1. AFAMS EO 005.02 Maintaining Undercontrol Medication Inventory (Dari) 01/09/2013

2. 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

3. 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

4. AFAMS Overview EO 005.02 (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

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

6. AFAMS Form 58

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

8. 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

9. 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.

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

11. 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

12. AFAMS Authority to Order Controlled Drugs Dari OTSG Policy 18

13. AFAMS Authority to Order Controlled Drugs Dari OTSG Policy 18

14. AFAMS Authority to Order Controlled Drugs Dari OTSG Policy 18

15. AFAMS Uncontrolled Access OTSG Policy 18

16. 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.

17. AFAMS Appendix A

18. AFAMS Appendix B

19. AFAMS Uncontrolled Access OTSG Policy 18:

20. AFAMS Uncontrolled Access OTSG Policy 18:

21. AFAMS Uncontrolled Access OTSG Policy 18:

22. AFAMS Physical Count Requirements Dari OTSG Policy 18

23. AFAMS Physical Count Requirements Dari OTSG Policy 18

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

25. AFAMS Physical Count Requirements Dari ANA 6-81:

26. AFAMS Physical Count Requirements Dari OTSG Policy 18:

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

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

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

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

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

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

33. 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

34. AFAMS Dari Perpetual Log Dari

35. AFAMS Perpetual Log Example Dari

36. AFAMS Dari Perpetual Log Dari 20 Apr 13 Mohammad Taj Abdullah 0950 Behroz BehnamLatifa Ahmad 28----- 72 100 Previous page qty------ Morphine 10mg tablets -------

37. AFAMS Ward Requirements Dari Policies and Procedures of Pharmacy Department ANA

38. AFAMS Ward Requirements Dari Policies and Procedures of Pharmacy Department ANA

39. AFAMS Ward Transfers/ Dari

40. AFAMS Updating the Perpetual Log Dari

41. AFAMS Return from a Ward Dari

42. AFAMS Dari Perpetual Log Dari 20 Apr 13 Mohammad Taj Abdullah 0950 Behroz BehnamLatifa Ahmad 28----- 72 100 Previous page qty------ Morphine 10mg tablets ------- 20 Apr 13 1230 Pharmacy Behroz Behnam1587

43. AFAMS Error in Recording Dari

44. AFAMS Dari Perpetual Log Dari 20 Apr 13 Mohammad Taj Abdullah 0950 Behroz BehnamLatifa Ahmad 28----- 72 100 Previous page qty------ Morphine 10mg tablets ------- 20 Apr 13 1230 Pharmacy Behroz Behnam1587 20 Apr 13 1430Rm 5430Behroz Behnam Mohammad Taj Abdullah 15 ------ 20 Apr 13 1430Rm 5415Behroz Behnam Mohammad Taj Abdullah 15 ------ 102 signature

45. AFAMS Recording Accidental Destruction (Broken, Unserviceable) Dari

46. AFAMS OTSG Policy 18

47. AFAMS Dari Perpetual Log Dari 20 Apr 13 Mohammad Taj Abdullah 0950 Behroz BehnamLatifa Ahmad 28----- 72 100 Previous page qty------ Morphine 10mg tablets ------- 20 Apr 13 1230 Pharmacy Behroz Behnam1587 20 Apr 13 1430Rm 5430Behroz Behnam Mohammad Taj Abdullah 15 ------ 20 Apr 13 1430Rm 5415Behroz Behnam Mohammad Taj Abdullah 15 ------ 102 signature 21 Apr 13 1030PharmacyBehroz Behnam Destroyed 15 Destroyed ------ 87

48. AFAMS Returning Expired to QM Dari

49. AFAMS Dari Perpetual Log Dari 20 Apr 13 Mohammad Taj Abdullah 0950 Behroz BehnamLatifa Ahmad 28----- 72 100 Previous page qty------ Morphine 10mg tablets ------- 20 Apr 13 1230 Pharmacy Behroz Behnam1587 20 Apr 13 1430Rm 5430Behroz Behnam Mohammad Taj Abdullah 15 ------ 20 Apr 13 1430Rm 5415Behroz Behnam Mohammad Taj Abdullah 15 ------ 102 signature 21 Apr 13 1030PharmacyBehroz Behnam Destroyed 15 Destroyed ------ 87 23 Apr 13 1130QuartermasterBehroz Behnam Expired 10 ------ 77 2x signature

50. 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

51. AFAMS Under Control/ Controlled Medication Discrepancies Dari

52. AFAMS Reporting Discrepancies OTSG Policy 18: On Ward:

53. AFAMS Dispensary Responsibility Policies and Procedures of Pharmacy Department ANA

54. AFAMS Dispensary Responsibility OTSG Policy 18:

55. AFAMS Questions?

56. AFAMS Review Above Slides (Dari) AFAMS

57. 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): 20-30 mins Insert Dari

58. AFAMS Scenario

59. 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.

60. 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

61. AFAMS Dari Answer: Perpetual Log Dari 10 Sept 13 1425 Behroz BehnamPharmacy ------100 175 75 Previous page qty------ Tramadol 100mg tablets ------- When starting a new page always transfer the quantity on hand to the new page. Quartermaster

62. AFAMS Dari Answer: Perpetual Log Dari 10 Sept 13 1425 Behroz BehnamPharmacy -------100 250 150 Previous page qty------ Morphine 10mg tablets ------- When starting a new page always transfer the quantity on hand to the new page. Quartermaster

63. 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.

64. AFAMS Dari Answer: Perpetual Log Dari 10 Sept 13 1425 Behroz BehnamPharmacy -------100 175 75 Previous page qty------ Tramadol 100mg tablets ------- Quartermaster 10 Sept 13 1545 Behroz BehnamLatifa Ahmad 14----- 161Dr Abdullah

65. 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.

66. AFAMS Form 58 Patient Total of Each Drug Required Tablets

67. AFAMS Dari Answer: Perpetual Log Dari 10 Sept 13 1425 Behroz BehnamPharmacy -------100 250 150 Previous page qty------ Morphine 10mg tablets ------- Quartermaster 10 Sept 13 1545 Behroz Behnam5845 30 ------220 Dr Hussein 10 Sept 13 1545 Behroz Behnam 5846 10 ------ 210 Dr Hussein

68. AFAMS Questions?

69. AFAMS End of Lecture Dari