Routine monitoring and auditing

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Chapter: Hospital pharmacy : Controlled drugs in hospital pharmacy

The accountable officer must ensure that the use of CDs is monitored through routine processes such as data analysis, audit and clinical governance, all of which should form an integral part of the organisation’s normal governance systems.


Routine monitoring and auditing

 

The accountable officer must ensure that the use of CDs is monitored through routine processes such as data analysis, audit and clinical governance, all of which should form an integral part of the organisation’s normal governance systems.

 

Hospital pharmacists are key members of the multidisciplinary team sup-porting accountable officers in their monitoring role. Different models and approaches to routine monitoring and auditing exist across hospitals but it is generally recommended that the security of CDs is checked, by pharmacy staff, at least every 3 months.

 

The process of monitoring should include aspects of both audit and rec-onciliation, and should occur in all locations where CDs are stored. This independent assessment of local CD management supported by knowledge and data can help assess and detect discrepancies between amounts supplied and amounts prescribed and used. Even simple acts such as roughly correlat-ing supply and prescription can act as indictors to trigger more in-depth investigations and help eliminate error, misuse or misdirection. E-prescribing, electronic data collection and automated data analysis tools have been devel-oped within some organisations to provide reports which can be used to support the audit and reconciliation processes.

 

The same principles of having an independent approach to the monitoring of CD stock held within hospital pharmacies should be considered best prac-tice. It is recommended that organisations arrange for periodic checks of pharmacy-held CDs by appropriate personnel who do not routinely work in the particular pharmacy service.

 

The focus of clinical area– including pharmacy checks is often solely on schedule 2 CDs for which a register or record book is required. However, it should be remembered that all drugs classified in the misuse of drugs legisla-tion are known to have the potential for misuse. Therefore, hospital phar-macies should develop systems to assess periodically the local management and use of other medicines with the potential for misuse, including medicines in schedules 3 to 5.

 

Currently, primary care trust accountable officers are required to monitor all prescriptions for CDs dispensed in the community through the Electronic Prescribing Analysis and Costs (ePACT) data analysis tools available from the Prescription Pricing Division of the NHS Business Services Authority. Hospitals who issue FP10 (HNC) prescriptions, which are dispensed in the community, should ensure that their hospital CD ePACT reports form part of their local CD prescription monitoring processes.

 

Systems were introduced in 2006 to control and collect data on all private prescriptions for schedule 2 and 3 CDs dispensed by community pharma-cies. Non-NHS prescribing of schedule 2 and 3 CDs, which are to be dispensed by a community pharmacist, must be on a dedicated prescription form (FP10PCD) and each prescriber must be allocated a unique six-digit private CD prescriber’s code. Private prescriptions issued and dispensed within the same hospital are not currently subject to the same requirements; this is one area where the hospital accountable officer may require additional specific and comprehensive monitoring arrangements if such a service is provided.

 

The Care Quality Commission (CQC) is required to produce an annual report on the safer management of CDs. This provides data and an overview against which certain aspects of hospital prescribing and medicines use can be further analysed.

 

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