Shipman 4

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• Shipman 4 Implications for Pharmacy Controlled
  Medicines
• Implications for Hospital Pharmacy
• Liz Kay
• Head of Pharmacy Services

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What should hospital pharmacists be considering?

• What do you mean by a controlled drug?
• How do you balance access to CDs?
• Have you reviewed prescribing practices?
• How will you engage multidisciplinary teams?
• Do you need to train staff to undertake
  investigations?
• What are the workload implications?

CLINICAL NEEDS OF PATIENTS
SECURITY OF STOCK FROM THEFTS
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What is a controlled drug?

• Confusion exists in hospitals
• Schedules 2 5 of Misuse of Drugs Regulations
• Products liable to clinical error
• potassium chloride injection
• Products liable to misuse
• ketamine
• Others?

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Balancing Access to CDs

• Policy and procedures
• - where are the stock holding units?
• - are they appropriate?
• cupboards / locks / keys
• authorised product lists
• authorised staff with access
• accountable staff for stock

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Balancing Access to CDs

• How do you undertake proactive audit?
• Within Pharmacy how and when
• All other stock locations how and when
• Use of product issue data and register
• Electronic tools record audits, identify
  potential misuse

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Reviewing Prescribing Practice

• Regular opioids choice, dose, frequency, legal
  requirements
• PRN opioids avoiding errors and incidents,
  dosing, frequency
• Self administration supporting pain management
• Patients own medicines

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Engaging Multi Disciplinary Teams

• Accountability, responsibility, authority
• Standards for Better Health medicines safe and
  secure handling declaration
• Accountable officer leadership
• CDs in context of clinical quality
• Relative importance

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Positive Negative Implications of Shipman 4

• Positive
• Improve patient care - patient record card
• Review, audit, investigate use of CDs
• Improve safe handling (especially parenterals)
• Leadership

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Positive Negative Implications of Shipman 4

• Negative
• Workload implications (LTH examples)
• Proactive monitoring
• Reactive investigation
• Patient record card

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• Questions?