Controlled Drugs

1.         Check Use History in particular overlap’s of medication / Loss of medication

2.         Check OOH reports for other prescriptions

3.         Consider the patient being placed on weekly scripts

           4.    Read Code monitoring and record clinical decision;

ALERT – Weekly Scripts – Any patient on weekly Scripts has already been identified as a ‘Risk’ patient, before issuing medication, check

Clinician Actions when faced with this Alert before issuing next week supply;

1.       Compliance of Weekly scripts

2.       Check OOH reports for other prescriptions

3.       Do you have a face to face review recall set

4.       Read Code monitoring and Record Clinical Decision

ALERT –Daily Scripts – Any patient on daily Scripts has already been identified as a ‘Risk’ patient, before issuing medication, check

Clinician Actions when faced with this Alert  before issuing next batch of prescriptions;

1.       Compliance of Daily scripts

2.       Check OOH reports for other prescriptions

3.       Do you have a face to face review recall set

4.       Read Code monitoring and Record Clinical Decision  

ALERT – Management Plan – Any patient identified at Risk and who needs to be escalated to a management plan – this involves planned monitoring of this patient at agreed intervals with the patient and putting into place an agreed management plan of their medication. The patient will be managed by a ‘usual Dr’ who knows the patient the best.

Print off Opioid Agreement and have the patient sign the agreement, scan into patients records and arrange the follow up review

ALERT – Partner Led Management Plan – The partner led management plan is for patient’s identified at a greater risk, this may be due to the patient being a SG patient or a patient who needed additional management, when presented with these patients, time is to be taken to look through their records, discharge summaries, medication history etc… this is then to be discussed with a Partner colleague before prescribing – the number of patients on the Partner Led Plan should be minimal. 

Each OOH CD request / prescription triggers a review of the medical records and the medication record. The reviewing clinician is to make an entry of this in the patients records – The Clinical Read-Coding Admin Staff are you look for these OOH reports as first line to highlight for the GP to action.

The practice has a SEA process in place to support review of incidents including those that involve CDs

The Lincolnshire Police Liaison team number is:

Incidents involving CD’s are reported on Datix

Incidents involving CD’s are to be reported to NHS England CDAO via www.cdreporting.co.uk. This should occur within 48 hours.

*** Schedule 2 and 3 CDs are NOT to be prescribed as REPEATS

*** Hand Signed Prescriptions for Schedule 2,3 or 4 CDs without consultation is a clinical decision that can only be made on a case by case basis.

·  Opioids should not be added to repeat prescribing lists and should be generated as acute prescriptions

·  The prescriber and the patient together should review the continuing benefit of opioid therapy and potential harms at regular intervals (at least twice a year)

·  Requests for 2,3 or 4 CDs are subject to strict Standard Operating Procedures within the practice with clear lines of accountability and responsibility for admin staff and clinical staff.

·  Medication review is auditable with clear evidence in the medical records that total quantities issued have been reviewed and have been found to be clinically appropriate by the doctor that knows the patient the best ‘the usual Dr’

·  The prescription for the CD is signed by ‘the usual Dr’

****This should be read in conjunction to the Practice Prescribing Policy

The practice monitors the prescribing of Controlled Audits Monthly by  auditing patients prescribed the following drugs:

Key area’s we are looking for in the audit are:

1.       Supply in excess of 30 days

2.       Overlapping of issued drugs

3.       OOH prescriptions

4.       Increasing dosage

5.       Management reviews taking place

6.       Pop Up Alerts In place to reflect the management plan