CHAPTER 13

Dispensing of
Controlled
Substances
 CONTROLLED SUBSTANCES
A controlled drug may have a high potential for
abuse, lack of accepted safety for use and the use
of which may lead to severe psychological or

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physical dependence. The Drug Law 1976, in
schedule B furnishes a list of such drugs.

Hospital Pharmacy By Noman ul Haq

 The check on the controlled substances in a hospital is a
joint responsibility of hospital administration, pharmacist
and nurse.
 The administrative head of the-hospital is basically
responsible for the proper safeguarding and the handling
of controlled substances.
 The responsibility for the purchase, storage, accountability
and proper dispensing of controlled substances is
delegated to the pharmacist.
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 Nurse is responsible for the storage and adminstration of
controlled substances at nursing units.
ROLE AND RESPONSIBILITIES OF
ADMINISTRATION

 A hospital administrator execute its responsibilities

for drug control by formulating appropriate policies

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regarding ordering, prescription, dispensing,
administration' and documentation of controlled
drugs.

Hospital Pharmacy By Noman ul Haq

 For an effective documentation of controlled drugs,
an administrator may direct to devise following
forms:
1. Controlled drugs requisition form to be used by the head nurse
to order drugs from the pharmacy.
2.Daily controlled drugs administration form to have a 24-hour
administration record, used for inventory count for each
nursing shift, and to record of losses: This form can be used
also as a basis for review of errors.
3.Monthly Controlled Drugs Inventory serves as a monthly
dispensing record for each nursing unit and receipt for
controlled substances dispensed directly from Pharmacy. 3
Policies and procedures for ordering of
controlled substances: Implementation of
following policies and procedure promotes
safeguarding of drug abuse in a hospital:

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Preparation of orders: All controlled substances
orders and records are to be typed or written in

Hospital Pharmacy By Noman ul Haq

ink or indelible pencil and signed in ink or
indelible pencil.
Doctor's orders for administration of controlled
drugs: The doctor's orders for administration of
ward stock controlled drugs must be written on
the doctor's order sheet or patient's chart.
Doctor's signature: The doctor's full name or initials
are required on the doctors order sheet and on a
controlled drug prescription by doctor's own hand.4
Telephone orders: The order must then be signed by
the doctor with either his signature or his initials
within 24 hours.

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Verbal orders: The doctor must sign the order with
either his signature or his initials within 24 hours.

Hospital Pharmacy By Noman ul Haq

 The prescription must have the following
information:
1. Patient's full name.
2. Patient's address or hospital number.
3. Date.
4. Name and strength of drug prescribed.
5. Total amount of drug to be dispensed.
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Prescribing:
 Prescription for own personal use: A physician may not
prescribe any drugs in category of controlled substances for
his/her own personal use.

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 Refilling: The prescriptions for controlled drugs should not
be refilled.

Hospital Pharmacy By Noman ul Haq

 Prescribing controlled drugs in outpatient department:
Prescriptions for controlled substances may be dispensed to,
outpatients from pharmacy and must include the
information mentioned above.

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Dispensing of controlled substances:
Dispensing of ward supply to patients for home use:
The ward supplies of controlled drugs are to be
used only for patients in the ward. They may not

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be given to patients to take home except as an
emergency measure.

Hospital Pharmacy By Noman ul Haq

Dispensing to employees: The ward supplies of the
controlled drugs are not for the treatment of
employees.
Dispensing of controlled drugs for home use during
pharmacy off-hours: Occasionally patients who
require drugs for use at home are discharged from
the hospital or released from emergency ward 7
during hours when the pharmacy is closed.
Administration:
Administration by nurse: The nurse should use
proper number of tablets or ampules from
nursing stock and should record their number

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used and the dose given in tile proper columns
on daily controlled drugs administration form.
Information necessary on daily controlled drugs

Hospital Pharmacy By Noman ul Haq

administration sheet: The full information
required on the daily controlled drugs
administration Sheet is as follows:
a) Date
b) Amount given
c) Patient's full name
d) Patient's hospital number
e) Number of tablets or ml administered
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f) Filing out inventory column
Delivery of controlled substances to nursing station:
The delivery of controlled drug from the pharmacy to the
nursing station must be assigned to a reliable person of
the hospital pharmacy, nursing staff, or the messenger
staff.

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Documentation: Record keeping of all activities during
handling of controlled drugs helps in control of the

Hospital Pharmacy By Noman ul Haq

controlled drugs in hospitals. An efficient record must be
maintained that can be audited periodically to check any
illegal use of controlled substances.

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ROLE AND RESPONSIBILITIES OF PHARMACY
DEPARTMENT
 A pharmacist is responsible for purchase, storage,
accountability and proper dispensing of controlled

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substances.
 It is the responsibility of hospital pharmacy to have a

Hospital Pharmacy By Noman ul Haq

check on the controlled drugs in an institution.
 Various efficient systems can be devised including:
 System of controlled drug loss report.
 Controlled drug delivery system for the nursing station.
 Protocol for drug abuse and diversion.
 Documentation.

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ROLE AND RESPONSIBILITIES OF
NURSES
 Once the controlled drugs have been supplied from
the pharmacy to nursing station, the nursing

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service is responsible for administration, control
and auditing of the inventory.

Hospital Pharmacy By Noman ul Haq

 The auditing is accomplished by taking a physical
count of narcotics on nursing station by both the
nurses coming on and going off duty.
 The counted quantity is mentioned on an audit
record and is signed by both of the nurses.
 On detection of any missing of inventory,
medications ordered for the day by physicians is
checked so that omission of recording can
immediately be corrected 11
 USE OF CONTROLLED DRUGS IN RESEARCH
Notification to pharmacy and therapeutics
committee: The persons engaged in research
including preclinical and clinical investigations of

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drugs on controlled substances are required to
notify the institutional P&TC. The persons can

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conduct the research only after the authorization.
Documentation: Each person authorized by the
committee to conduct research or related activities
with controlled substances is required to keep
records. The person must notify committee of the
name and address. The other documentation
includes maintenance of an inventory accounting
for each controlled substance and that of awaiting
disposal, held for quality control purposes or
maintained for extemporaneous compounding or 12
similar purposes.