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Katharine House Hospice Drug Policy

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Katharine House Hospice Drug Policy KATHARINE HOUSE HOSPICE DRUG POLICY 5th EDITION Approved by: Date of Approval: Originator: Medical Director Ref: BR/Policies/Drug Revision: 4 Approved: Page 1 of 108. Revision due by: KATHARINE HOUSE HOSPICE Preface The use of drugs is an essential part of Palliative Care, but drugs are potentially dangerous if used without due care and attention. This Drug Policy collates a range of policy and multiple drug- related procedures into one document in a way that is intended to minimise the risk of drug- related harm at Katharine House Hospice. Because of the interrelatedness of much of this information, the document is extensively cross-referenced. However, every effort has been taken to make each separate section complete in itself and, in order to achieve this, certain key points may have been repeated in different parts of the document. This Policy has taken account of all appropriate pieces of national legislation. Every relevant standard in the Department of Health National Minimum Standards for Independent Health Care 2002 has also been considered in drawing up this policy, as well as all pertinent advice contained in any correspondence we have had with the HealthCare Commission. Guidance from a range of advisory bodies has also been considered. The hospice is now regulated by the Care Quality Commission. However, reference is still deliberately made to the now defunct Health Care Commission when this specifically relates to correspondence with that organisation that helped to clarify aspects of hospice policy and procedure. A number of in-house procedures and clinical guidelines supplement the Drugs Policy. These include: • Procedure for the Procurement, Handling and Storage of Oxygen Cylinders (Clinical Policies Folder). • Patient Self-Administration of Medicines Policy and Procedure (Clinical Policies Folder) • Procedure for Access to Specialist Advice & Support, including out-of-hours access (Clinical Policies Folder). • Syringe Driver Guidelines (Clinical Guidelines Folder). • Enteral tube policy and procedure (Clinical Policies Folder). • Enteral tube guidelines (Clinical Guidelines Folder). In order to check our compliance with regulations regarding the prescribing of Schedule Two Controlled Drugs, it was felt necessary to ascertain whether or not the hospice drug charts were “prescription” charts. Both the Royal Pharmaceutical Society and Nursing and Midwifery Council avoid the term “prescribing” with regard to inpatients and they describe such charts as “drug administration charts”. We have therefore taken the same approach, and spoken about “drug instructions” for inpatients and “drug orders” for the medication that patients require on being discharged from the unit (TTOs). Only drug orders for Schedule Two Controlled Drugs need fully comply with the regulatory prescribing requirements for such drugs. The safe use of therapeutic drugs is an important professional responsibility. Any member of staff with a concern about the administration of any drug to any patient is actively encouraged to raise this with a member of the medical team (ideally the doctor responsible for writing the drug instruction) and/or the Pharmacist as soon as possible. Any doctor who is approached about such a matter is expected to deal with it immediately and carefully, typically through careful joint exploration of the perceived problem with the person raising the concern so that a safe and satisfactory outcome can be achieved. Likewise, any member of staff with concerns about any aspect of the Drug Policy is advised to bring these to the attention of the Medical Director. All such concerns will be considered very carefully. Ref: BR/Policies/Drug Revision: 4 Approved: Page 2 of 108. Revision due by: KATHARINE HOUSE HOSPICE CONTENTS A: Responsibilities, Regulations, Drug formulary and drug administration rights ... 7 A.1: Responsibilities ....................................................................................................... 7 A.2: Regulations............................................................................................................ 10 A.3: Drug formulary...................................................................................................... 12 A.4: Drug administration rights .................................................................................... 13 A.5: Payment for Hospice Pharmacy Services.............................................................. 14 B: Procedure for safe and secure storage of medicines on the ward. ......................... 15 B.1: Accommodation for medicines.............................................................................. 15 B.2: Custody and safe keeping of keys. ........................................................................ 17 B.3: Drugs that may be kept at a patient's bedside rather than in a locked medicine cupboard........................................................................................................................ 18 B.4: An audit trail for all drugs ..................................................................................... 19 B.5: Action to be taken in the event of failure of the refrigerator for medicines requiring refrigeration ................................................................................................... 21 C: Pharmacy supplies for non-Controlled Drugs......................................................... 22 C.1: Drug supply from Pharmacy. ................................................................................ 22 C.2: Routine top-up service for stock items that are obtained from Pharmacy. ........... 23 C.3: Stock items obtained from Pharmacy that are requested between top-up days. ... 24 C.4: Ordering non-stock items from Pharmacy. ........................................................... 25 C.5: Ordering stock items that are not obtained from Pharmacy.................................. 26 C.6: Ordering discharge medication from Pharmacy. (See also Section K.7).............. 27 C.7: Procedure for the delivery and receipt of discharge medication and any non- Controlled Drugs required between weekly formal top-ups. ........................................ 29 C.8: Procedure for handling oral cytotoxic drugs. ........................................................ 30 D: Arrangements for urgent supplies of drugs, including out-of- hours. .................. 31 D.1: Urgent supplies of drugs from Pharmacy.............................................................. 31 E: Patients' Own Drugs................................................................................................... 32 E.1: Procedure for dealing with Patients’ Own Drugs brought in it the time of admission....................................................................................................................... 32 E.2: Patient Self-Administration of Medicines ............................................................. 34 F: Dealing with unwanted stock drugs and fluids. ....................................................... 35 F.1: Patients' Own Drugs that were temporarily moved into ward supply ................... 35 F.2: Excess Ward Stock ................................................................................................ 35 F.3: Intravenous fluids................................................................................................... 35 F.4: Drugs that have been prepared on the inpatient unit but not administered to a patient............................................................................................................................ 35 Ref: BR/Policies/Drug Revision: 4 Approved: Page 3 of 108. Revision due by: KATHARINE HOUSE HOSPICE G: The disposal of non-Controlled Drugs ..................................................................... 36 G.1: Introduction ........................................................................................................... 36 G.2: Non-cytotoxic, non-Controlled Drug Disposal Bins............................................. 36 G.3: Cytotoxic and cytostatic non-Controlled Drug disposal bin ................................. 37 G.4: The disposal procedure.......................................................................................... 38 H: Procedure for missing drugs other than Controlled Drugs.................................... 39 J: Procedure relating to Schedule Two Controlled Drugs........................................... 40 J.1: What is a Controlled Drug?.................................................................................... 40 J.2: Controlled Drug Legislation, Regulation and Guidance. ....................................... 41 J.3: Responsibility for Controlled Drugs in the hospice. .............................................. 42 J.4: The handling of Controlled Drugs that come from the patient............................... 43 J.5: Controlled Drugs used in clinical trials. ................................................................. 44 J.6: Use of a patients own supply of Controlled Drug when their requirements cannot be immediately met from ward stock............................................................................ 45 J.7: The ordering, supply, delivery and receipt of Controlled Drugs into ward stock. 47 J.8: The orderly use of Controlled Drugs from ward stock........................................... 50 J.9: Record keeping for Controlled Drugs that form part of ward stock....................... 51 J.10: Controlled Drug Storage and Controlled Drug
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