Background In response to a perceived increase in patient needs and associated increase in workload, a simple analysis of nursing activity highlighted a need to revisit working practices and procedures. Of particular note for this poster was that each day 15 hours of registered nurse (RN) time was dedicated to the administration of ‘as required’/PRN controlled drugs (CDs) along with additional (unmeasured) time required to administer those on a recurring prescription.

Aims

• Optimise symptom management

• Administer CDs alongside other medications

• Improve response time to requests for PRN CDs

• Create efficiencies in RN time management.

Methods

• Established a time limited working party to consider and modernise CD working practices. The group comprised:

  • Two staff nurses

  • Medical representation

  • Ward manager and sisters

  • CD Accountable Officer/registered manager

• Consider relevant aspects of The Misuse of Drugs Regulations 2001, Controlled drugs regulations and associated guidance

• Developed a robust and safe approach to CD management

• In conjunction with NHS England, a thorough risk assessment was completed.

Results A system has been devised which will make greater use of named patient CDs (oral/transdermal) rather than ‘stock’ CDs; this will enable:

• Storage of named patient CDs (regular prescriptions and PRN) in high quality medicines cupboards at each individual patient’s bedside

• Secure and prompt access to the cupboards by registered nurses

• Single nurse administration of these CDs supported by a robust system of checks and balances

• Fully revised Standard Operating Procedures (CDs)

• Scope does not include parenteral medications.

Conclusion Benefits:

• Rapid access to PRN medications when needed

• Timely administration of regular prescription CDs and non-CDs; thus, a more responsive approach to much needed symptom management

• Reduced time locating stock cupboard keys

• Reduced risk of incorrect administration.