12 Jun Which controlled drugs (CDs) need to be locked up, recorded and witnessed?
Legally, in a care home, which of the following needs locking up in a CD cabinet? (There may be more than one correct answer):
- Oramorph 10mg/5ml oral solution
- Oramorph 20mg/ml oral solution
- Gabapentin 100mg capsules
- Pregabalin 100mg capsules
- Midazolam 10mg pre-filled syringe
- Temazepam 10mg tablets
- Diazepam 5mg tablets
To answer this, let’s take a look at this introduction from our online course in Managing and Administration of Controlled Drugs.
For full course details: click here
To see our new CD register: click here
Which controlled drugs need to be locked up, recorded and witnessed?
Controlled Drugs (CDs) can be confusing until you realise there are 5 different schedules. Schedule 1 CDs have the strictest controls, down to….(add break here) schedule 5 with the fewest controls.
Here are some common examples of CDs:
| Schedule 1 | Schedule 2 | Schedule 3 | Schedule 4 | Schedule 5 |
|---|---|---|---|---|
| LSD | Diamorphine | Temazepam | Diazepam | Morphine 10mg/5ml liquid |
| Mescaline | Morphine 20mg/ml liquid | Buprenorphine | Clonazepam | Co-codamol |
| Oxycodone | Midazolam | Lorazepam | ||
| Fentanyl | Tramadol | |||
| Gabapentin | ||||
| Pregabalin |
Care homes must apply these extra controls:
- lock in a CD cabinet
- record in a CD register
- give with a witness
to all Schedule 2 CDs, plus just temazepam and buprenorphine from Schedule 3.
All other CDs in schedule 3 CDs and no CDs in schedules 4 and 5 have any of the controls that apply.
The witness
The witness is actually a best practice (not a legal) requirement in care homes. They must witness that all CDs are received, administered, and disposed of correctly (to protect you from accusations if a CD goes missing). They also provide a second accuracy check.
Does the witness need to be a nurse?
In care homes with nursing, it’s best practice that registered nurses administer CDs. However, the witness can be a suitably trained care worker (rather than a nurse). The witness must understand what the person handing the CD is doing, and therefore needs training relevant to their role (we’d advise they receive the same CD training).
Don’t withhold CDs if there is no witness
The CQC advises that you should not withhold CDs to someone just because there isn’t a suitably trained witness. This is because the witness is a best practice requirement, not a legal requirement.
Schedule 3 CDs – the ‘in between schedule’ explained
Schedule 3 contains over 40 drugs, some of which legally need to be kept in the CD cabinet and some don’t. On the face of it, this could get complicated, but luckily, most of the 40 plus schedule 3 CDs haven’t been prescribed in years and aren’t even in the BNF. The only commonly used schedule 3 CDs in the BNF that need to be kept in the CD cabinet are temazepam and buprenorphine.
CD register for Schedule 3 CDs
Legally, none of the Schedule 3 CDs need to be recorded in the CD register. In fact, schedule 3 is also actually called CD NO REG.
However, this makes no sense for temazepam and buprenorphine, as legally these have to be locked in the CD cabinet. So we advise (as a “good idea”) adding temazepam and buprenorphine to the CD register as well. Otherwise what’s the point of locking them up if we don’t know how many should be in the CD cabinet?
It then follows logically that if it is locked away and recorded it should also be witnessed, therefore we would advise this is also a good idea.
So that now means EVERYTHING in the CD cabinet now gets entered into the CD register and is witnessed, simpler eh?
Schedules 4 and 5
No legal or best practice guidance asks that these are locked in the CD cabinet, recorded in the CD register, or given with a witness.
Having said this, organisations can choose to apply extra controls to CDs in the lower schedules if they want to. NICE guideline [NG46] April 2016 “Controlled drugs: safe use and management” outlines the factors that should be considered when carrying out a risk assessment to determine if controls need to be applied to the lower schedules. These include (but are not limited to) frequency and quantity of controlled drugs used, staff turnover and the security setting of an organisation.
Many organisations choose to apply controls to morphine sulfate 10mg/5ml oral solution (sometimes called Oramorph) which is a Schedule 5 CD. Check with your manager to see if your care home applies extra controls to any other CDs in the lower Schedules.
So, from now on, when we talk about CDs, we are only referring to the CDs in Schedule 2, temazepam and buprenorphine from Schedule 3, morphine sulfate 10mg/5ml oral solution and any other CDs from the lower Schedules that your organisation wishes to apply extra controls to.
How do you know if a medicine is a CD?
Most manufacturers print a CD symbol in a triangle on the container of all Schedule 2 CDs. However, if the pharmacy has re-packed the CD in a white carton, you’ll lose this symbol, so can’t always rely on this. Many pharmacies handover CDs in a clear plastic bag and ask you to sign for them. However, be careful as we know of cases where this hasn’t happened.
Check the BNF
The best place to check is the British National Formulary (BNF). The BNF is available as an app (free to download) and website.
Type the name of the medicine in the search box, select it, and then scroll down to ‘medicinal forms’. Here you’ll see all the different forms available. Next to each form, you’ll find a CD symbol and which schedule it belongs to.
In the examples above, you can see that Zomorph modified release capsules are a Schedule 2 CD.
This excerpt was taken from our training course on Managing and Administration of Controlled Drugs click here to see the full course
We also have a new controlled drugs register designed for care homes, click here for details
If you’re interested in learning how to manage CDs in the community email paula@medicationtraining.co.uk to register your interest