Vets, pharmacists and anyone involved in prescribing, supplying, keeping records of, storing, disposing or destroying veterinary medicines that contain controlled drugs (CDs) must comply with the law on the misuse of drugs and veterinary medicines. You should consider recording the total use of the product, even if the reconciliation of the quantity used exceeds the nominal volume on the product stated on the label. This will help to ensure accurate record keeping of the use of the CD. Recording use and wastage of multi-dose preparations The Medipost Recording Book Bundle – Set of 6 consists of 6 of our best selling Recording Books. Ideally designed for the Care and Nursing Home sectors, Hospitals, Hospices and other Health, Medical and Social Care environments. If a safe is used, there should be a separate receptacle within it to store the CDs. Other items, such as keys, money, valuables and paperwork, should not be stored in the CD cupboard.

All Schedule 4 CDs (except anabolic steroids and injectables for treating addiction) and all Schedule 5 CDs can be included in PGDs. Legislation and guidance Discrepancies between the amounts recorded as used, the volume of the CD left in the vial, and the total stated volume, must be avoided. Pharmaceutical companies try to ensure that every bottle of medicine is precisely filled but some small variability may occur. This may result in discrepancies regarding the amount of CD used when taking into consideration the volume remaining in the container. There may also be some wastage within the needle and hub of the syringe each time the product is withdrawn, known as ‘deadspace’. If dispensing transmucosal buprenorphine, written informed consent should be obtained from the client, as this is off-licence use in accordance with the prescribing Cascade (see: RCVS Guidance Chapter 4). Frequency of review for further repeat prescriptions. Take the controlled drug and the person's individual circumstances into account.

Running balances and dealing with discrepancies

Detecting and reporting any adverse incidents is important so we can learn as an organisation to protect our casualties and team members. Veterinary nurses may be asked to administer CDs out of hours when there is no veterinary surgeon on the premises. In these cases, veterinary surgeons must prescribe the drug to an animal under their care and decide on the dose. They may also wish to draw up the correct dose, labelling it, and leaving it with instructions as to what time it is to be given to a particular patient before going off duty. A veterinary nurse cannot decide to give a CD or change the dose (i.e., make prescribing decisions) and may only act under the direction of a veterinary surgeon in this regard. CDs for euthanasia in practice Personally discuss this treatment with the client and be satisfied that the client is able to administer the medication responsibly. GP practices should have systems in place to ensure the safe management of controlled drugs. The following points will help practices identify and demonstrate that they have systems in place to minimise risk when managing CDs:

CD - a controlled drug as defined by the Home Office under the Misuse of Drugs Act 1971, and the Misuse of Drugs Regulations 2001

be either a computerised system or a bound book (which does not include any form of loose leaf register or card index) This is a rare privilege, and all team members should understand the significance of this. Their actions as individuals in respect of CD handling could fundamentally affect the whole organisation’s ability to retain a licence, not just the team to whom the individual belongs. Licensing conditions and team’s/individual’s obligations It is recognised that there are currently no suitable electronic registers for veterinary practices, however, CDLOs may be able to advise further on possible options. It is the responsibility of the medical officer to ensure team members who hold the Casualty Care certificate are trained in the use of controlled drugs and that this competence is maintained between casualty care assessments.

each practice should have clear, written standard operating procedures (SOPs) covering all aspects of CD management that are known, understood and followed by all relevant staff. Drugs should be removed when a vehicle goes for service or is left unattended. Drugs should not be routinely carried in personal vehicles. In no circumstances should a personal vehicle safe be used as a storage location for drugs outside of a deployment. Some services may choose to store other schedule controlled drugs in the controlled drugs cupboard and record them in the controlled drugs register. You should always follow your service’s medicines policy. Schedule 3 Some vets use insulin syringes to minimise wastage. This is acceptable although it is important to ensure that the syringe allows accurate measurement of the dose in millilitres. All thefts, losses or near misses should be reported to the Home Office and the police via your team leader and in turn to the MREW medical director. We recognise the practical challenges posed by administering CDs in a ‘field’ environment and a consequential possibility for a loss there, though these are in practice extremely rate. Adverse incidents with CDsDrugs in certain schedules must be stored in accordance with the Misuse of Drugs Safe Custody Regulations 1973. In practice, the requirements set out in the SCRs 1973 are regarded as an absolute minimum standard for all controlled drugs, regardless of quantity or schedule. This determines how drugs should be stored in base safes, and, where storage on a team vehicle is appropriate, in vehicle safes. Many teams will have 2 or 3 places where CDs are stored (e.g. in 2 vehicles and a base reserve supply). If all these are in the same building a single register is okay; if different buildings, individual registers may need to be kept. You must store schedule 2 drugs in a controlled drugs cupboard. Keep records of these drugs in your controlled drugs register. Examples include: However, it is preferable for the denaturing process to be witnessed by another member of staff familiar with CDs Only specific CDs in Schedules 2 and 3 can be included in a PGD and there are stipulations as to who can supply or administer them and under what circumstances:

Reviewed and updated including the interpretation of ‘independent veterinary surgeon’ that can witness the destruction of CDs. the use of a separate, larger bore needle to withdraw the product from the vial before changing to a smaller needle to administer the product The Misuse of Drugs Regulations 2001 categorise controlled drugs into 5 schedules. The schedules correspond to the level of therapeutic usefulness and the potential for harm from misuse, with lower schedules having higher risk. The Home Office has produced a list of the most commonly prescribed controlled drugs. Schedule 2 Transmucosal buprenorphine is sometimes used for cats as a short-term analgesic treatment and in some circumstances may be supplied to clients to administer to their cats at home. Where this is the case, veterinary surgeons should:The following must be recorded in the register when Schedule 2 CDs are supplied (which includes by way of administration): The CDR must also record the following information for all Schedule 2 CDs supplied (including by way of administration): These forms are available to those doctors with PIN. The doctor fills in the form stating the purpose as ‘other’ – “to supply xx mountain rescue team under Home Office Licence 887516”.