Is there another use for a Locum?

RE: Is there another use for a Locum?

Thomas Johnson — Mon, 30 Oct 2017 09:35:49 GMT

[quote user="Gillian Mostyn"]

[quote user="Anthony Todd"]the key storage, as it is decreed now, makes "security" conceivably to easily breached.[/quote]

If you are talking about password protected safes, we have one of those. (Not for drug storage currently.) You can change the password as often as you wish. They also have a key for back-up. They can be handy in emergency situations as you can give someone remote access with no need for a key.

[/quote]

The key for our controlled drugs cabinet is in a passcode protected box on the wall. There has been an occasion where I needed to give someone else the code, I think it was for a nurse to euthanase an injured wild animal when I wasn't in the building. The code was changed immediately afterwards.

RE: Is there another use for a Locum?

Michael Woodhouse — Sun, 29 Oct 2017 01:17:02 GMT

You'll be delighted to know that I took bottle size into account when sourcing our dangerous drugs storage in the practice and in the cars. We've taken a rather large and worrying leap from suicide to mass murder.....

I'm not going out on call without enough to kill at least 2 cows, so I'd have multiple, small bottles anyway. Not convinced they are any more dangerous.

RE: Is there another use for a Locum?

Anthony Todd — Sun, 29 Oct 2017 00:59:52 GMT

[quote user="Michael Woodhouse"]what is your perceived increased risk with 500ml bottles?[/quote]

Just that they were too big to fit easily into our drug safes and 100ml would be inherently safer, ie only kill one person, not 5.... and, I think, Euthatal was withdrawn at the time so we had no other option??

Not very robust reasons, I admit!

RE: Is there another use for a Locum?

Michael Woodhouse — Sat, 28 Oct 2017 20:38:59 GMT

[quote user="Anthony Todd"]Are 500ml bottles still around??[/quote]

Yes. I have 2 in my car and probably half a dozen in the practice. Usually run 200ml through a flutter valve to kill a cow or 60X3 In to a horse.

I'm 100% sure 100ml would kill a person, what is your perceived increased risk with 500ml bottles?

RE: Is there another use for a Locum?

Anthony Todd — Sat, 28 Oct 2017 19:51:19 GMT

[quote user="Gillian Mostyn"]I think if a vet planned to kill themselves or someone else there are easier ways than that. Who will allow someone to put that amount in their vein???[/quote]

Er, one vet did, I/V, in another vet's bath.

Anything else was in the drug safe...

Are 500ml bottles still around??

RE: Is there another use for a Locum?

Gillian Mostyn — Sat, 28 Oct 2017 19:40:05 GMT

[quote user="Anthony Todd"]the key storage, as it is decreed now, makes "security" conceivably to easily breached.[/quote]

RE: Is there another use for a Locum?

Gillian Mostyn — Sat, 28 Oct 2017 19:38:08 GMT

[quote user="Anthony Todd"]

[ I assume the 500mls of pentobaarb for euth isn't still available as I know, definitely of two instances, one tragically successful, one not, where this was used]

I can't believe it is available still, 'cos it's obviously open to severe abuse!??

[/quote]

I think if a vet planned to kill themselves or someone else there are easier ways than that. Who will allow someone to put that amount in their vein???

I expect the regulations are as much about traceability as anything else. If a drug is abused or, in the worst instance, used to hurt someone else, then it should be easy follow up who took it. If there is general access, or lax recording, that would be difficult.

RE: Is there another use for a Locum?

Anthony Todd — Sat, 28 Oct 2017 19:33:37 GMT

[quote user="Gillian Mostyn"]OK. You seemed to think that the secure storage was unnecessary, which puzzled me. I think it is really important.[/quote]

No it is necessary and important; [see my other post] the key is "secure". and the key storage, as it is decreed now, makes "security" conceivably easily breached.

Key in responsible person's pocket would be better??

RE: Is there another use for a Locum?

Gillian Mostyn — Sat, 28 Oct 2017 19:27:45 GMT

OK. You seemed to think that the secure storage was unnecessary, which puzzled me. I think it is really important.

Anyway, I agree with you. I do think that we should be able to dispose of CDs in house, although I think there should be at least 2 professionals present to carry it out and witness it.

Hope I explained myself clearly dear.

RE: Is there another use for a Locum?

Anthony Todd — Sat, 28 Oct 2017 19:22:30 GMT

Just:

[quote user="Gillian Mostyn"]the need for an external witness to their disposal?[/quote]

[ I assume the 500mls of pentobaarb for euth isn't still available as I know, definitely of two instances, one tragically successful, one not, where this was used]

I can't believe it is available still, 'cos it's obviously open to severe abuse!??

RE: Is there another use for a Locum?

Gillian Mostyn — Sat, 28 Oct 2017 19:05:57 GMT

Anthony...just for the avoidance of doubt, what is it you are annoyed about WRT CDs? The strict record keeping of purchase, use and disposal, the restricted access to them by certain staff, or the need for an external witness to their disposal?

RE: Is there another use for a Locum?

Anthony Todd — Sat, 28 Oct 2017 19:00:03 GMT

[quote user="Gillian Mostyn"]Yes...if you can tell me what emergency situation you're talking about needing it in?[/quote]

Give up, dear.

RE: Is there another use for a Locum?

Gillian Mostyn — Sat, 28 Oct 2017 18:22:32 GMT

[quote user="robloxley"]Fentanyl injection? Do I get a prize[/quote]

Yes...if you can tell me what emergency situation you're talking about needing it in?

RE: Is there another use for a Locum?

Rob Loxley — Sat, 28 Oct 2017 12:33:23 GMT

[quote user="Gillian Mostyn"]

[quote user="Anthony Todd"]Anaesthetic problem whilst scrubbed, shouts password for key; safe opened a bit too late,[/quote]

I'm obviously missing something...but I can't think of a CD that would be needed in a time sensitive anaesthetic emergency... ???

[/quote]

Fentanyl injection? Do I get a prize?

RE: Is there another use for a Locum?

Anthony Todd — Sat, 28 Oct 2017 12:31:37 GMT

PS Or vet and nurse bailed up in consult room by wild staffie-cross??

Come on, it's the principle, not an excuse for scoring points.

RE: Is there another use for a Locum?

Anthony Todd — Sat, 28 Oct 2017 12:22:43 GMT

[quote user="Gillian Mostyn"]I'm obviously missing something...but I can't think of a CD that would be needed in a time sensitive anaesthetic emergency... ???[/quote]

Nor can I. it was meant to demonstrate the holes in the system.....

ie the password for the key will soon be common knowledge.

RE: Is there another use for a Locum?

Gillian Mostyn — Sat, 28 Oct 2017 11:46:05 GMT

[quote user="Anthony Todd"]Anaesthetic problem whilst scrubbed, shouts password for key; safe opened a bit too late,[/quote]

I'm obviously missing something...but I can't think of a CD that would be needed in a time sensitive anaesthetic emergency... ???

RE: Is there another use for a Locum?

Anthony Todd — Sat, 28 Oct 2017 11:14:48 GMT

Talking to a vet yesterday; drug safe key in separate password protected little safe.

Anaesthetic problem whilst scrubbed, shouts password for key; safe opened a bit too late, so key now kept in drug cupboard lock now all day.

Regulation, regulation, regulation.....

RE: Is there another use for a Locum?

Anthony Todd — Sat, 28 Oct 2017 11:06:46 GMT

[quote user="Alistair Graham-Evans"]Some clinics with poor records never seem to be inspected! [/quote]

Of course not!!

Gotta show the system is working perfectly or awkward questions might be asked and fingers pointed!!

RE: Is there another use for a Locum?

Alistair Graham-Evans — Sat, 28 Oct 2017 00:46:47 GMT

About 6 years ago, just prior to me buying the business a nurse was caught stealing morphine vials for personal use. It was discovered very early when the register was out by a couple of vials and the individual had stolen a vet's safe key to gain access.

There was a suspect and confirmed when caught in the act on the next occasion. It was reported to Queensland Health who are the regulatory authority and they treated the clinic owners like criminals despite the accurate record keeping alerting them to the problem as soon as it happened. They seemed to totally miss the point that the drug recording book was perfect and indicated the problem immediately! I have been a locum in many clinics where the record keeping is abysmal. Anther example of the clipboard brigade only interested in ticking boxes - they inspect this clinic every year with spot checks and often bring along trainees and know the books and facilities are perfect. Some clinics with poor records never seem to be inspected!

RE: Is there another use for a Locum?

Michael Woodhouse — Sat, 28 Oct 2017 00:27:34 GMT

[quote user="robloxley"]Shipman was pocketing huge quantities of diamorphine and killing lots of patients with it so the audit trail needed tightening and you can see why it was deemed necessary to have some independent oversight of the CD disposal.[/quote]

Clear liquid, multi dose vial, clever people. A CD register is practically meaningless. I'm sure every single one of us could obtain CDs if we wanted. That's what annoys me.

RE: Is there another use for a Locum?

Rob Loxley — Fri, 27 Oct 2017 18:11:40 GMT

[quote user="J G Wray"]

[quote user="Malcolm Ness"]I think it has more to do with the gradual dilution of the concept of a Liberal Profession. T[/quote]

I think it is Home Office thinking post Shipman. It's not appropriate, but there we are. It'll take VMD and RCVS to change things

[/quote]

Shipman was pocketing huge quantities of diamorphine and killing lots of patients with it so the audit trail needed tightening and you can see why it was deemed necessary to have some independent oversight of the CD disposal.

RE: Is there another use for a Locum?

Anthony Todd — Fri, 27 Oct 2017 15:20:25 GMT

PS One side-effect of this ridiculous "dispose-after" regulation is that it should be possible to record what is actually being "disposed of" and then publish, say over a year, how much, by any parameter is being wasted and at what cost.

This waste is not only to clients, ['cos the waste is factored in the cost] and vets but even the environment, in the energy, valuable resources, environmental damage etc. etc.

All with no evidence at all to back it up!

RE: Is there another use for a Locum?

Anthony Todd — Thu, 26 Oct 2017 17:53:10 GMT

[quote user="J G Wray"]It'll take VMD and RCVS to change things[/quote]

But both organisations will have an edifice of hard-working staff who are so busy that they can't get back to you within 15 days, sorry 15 working days that's three f'ing weeks....., and are doing this 15 day time-lag job exactly to control what you want to abolish.

Does anyone think any VS is going to risk their career by transgressing these [non EBVM] regulations

No chance.

Ironically the public [your clients] are being over-charged because of this "regulation" founded solely on "regulation".

RE: Is there another use for a Locum?

Wren — Thu, 26 Oct 2017 12:12:56 GMT

[quote user="Michael Woodhouse"]To be clear - I forget some vets only use ketamine in tiny volumes in cats and thererfore may not get through the full 10/50ml bottle inside 28 days. We record it but generally buy 8 or 10 bottles at a time and I can't recall one ever staying open more than 28 days.[/quote]

Ditto. Even a small Shetland colt gets 6ml!