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Controlled Drugs Management in Care Homes Policy

Policy Statement

This policy describes the procedures for the safe storage, administration and disposal of any controlled drug used in the home.

“Controlled drugs” refer to those medications that have been identified as potentially addictive or hazardous and thus require special provisions if they are to be prescribed, kept and used.

Such drugs are covered under the Misuse of Drugs Act 1971, as amended, which classifies them into three separate categories according to their capacity for harm: Class A, Class B and Class C. The Misuse of Drugs Regulations 2001 further classifies the drugs into five schedules relating to lawful possession and supply.

Controlled drugs are subject to the same procedures for medicines administration in the home in line with its medicines policies and procedures, but with extra precautions and safeguards.

{{org_field_name}} supports the NHS STOMP initiative in respect of the overprescription of psychotropic and other drugs to control behaviour that are often inappropriately prescribed, particularly for people with learning disabilities and autism. From its observations it will always question the prescribers about any situation where it considers there has been overprescribing that is affecting the health and wellbeing of the individual concerned.

Legislation and Guidance

The policy and procedures which the home has developed are in line with the applicable national standards for health and social care, relevant legislation and best practice guidance relating to the management and administration of medication in adult social care, including:

• the Medicines Act 1968
• the Misuse of Drugs Act 1971
• the Misuse of Drugs Regulations 2001
• the Misuse of Drugs (Safe Custody) Regulations 1973
• SC1 Managing Medicines in Care Homes (March 2014) National Institute for Health and Care Excellence (NICE)
• NG11 Challenging Behaviour and Learning Disabilities: Prevention and Interventions for People with Learning Disabilities Whose Behaviour Challenges (May 2015), National Institute for Health and Care Excellence (NICE)
• QS85 Medicines Management in Care Homes (March 2015) National Institute for Health and Care Excellence (NICE)
• The Safe and Secure Handling of Medicines (December 2018) Royal Pharmaceutical Society.

The Care Quality Commission have supported regulation by publishing an online resource, Medicines Information for Adult Social Care Services. Updated in March 2023, the resource provides links to a range of webpages providing information and guidance, including Controlled Drugs in Care Homes.

Procedure

In {{org_field_name}}, the following applies.

1. Controlled drugs must be kept in the lockable metal cupboard specifically provided for the purpose. The cupboard is secured to a solid wall and has a double lock mechanism. It complies with British Standard BS2881:1989 security level 1 and with relevant legislation.
2. The controlled drugs cupboard must be kept locked at all times. Access to the cupboard should be limited to approved staff only. For each shift the controlled drugs cupboard keys must be kept by the designated responsible duty person in charge. Spare keys must be kept securely by {{org_field_name}} manager.
3. Any controlled drugs in {{org_field_name}} must be prescribed for individual residents by an appropriately qualified healthcare professional and dispensed by a pharmacy or dispensing practice. Controlled drugs for individual residents will be dispensed by the pharmacist in line with their procedures. On receipt at the home, the supply will be checked against the prescription by a registered nurse or responsible staff member who has been trained in medicines administration and witnessed by another member of staff who is also suitably trained in medicines administration.
4. The name of the resident, quantify of medication, and type and date of medication should be recorded in the Controlled Drugs Register and the medication immediately transferred to the controlled drugs cupboard and locked away. This procedure should also be recorded by the responsible person and witnessed by another competent person. (NICE guidance recommends that care homes should have at least two staff members with the training and skills to order and be responsible for the safe storage, administration and disposal of medicines, including controlled drugs, although ordering can be done by one member of staff. In nursing homes, registered nurses will usually act as the responsible persons.)
5. Different strengths and forms of the same medication should be entered on separate pages and a new page should be started for each new receipt.
6. The total balance of drugs in stock will be recorded and any returns to the pharmacy must be signed for by a designated person. Any discrepancy in the quantity should be reported immediately to the pharmacist concerned.
7. Only controlled drugs should be recorded in the controlled drugs register and kept in the controlled drugs cupboard. Other medicines should be kept in the standard medicines cupboard.
8. The home is aware that the requirement to use the controlled drugs register and to store products in the controlled drugs cupboard only legally applies to certain schedules of drugs. However, to ensure safety, in {{org_field_name}} it will apply to all controlled drugs from all schedules.
9. When controlled drugs are administered by care staff, a second appropriately trained member of staff should be on hand to double-check the dose. Both members of staff must witness the person taking the medication and both should sign the Controlled Drugs Register and relevant medicine administration record (MAR) chart.
10. Extreme care must be taken when measuring volumes of liquids and staff should always read-off volumes from the bottom of the meniscus at eye level to avoid errors.
11. If a dose is refused, or only partly taken, both members of staff must witness the disposal of the remaining medication, record the details and sign to that effect in the Controlled Drugs Register and on the MAR chart.
12. Where a controlled drug dose is refused, the resident’s GP should be contacted for advice if the resident’s health or wellbeing is at risk due to the refusal.
13. If a tablet is dropped on the floor or somehow spoilt, an entry should be made in the register and witnessed by a second member of staff. The tablet should then be stored in the controlled drugs cupboard awaiting disposal.
14. Stock checks should be conducted by two approved members of staff who should note all quantities and make an appropriate entry in the register. Any discrepancies should be communicated to {{org_field_name}} manager immediately.
15. Any adverse events, incidents, errors and near misses involving controlled drugs should be handled according to the Drug Errors Policy and thoroughly investigated.
16. Where a self-medicating resident uses a controlled drug, a risk assessment should be conducted regarding the safety of the resident self-administering the drug and storing it in their room with the rest of their medication.
17. Where the risk assessment suggests that it would be safe and appropriate for the resident to keep and administer the drug themselves, sensible precautions should be put in place to ensure that controlled drugs are not stolen from the resident or left lying around.
18. When the person manages their own medication and is wholly independent (ie they are responsible for requesting a prescription and collecting the controlled drugs personally from the pharmacy) there is no need to keep a record in the Controlled Drugs Register.
19. When a resident’s controlled drugs are no longer required they should be disposed of safely and a record kept in the Controlled Drugs Register of who returned them, the quantity and the date. This disposal should be witnessed. In {{org_field_name}}, waste controlled drugs should be returned to the supplier.
20. When a new resident transfers into {{org_field_name}} {{org_field_name}} manager or the person responsible for a resident’s transfer into the home should co-ordinate the accurate listing of all the resident’s medicines (medicines reconciliation) as part of a full needs assessment and care plan. This should include not only the name of any controlled drugs but also the strength, form, dose, timing and frequency, how the medicine is taken (route of administration) and what it is for. The date and time the last dose of any “when required” doses should also be recorded.

Implementation

All staff are responsible for the implementation of this policy. Overall responsibility for ensuring that the policy is implemented, monitored and reviewed rests with {{org_field_name}} manager. Information on the policy will be:

• circulated to all staff
• provided to all new employees
• included in the Medication Management in Care Homes Policy.

{{org_field_name}} manager will ensure that the procedures contained within this policy are followed by all staff and will ensure that all staff expected to deal with controlled drugs are aware of how to access the policy. The manager will identify any areas of significant risk and take action to control this risk, promoting and demonstrating good practice associated with controlled drug use at all times.

All staff dealing with controlled drugs will ensure they are familiar with this policy and will be expected to follow the correct procedure when undertaking any task involving controlled drugs. They must report any concerns relating to the risks associated with controlled drugs to {{org_field_name}} manager or the relevant pharmacist so action can be taken.

Training

All new staff must understand this policy, which will be introduced in their induction training. Staff with specific duties and responsibilities under the policy will be given the appropriate training, including refresher training, to ensure and maintain their competence.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

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