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Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
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pills1577x362April 20 2016

NICE has issued guidance bringing together legal requirements and existing guidance around the safe use and management of controlled drugs (CDs).

Recommendations in the guidance, NG64, cover:

  • developing and establishing systems and processes for organisations
  • record keeping for organisations
  • risk assessment for organisations
  • processes for reporting controlled drug-related incidents
  • prescribing CDs
  • obtaining and supplying CDs
  • administering CDs
  • handling CDs
  • monitoring the use of CDs.

The new guidance is intended to “help health and social care professionals negotiate complex legislation and regulations to ensure they are doing all they can to care for patients being treated with controlled drugs,” said NICE.

Among the recommendations it has highlighted are:

  • pharmacists should tell patients when only part of their prescription is available, and they should also tell patients when the rest will be ready and how soon they must collect it;
  • doctors should prescribe enough of a controlled drug to meet the person’s clinical needs for up to but no more than 30 days. If, under exceptional circumstances, a larger quantity is prescribed, the reasons for this should be documented in the person’s care record;
  • health professionals should provide advice and information to people prescribed medications about how to store and dispose of them safely – discuss lockable or non-lockable storage boxes, whether drugs will be accessible to others and whether the chosen storage method increases the risk of a drug-related incident;
  • health organisations should keep a record log for the supply, administration, transfer and disposal of controlled drugs.

“Since the Shipman Inquiry's Fourth Report in 2004, the government have introduced significant legislative changes to the Act to strengthen the governance arrangements for CDs,” said NICE. “A lot of work has been done to help ensure that CDs are managed and used safely at a local and national level. However, ongoing activity and vigilance is needed to sustain the positive developments that have been achieved.”

NICE has noted that the risk of death with CDs is far greater than with other medications, according to a seven year review of medicines-related safety incidents concerning CDs in England and Wales. It found that five commonly used CDs were responsible for 113 incidents (88.4%) leading to serious harm (death and severe harm), with overdose accounting for 89 (69.5%) of the 128 incidents of serious harm.

“This guideline provides further clarity and good practice recommendations for the safe use and management of controlled drugs across all NHS settings,” said NICE. “It supports organisations and health and social care practitioners to minimise harms associated with controlled drugs by having robust systems and processes in place. The recommendations were developed with the aim of bringing together legislation, policy advice, good practice advice and published evidence.”

Links:

NICE announcement

NICE guideline NG64 ‘Controlled drugs: safe use and management’

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