8 drug to the patient to take home

23. Using the record of drugs received administered or supplied page continued Record  The balance as the physical amount ie, number of tablets, capsules, injections etc) Note: A balance should be maintained at all times.

24. Using the record of drugs received administered or supplied page continued For identification purposes the person authorised to complete the ‘Administered, supplied or received by’ column must:  Sign name  Print name Registered nurses should complete this column if they:  receive S8 drugs onto the ward or  administer a S8 drug to a patient in accordance with the instructions on the medication chart. Medical practitioners should complete this column if they:  supply an S8 drug to a patient.

25. Using the record of drugs received administered or supplied Page continued For identification purposes, the person authorised to witness the administration, supply or receipt of S8 drugs must:  sign name  print name The witness can be from the same professional category as the person completing the ‘Administered, supplied or received by’ column.

26. Using the record of drugs received administered or supplied page continued When the page is full record:  S8 drug’s current balance  page number of the new record of drugs received administered or supplied page that will record the drug’s transactions. Note: a new page number is to be recorded in the index page When commencing a new page to record an S8 drug’s transactions (following the page used previously being full), record:  balance of the page used previously  page number the balance is being transferred from.

27. General notes on record of drugs destroyed page  Partially used contents of an S8 drug e.g. in the form of an injection, vial or infusion are not to be recorded in the record of drugs destroyed page. The amount to be discarded should be recorded in the ‘amount discarded’ column on the same line as the entry for the dose administered in the records of drugs received administered or supplied page.  There are no individual drug pages to record the destruction of S8 drugs. They are all recorded in the same page of the record of drugs destroyed. Return to previous slide

28. Worked example of record of drugs destroyed New page in Register 2011 Return to previous slide

29. Using the record of drugs destroyed cont. Record:  name, form and strength of drug  amount destroyed (eg number of injections, number of tablets) Note: All S8 drugs destroyed are recorded on the same page of the record of drugs destroyed page. There is not an individual page for each type of S8 drug destroyed.

30. Using the record of drugs destroyed page Reason for destruction includes:  damaged Stock  expired Stock Page number refers to the page in the ‘Record of drugs received, administered or supplied’ where there is an entry recording that the S8 drug is to be destroyed.

31. Using the record of drugs destroyed page continued For identification purposes the authorised person must:  sign name  print name Note: The authorised person destroying the S8 drug cannot be from the same professional category as the authorised witness unless the destruction and witnessing is done by two pharmacists.

32. Who can destroy and who can witness the destruction of an S8 drug? Authorised person + Authorised witness Authorised personAuthorised witness registered medical practitioner director of nursing or registered pharmacist registered pharmacistregistered pharmacist, registered medical practitioner or director of nursing director of nursingregistered medical practitioner or registered pharmacist registered veterinary surgeonregistered pharmacist, registered medical practitioner or director of nursing registered dentistregistered pharmacist, registered medical practitioner or director of nursing Return to previous slide

33. S8 balance checks If the actual balance on hand does not equate to the recorded balance in the Register then the discrepancy needs to be identified.  Identified discrepancy: an entry is to be made in the Register to show the reason for the discrepancy and the balance is to be amended.  Unidentified discrepancy: an entry is to be made in the Register to indicate that the discrepancy has not been identified but is being investigated. The balance is to be amended to reflect the actual balance on hand and the discrepancy is to be reported to the CEO. Return to previous slide

34. Reporting discrepancies in Register  Any discrepancies in the Register are to be notified to the CEO of the Department of Health via the Corporate Governance Directorate within 24 hours of becoming aware of the discrepancy.  Discrepancies should be reported via the approved notification form.  All discrepancies should be reported and followed up including identifying the reason for the discrepancies and documenting and reviewing the reasons for the discrepancies.  The Pharmaceutical Services Branch of the Department of Health which is responsible for the monitoring of S8 drugs will be advised via the Corporate Governance Directorate of the discrepancy.  Other misconduct issues such as ordered stock not being received, possible misuse or diversion of the S8 drugs or concerns regarding entries in the Register should also be reported to the Corporate Governance Directorate.  The poisons permit holder of the S8 drugs should be advised of all investigations requiring follow up and review. Return to previous slide

35. Reporting discrepancies in the Register The approved form for reporting a discrepancy in the Register is to be completed and forwarded to Corporate Governance Directorate by: Facsimile to (08) 9222 2398 Email: accountability@health.wa.gov.auaccountability@health.wa.gov.au Refer to Operational Directive OD 0140/08 for further information.

36. General information on S8 drugs The following provides information on other features of S8 drugs including:  the names of S8 drugs the names of S8 drugs  how to store S8 drugs how to store S8 drugs  inventory of S8 drugs inventory of S8 drugs  patient’s own S8 medicine patient’s own S8 medicine Return to previous slide

37. S8 drugs S8 drugs are those drugs listed in Schedule 8 of the Standard for the Uniform Scheduling of Medicines and Poisons (SUSMP) and include:  morphine  pethidine  fentanyl  hydromorphone  ketamine  oxycodone  pentazocine  methadone  buprenorphine  dexamphetamine  methylphenidate Return to previous slide

38. How to store S8 drugs  All S8 drugs in hospital wards should be stored in a lockable cupboard in the ward or in a lockable portion of a cupboard in the ward where the area has been designated solely for the purposes of storing S8 drugs.  The registered nurse in charge of a ward where S8 drugs are stored is required to keep the key to the cupboard or the lockable portion of the cupboard in their personal possession. They are required to ensure that the cupboard or lockable portion of the cupboard is locked at all times except when stock is being removed or placed into the cupboard or lockable portion of the cupboard. Return to previous slide

39. Inventory of S8 drugs An inventory of S8 drugs should be done:  at intervals of not more than one month or  by persons handing over control of the S8 drugs and  by persons taking control of the S8 drugs If an inventory does not balance i.e. the physical balance does not match the actual recorded balance in the Register then the discrepancy should be identified. If the discrepancy cannot be identified then the person in charge of the S8 drugs at the time is required to advise the CEO in writing immediately. Refer to reporting discrepancies in Register for further information.reporting discrepancies in Register Return to previous slide

40. Patient’s own S8 medicine S8 medicine brought in by a person who is admitted to hospital should be:  stored in the ward where the patient is located  recorded in the ward where the patient is located in accordance with hospital policy. Return to previous slide

41. Related information and further enquires Related information  Operational Directive OD 0141/08 Code of practice for the handling of S8 medicines (drugs of addiction) in hospital and nursing posts.  Operational Directive OD 0140/08 Reporting of S8 medicine stock discrepancies in WA public hospitals including notification of S8 stock discrepancy form. Further enquiries  For further enquiries on the regulatory requirements of S8 drugs contact Pharmaceutical Services, Department of Health on 9222 6883. Return to previous slide