Controlled Drugs National Group 

Joint Sub-Groups Newsletter - December 2020. Number 10

Introduction The whole health and social care system is continuing to adapt to new situations and challenges posed by the coronavirus (COVID-19) pandemic period. In our last newsletter we launched our 2019 CD Annual Report and shared information from Government departments, professional and regulatory bodies and showcased some of the many initiatives local health and care organisations have introduced to cope with the demands posed by these challenging times.

Latest news from CQC State of Care Report State of Care is our annual assessment of health care and social care in England. The report looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve. In this year’s report we reported that the care that people received in 2019/20 was mostly of good quality. But while the quality of care was largely maintained compared with the previous year, there was generally no improvement overall. And in the space of a few short months since then, the pandemic has placed the severest of challenges on the whole health and care system in England. Please find a link to the full report here.

Updated guidance for services prescribing or supervising medicines to treat obesity

We have published updated guidance for healthcare professionals who treat people for weight reduction to help them understand if their registration with CQC is correct.

Staff Changes in the Controlled Drugs Team

We also wanted to take this opportunity to let you know that Sarah Dennison has now moved on from her role as National Controlled Drugs Manager at the Care Quality Commission to undertake the role of NHSE CDAO for the London region from 7 December 2020. Victoria Lea will be taking up the Controlled Drugs portfolio of work as CQC’s National Lead for Controlled Drugs. Rob Allan will continue in his role as Controlled Drugs Officer.

News from the Patient Safety Sub-Group

Generic opioid patch patient leaflet

A generic opioid patch patient leaflet has been published on NHS Health A–Z within their fentanyl and buprenorphine entries. The leaflet was the result of joint working by members of the Patient Safety Sub-Group in conjunction with Guy’s and St Thomas’ Hospitals NHS Foundation Trust. The links to the leaflets can be found below:

https://www.nhs.uk/medicines/buprenorphine-for-pain/ and https://www.nhs.uk/medicines/fentanyl/.

Syringe driver errors

Syringe driver errors continue to be reported across the country. The East Anglia quality surveillance group (QSG) have shared learning from the 30 Controlled Drug (CD) related incidents that were reported during April 2020. Causative factors identified from review of incidents include;

• staff redeployment on wards / in services where they are not familiar with processes
• reduction of pharmacy services on the ward
• increased end of life workload
• an increase in CD administration and
• new edition syringe drivers in circulation which need additional training.

Recommended actions:

• check whether appropriate protocols and processes are in place,
• these are known about, easily accessible and with clear lines of accountability to reduce the potential for similar CD incidents to occur during a major incident response, such as the COVID-19 pandemic.
• check whether your organisation uses more than one type of syringe driver and, if staff using them are not aware of the differences, provide extra training if needed

Over-the-counter medicines containing opioids

People who take prescribed or over-the-counter medicines containing opioids for non-cancer pain will now be given stronger warnings about the risk of dependence and addiction.

The September issue of Drug Safety Update (DSU) contains updated advice for healthcare professionals. These warnings should be discussed with any patient taking or planning to take an opioid-containing medicine. These discussions should also involve agreement of a treatment plan, including how long treatment should last, to minimise the risk of dependence. 

This follows a review of the risks of dependence and addiction associated with prolonged use of opioid medicines (opioids) for non-cancer pain.

Please find a link to the Press release here.

Pandemic initiatives Spire Healthcare redesigned their outpatient prescription forms to make them tamper evident and harder to copy. This action has been taken in response to the presentation of “photoshopped” versions of their current outpatient prescription form at retail chemists in the North West and South of the country.The image to the right is a template version of the new prescription forms.  Attempts to photocopy the forms will result in the backing text blacking out, the silver strip clearly stating “VOID” and the pink spot changing to black. These outpatient prescriptions forms have been in use since October.

Safe supply and use of alfentanil

Two strengths of injection are available

Prescribing and administration errors have occurred recently.

Factors contributing to errors included:

• Non-stock items not cleared out regularly from ward CD cupboards
• Product selection error at ward level
• Packaging does not communicate clearly that 5mg/1ml is a high strength product
• Some software does not highlight higher strength products when prescribing the 5mg/ml strength

Actions to prevent future errors:

1. The high strength product has been removed from all ward stock lists (an out of hours supply will be kept at the Guys site for use on authorisation of the resident pharmacist)
2. The strengths may be packaged in similar looking boxes. Make sure you select the correct strength and remember an independent second check
3. Always ask the screening pharmacist if the high strength product is *definitely* intended. Dispense high strength product only with patient’s name on the label. Do not use “temp stock” or “emergency stock”
4. Ward pharmacists/technicians must return the high strength product immediately once the patient is discharged or no longer needs it
5. Refer to prescribing guidance for end of life care in adults.

News from the Vigilance Sub-Group

GPhC takes action against six pharmacies regarding the sale of codeine linctus

After a series of unannounced inspections of pharmacies in August 2020, enforcement action has been taken following unusually high volumes of sales of codeine linctus, a P medicine. These pharmacies must not sell or supply any codeine linctus preparations, unless against an NHS prescription. Source: General Pharmaceutical Council

Beware of imposters  We have heard anecdotal reports of people impersonating healthcare professionals in order to enter peoples’ homes to remove medicines. We also heard about a non-registrant community pharmacy staff member entering the pharmacy when they should have been self-isolating in order to divert medicines. Their activity was picked up on CCTV. Both incidents highlight the importance of vigilance, identification checks and the need for DBS checks for new staff members.

News from the Prescribing Sub-Group

We have been made aware that whilst pethidine is no longer routinely prescribed, a number of patients still remain on it. Given these patients may have been taking it for a long time and could be dependent on it, their management requires specialist input. This would  usually take place in pain clinics within secondary care. We plan to look at current levels of pethidine prescribing by area and will share our findings in a future newsletter.