Outline Medication management: • This presentation will cover the legislative Complying with legislation impact on the supply and administration of medications in aged care facilities – Focus surrounding the use of Schedule 8 S HANE J ACKSON medications • Ordering C ONSULTANT P HARMACY S ERVICES • Storage • Documentation Experts in medicines 2 A few points of clarification Balance Checks • Balance checks not covered in the legislation • Supply • Question 1 ‐ Balance checks – Medication provided to a facility for use at the – “There is no legislative requirement for balance checks per facility se. The frequency of balance checks is in the domain of • Dispensing acceptable practice and is covered by the Nursing Board of Tasmania guidelines. I have been advised that AHPRA – Medication dispensed and labelled for an considers the old NBT guidelines are still applicable for individual patient (pharmacist or doctor) professional practice. The NBT guidelines state ‘Narcotic • Administration substances should be checked at the commencement of each shift by the registered nurse in charge coming on – The actual administration of the medicine duty and the registered nurse in charge going off duty’. 3 4
Balance checks Question 2 ‐ Schedule 8 documentation “I have come across some different ways that homes cope with having to • Certainly, PSB would take a dim view when • give out several S8 medications at about the same time, often to an area discrepancies in DD books are uncovered if frequent distant from the DD cupboard. balance checks were not undertaken” Of course, the ideal way is to give out each medication one at a time, • coming back to the cupboard between each administration to write out – Peter Boyles, Pharmacist, Pharmaceutical Services Branch, the book etc. DHHS I have seen staff use a locked safety deposit type box into which they put • the whole packets of medications, and then take the charts and narcotic register with them and 2 staff visit the resident, write out the book, administer the medication, sign the drug chart, lock up the box again and proceed to the next resident, returning all medications to the DD cupboard upon completion.” 5 6 Question 2: Answer Storage and stock? • I believe it consistent with the Poisons Act and Regulations if a An ‘Aged Care Facility’ (ACF) meets the Poisons Regulations of a • medical institution. Namely: person entitled to be in possession of the S8 removes all of the medication intended to be administered to patients on a Medical institution means an institution the sole or main object, or • one of the main objects, of which is, or is held out to be, the dosing round. They have a responsibility to keep the provision of accommodation (whether with or without medical or medication under their control however, and in the event of a other treatment) for – loss of theft of medication would need to be able to (a) persons suffering from any illness, injury, infirmity or mental demonstrate this. • disorder; or • With respect to DD register entries Regulation 29 is relevant (b) pregnant women or women immediately after childbirth; or • and in part states the entry must be made ‘as soon as (c) persons who are substantially and permanently handicapped by practicable’ and ‘not later than 24 hours form the occurrence • illness, injury or congenital deformity, or by any other disability; or of that event’. I would accept that making DD entries at the (d) persons who are aged ; end of a dosing round is ‘as soon as practicable’. • Peter Boyles, Pharmacist, Pharmaceutical Services 7 8 Branch, DHHS
Possession of S8’s POISONS REGULATIONS 2008 Aged Care facilities ‐ storage ‐ REG 9 Therefore Regulation 29 (Poisons Regulations) is the operative entry and it states: • In addition to the persons • Q: Who can carry the • Storage and control of narcotic substances in wards of medical institutions authorised by section 48 of the • keys to the drug Act to possess narcotic (1) The registered nurse or midwife in charge of a ward of a medical institution • cupboard substances, a person who is – must – (a) an authorised officer of a (a) keep the narcotic substances supplied to that ward stored apart from all other goods, other than – • – A: A Registered nurse declared restricted substances, in a separate cupboard or receptacle that is securely fixed to the medical institution; or premises; and (b) a registered nurse in charge of • (b) keep that cupboard or receptacle securely locked at all times when the substances in it are not – a ward in a medical institution; or being used. Having established that an ACF is a medical institution and therefore the charge (c) an authorised nurse; or • • nurse must keep a narcotic register and keep the S8s in a cupboard or receptacle (d) an ambulance officer – • etc we then need to refer to the Regulation 25 (1) (a) which states: may possess and use any narcotic • A person who is authorised by the Act or these regulations to possess narcotic • substances for the purposes of substances for the purposes of the person's profession or employment – his or her profession or (a) must keep them stored apart from other goods in an enclosure that is constructed and secured in – employment. a manner approved by the Secretary 9 10 Delivery of S8 substances POISONS REGULATIONS 2008 POISONS REGULATIONS 2008 ‐ REG 25 ‐ REG 12 Storage of narcotic substances A person may possess a • The person making the • (1) A person who is authorised by the Act or these regulations • narcotic substance for the delivery of the narcotic to possess narcotic substances for the purposes of the purpose of conveying it to any substance can be a person's profession or employment – person or place if – delivery person, or – (a) must keep them stored apart from other goods in an enclosure – (a) the narcotic substance is pharmacy assistant that is constructed and secured in a manner approved by the contained in a sealed package or container; and Secretary; and • Receipt of supply – (b) the person is acting – – (b) when the narcotic substance is not being used, must keep the (i) in the course of the person's enclosure securely locked and retain the key either on his or her • business or employment to carry, person or in a place not readily accessible to other persons. convey or deliver articles or containers of a similar nature; or (ii) under the directions of a • person authorised by the Act to have possession of that narcotic substance. 11 12
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