Administration, Custody & control of Dangerous Drugs

Objectives
At the end of this session Nurses will be able to:

 State the commonly used medications that are considered dangerous drugs in Jamaica
according to the Dangerous Drugs Act and UHWI Policy
 Discuss the custody and control of dangerous drugs
 Outline the process for the ordering and storage of dangerous drugs
 Describe the administration process for dangerous drugs following the principles outlined
by the Ministry of Health and UHWI Policy
 Discuss the process for handing over dangerous drugs according to the Ministry of Health
and UHWI Policy

Activity time
List of Dangerous Drug

Fentanyl

Codeine

Pethidine

Morphine

Custody and control of Dangerous drugs

 Registered Nurse/Midwife/Mental health can assume responsibility of the DD keys
 The DD keys are pinned on the clothes of the Nurse assuming responsibility for the drug
at all times
 Counting, administration and recording etc. must be done by two RN’s / RM / Mental
Health Nurse
 Physician/Pharmacist can be a witness to the administration of the DD
 Nurse’s assuming responsibility of DD key must possess knowledge of the laws that
govern custody, control and administration of dangerous drugs
 Student nurses or EAN can only observe the process they cannot serve nor have control
of the key.
Assuming responsibility of Dangerous Drug Key

1. Oncoming registered nurse accompanies off-going registered nurse to the narcotic

cupboard.

2. Oncoming nurse completes the book balance in the census book

3. Off-going nurse opens cupboard and retrieves medications.

4. Oncoming nurse opens each container. Counts all ampoules / tablets contained in
labeled box, ensuring that all ampoules are intact and contain fluid; the name on the
ampoule corresponds with the name on the container. He / she documents total
amount seen in appropriate column, both nurses agreeing that amount contained
corresponds with the book balance.

5. This process is repeated until all contents of all containers are counted and
documented.

6. Oncoming nurse receive the keys from the off-going nurse, return drugs to the inner
cupboard and lock both cupboards

7. Both nurses sign the book.

8. The nurse, having assumed responsibility for the key, will keep the key pinned on
him/ her until they are handed over in a similar manner at the end of his / her shift or
if she / he need to leave the ward.

Ordering of Dangerous Drug

Ordering

 Only RN’s can receive DD stock from the Pharmacy

 Not more than 14 days’ supply
 Ampoules unused for 6 months should be returned to pharmacy

Storage of Dangerous drugs

Storage

 Dangerous drugs are kept in a double locked cupboard.

 No distinguishing marks are put on the cupboard
 The cupboard stores only DD and documentation books

Administration of Dangerous drugs

Administration of Dangerous Drugs

9. When the narcotic medication is required for administration, the registered nurse
caring for the patient in need of pain relief takes the order along with a tray
containing syringe and needles, to the nurse holding the keys.

10. Both nurses check the order and the last time the medication was administered.

11. The nurse holding the keys opens the cupboards and retrieves the container with the
required drug.

12. The nurse who will administer the medication documents the relevant information in
the appropriate book i.e. date, patient's name and registration number and the
prescribed dose.

13. The ampoules are counted and compared with the book balance, then the required
ampoules are removed, and the remaining number documented.

14. The container is returned to the inner cupboard and the cupboard is locked.

15. The medication is pulled up into the syringe, excess is squirted out (down the drain),
until the required volume (dosage) is left in the syringe.

16. Both nurses identify the patient and one observes the other administer the medication.

17. The syringe and ampoule(s) are discarded in the sharps box, hands washed then the
nurse who administered the medication records the time in the book, makes notation
of any wastage, signs the book,

18. The nurse who witnessed the administration of the drug, signs in the appropriate
column (witnessed by).

In the event of error both nurses administering the drug is responsible.

Eventualities
 Breakage
 If ampoule is broken the pieces should be taken up and place in a small biohazard bag.
 Incident report should be done in triplicate
 The incident forms should be sent to the pharmacy, to Nursing office and one stay on the
ward
 Going home with DD key
 If a nurse go's home with the DD key the nurse should be contacted and the nurse
must return to the ward as soon as possible
 The maintenance department should be called to change the lock on the cupboard
immediately
 The drugs should be checked off by two RN or Midwife once the cupboard is open
and lock changed
 Incident report must be written up
 If the nurse refuses to come back the ward a report will be filed at the police station

The End