Controlled drugs are classified in the order of their abuse risk and placed in Schedules by the Federal Drug Enforcement Administration (DEA). The drugs with the highest abuse potential are placed in Schedule I (heroin, marijuana, LSD, and cocaine), and those with the lowest abuse potential are in Schedule V.
In large hospitals, dangerous drugs like; opium
derivatives, morphine, and pethidine are used for various purposes.
Barbiturates and non-barbiturates are also used as CNS depressants. To exercise
control over the use of these drugs, the Narcotics and Psychotropic Substances
Act, of 1985 was passed and such substances are entered in Schedule “X” of the Drug
and Cosmetic Act. 1940.
While maintaining a stock of these drugs they should be
kept under lock and key and must be accurately received and issued. A separate
register should be maintained to record them and a controlled procedure is used
to issue or receive these drugs. The various steps are:
1. Medical superintendent is overall responsible for the
handling of controlled drugs. The chief pharmacist procures stores and is
responsible for the proper dispensing of drugs within the hospital.
2. Prescription for Narcotic drugs under Narcotics and
Psychotropic Substances Act, 1985 must include the following information:
- Patient’s full name.
- Address.
- Date.
- Name and strength of the drug.
- Quantity of drug.
- Signature of a prescriber.
- Dose and route of administration.
3. If the required drug is not in stock in the ward,
the complete controlled drug prescription must be written on a hospital
prescription blank form by a registered medical practitioner, and then it is
signed and sent to the hospital pharmacy.
Abbreviations like P.R.N. (Pro Re Nata) or S.O.S. (Si Opus Sit) must be
discouraged for such drugs. The complete
form along with the empty containers and nurse's inventory sheet is sent to the
pharmacy for dispensing. The prescription signed by Registered Medical Practitioner
will also permit the patient to purchase drugs from an outside pharmacy.
4. The delivery of narcotic drugs from the pharmacy to
the wards and nursing stations must be carried out through reliable
persons.
5. Charges for Narcotic and Psychotropic Substances
depend upon the policy of the hospital. It could be like the charges may be
made for individual doses received or flat charges for all narcotics and
hypnotics.
6. After the dispensing of narcotics by the pharmacy,
nurses resume the responsibility for administration, control, and auditing of
the inventory. Nurses on duty count physically narcotics at each nursing
station to check the records.
7. While administering a dose, if the patient refuses
or the doctor cancels any dose, the nurses must destroy the drug into the sink
and record “Refused by a patient” or “order canceled by a doctor”. Nurses
should always maintain a proper record in case of
wastage/destruction/contamination.