Controlled drugs

Re: Controlled drugs

Bob Russell — Wed, 07 Nov 2012 09:32:21 GMT

Apologies to Bob! On reflection there is a need to have a practical approach to the problem.

I can see no problem with just using the weight of the bottle (if you have good enough scales). The is no requirement to record volumes. Perhaps just keep a record of the weight.

If any goes missing it has some chance of being picked up. Still cynical about the practicalities though.

If we are going to jump through hoops because the Royal College says we do then we should make them large hoops at ground level!

Re: Controlled drugs

bob lehner — Tue, 06 Nov 2012 17:43:59 GMT

[quote user="Mark Holmes"]Weight per ml will be 1g/ml or at least close enough and any inaccuracy negliagable.[/quote]

Indeed - I was going to suggest getting the SG of the solution on your refractometer to aid the calculation - but thought I would probably be condemned as a total jobsworth/nerd ... and red-starred to death...!

Re: Controlled drugs

bob lehner — Tue, 06 Nov 2012 17:40:44 GMT

[quote user="Bob Russell"]Wow1 We are now expected to weigh our bottles to keep Belgravia House happy.[/quote]

Ummm - no - that's just my suggestion - came to me in a flash one day, having dealt with many unhappy practitioners...!

Re: Controlled drugs

Mark Holmes — Tue, 06 Nov 2012 17:10:28 GMT

Weight per ml will be 1g/ml or at least close enough and any inaccuracy negliagable.

Re: Controlled drugs

Bob Russell — Tue, 06 Nov 2012 15:54:07 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="bob lehner"]One simple solution is to weigh a full bottle of the product, then an empty bottle - thus work out the wt per ml and then weigh the bottle weekly to determine how much has been used. (Do need some accurate small scales - but the sort you might use to weigh tiny critters should be OK).[/quote]

A useful tip.

(If circumstances should require you to be so meticulous. I repeat, RCVS has no power to change the law or make new laws.)

[/quote]

Wow1 We are now expected to weigh our bottles to keep Belgravia House happy.

Re: Controlled drugs

Evelyn Barbour-Hill — Tue, 06 Nov 2012 15:44:33 GMT

A useful tip.

(If circumstances should require you to be so meticulous. I repeat, RCVS has no power to change the law or make new laws.)

Re: Controlled drugs

bob lehner — Tue, 06 Nov 2012 15:16:17 GMT

[quote user="Evelyn Barbour-Hill"]s for auditing the CD: sucking the contents out of the bottle every week and squirting it back in? Every time you muck about with the contents of a bottle you mess it up more. This is insanity.[/quote]

I tend to agree. However it is an interesting problem if you do want to follow the rules and do a reasonably accurate audit on a weekly basis for Sch 2s (and ketamine).

A visual check on the bottle is not going to be very accurate (you can mark a scale down the side of the bottle with an indelible marker to help), but some bottles do not really lend themselves to a visual check - e.g. Ketaset, where the label goes all the way round the bottle, so you can't see the level inside.

One simple solution is to weigh a full bottle of the product, then an empty bottle - thus work out the wt per ml and then weigh the bottle weekly to determine how much has been used. (Do need some accurate small scales - but the sort you might use to weigh tiny critters should be OK).

Re: Controlled drugs

Michael Woodhouse — Sun, 04 Nov 2012 23:45:26 GMT

[quote user="Richard Larkin"]

I reckon there are 3 possible reasons for losses.

1) Inevitable losses; ie needle, hub losses, losses of a drop or two when getting rid of air etc

2) failiure to book out injections in register

3)Theft[/quote]

Don't forget evaporation. Depending how quickly you get through these bottles it can be quite significant. I went through a stage of keeping the last ~1ml of Domitor and ~1ml of Antisedan in my car for sedating dogs forPTS or other situations where I may need to reverse an alpha 2 (bulls and foot trimming etc). Bearing in mind these vials had been broach a good number of times the bottles could empty in a few weeks.

I now carry a full bottle of generic atipamazole and if I open it I take it into the surgery to be used up and only keep new, sealed bottles in the car. Sedate dogs for PTS with Xylazine.

Re: Controlled drugs

Rob Loxley — Sat, 03 Nov 2012 15:24:51 GMT

[quote user="Evelyn Barbour-Hill"]As for auditing the CD: sucking the contents out of the bottle every week and squirting it back in? Every time you muck about with the contents of a bottle you mess it up more. This is insanity[/quote]

Indeed; we count the countable (fentanyl patches, individual glass ampoules) and reconcile the multidose vials when a new one is broached (eyeballing in between times).

Re: Controlled drugs

Evelyn Barbour-Hill — Sat, 03 Nov 2012 14:42:12 GMT

[quote user="bob lehner"]

Recommended to do ketamine CD Register exactly as for Sch 2 drugs -but VS does not have to sign each entry. i.e. record your purchases, supply and a running balance, with a weekly audit.

Re running balance and weekly audit -I think it is recognised that it is not possible to achieve precise accuracy in matching volumes in view of small losses as you state. My opinion is that you are required to be able to account for your usage of Sch 2 CDs and ketamine - you want to know that what you have in the cabinet matches what it says you have in the register, within a small margin of error.

[/quote]

It seems it cannot be said too often: Belgravia House has no powers whatever to change the law on ketamine. The law does not require a register of ketamine. Belgravia House know that in their hearts, hence the deliberately vague "informal register". Having said that, it is sensible to keep ketamine locked up and to take steps sufficient to determine if quantities are going missing. This is a classic example of Professional Conduct as opposed to Law and if properly applied is an example of how a professional code can actually be superior to law.

Exactly how much recording of ketamine you need to do depends very much on individual circumstances: how big the practice is, how many people have access, how much is stocked, how much is used and how often. I'd maintain that at the lowest level the only register needed is the one in the boss's brain.

As for auditing the CD: sucking the contents out of the bottle every week and squirting it back in? Every time you muck about with the contents of a bottle you mess it up more. This is insanity.

Re: Controlled drugs

Richard Larkin — Fri, 02 Nov 2012 08:32:11 GMT

Thanks everyone for your thoughts. The main issue for us being a relatively large practice is the number of people with access and I am just trying to be as accurate as possible without being too time consuming.

I reckon there are 3 possible reasons for losses. 1) Inevitable losses; ie needle, hub losses, losses of a drop or two when getting rid of air etc

2) failiure to book out injections in register

3)Theft

Re: Controlled drugs

Bob Russell — Thu, 01 Nov 2012 17:51:47 GMT

However much you try to account for the volumes used it is completely impractical and virtually pointless. We record each dose used (the computer produces a label). It is recorded in a book and that is that.

A few ml's going astray is going to be impossible to identify. Fortunately I am the only one routinely drawing up ketamine which make it easier.

In a bigger practice I can appreciate the risks of abuse not being picked up and I don't have a good answer for it. If anyone genuinely was that bothered I am sure multidose vials would be made illegal. Licencing a multidose methadone seems a pretty irresponsible step. Single ampules would be much more secure and easier to monitor.

Veterinary ketamine is probably much more hassle to abuse than the cheap stuff readily available out there for recreational use.

Re: Controlled drugs

Martin Atkinson — Thu, 01 Nov 2012 14:51:19 GMT

[quote user="Richard Larkin"] Am I being overly zealous in doing this?[/quote] Probably yes, I think so long as each complete vial/bottle is accounted for you're OK, but paradoxically I do record every fraction of a ml of ketamine used in a spare diary. But then I'm the only one with a key to the cabinet.

Re: Controlled drugs

Rob Loxley — Thu, 01 Nov 2012 14:27:37 GMT

[quote user="Richard Larkin"] I reckon every time we draw up a dose we are 'losing' 0.05 mls[/quote]

Suggest using insulin syringes or low-dead-space 1ml syringes to reduce these losses

Re: Controlled drugs

Michael Woodhouse — Thu, 01 Nov 2012 12:20:35 GMT

There is just me and my wife with access to DD cabinet. We just use computer to record ketamine, but if it was a bigger practice I would start a register.

We find the Comfortan says about right.

Re: Controlled drugs

James Laidlaw — Thu, 01 Nov 2012 12:10:26 GMT

If you keep a running total of what's been used you'll have a better idea when the bottle goes empty of what was used, rather than drawing up continually. Also regular drawing up is potentially more contaminant if not absolutely necessary?

We keep a log with the amount used for each patient as they go and a running total plus any discard (unused vial components). Seems to work fine and allow us to track any losses - which we haven't had so far!

Re: Controlled drugs

bob lehner — Thu, 01 Nov 2012 11:55:10 GMT

[quote user="Richard Larkin"]Also ketamine is supposed to be monitored by an 'informal' register, how do people interpret 'informal'. We do the same as Sched 2 drugs.[/quote]

Recommended to do ketamine CD Register exactly as for Sch 2 drugs -but VS does not have to sign each entry. i.e. record your purchases, supply and a running balance, with a weekly audit.

Essentially you want to know that the stuff is not going missing for whatever reason - i.e not booked out, stolen etc etc.

In the real world 0.25 ml is neither here nor there - but if you are say 5-10 mls down then there is a problem that needs looking into big time.