At the start of a new year, I always get a little reflective on the past year. What have I achieved? Could I do better? Definitely is the answer to that one! What should I have done that I didn’t? You know how it goes. I drove into work thinking about all the jobs that I’ve still got to do and now less than three months ‘til the end of March! I thought about staff who moved on during the year to bigger and better things; I was thinking that I really ought to stop eating biscuits and increase my exercise (not a hope in hell), I promised myself that I would stop leaving sticky notes all over my desk (it’s akin to a disaster site!) but the list just went on and on. It’s not that I’m not organised – I’ve already shared levels of OCD with you that I know drive my hubby nuts, and I’m sure everyone I work with! My inner control freak does occasionally need to take a back seat; I really don’t need to know absolutely everything – my Assistant PM is a real diamond and she knows all the stuff about the tiny cogs that support my bigger cogs.
However, something troubled me recently and I have shared this concern with my local colleagues (a more in-depth article has been written for our LMC). The issue surrounds drugs that are returned to the surgery when they’re no longer required; the patient has passed away or medication has been changed. I do recognise that this might not be an issue for many non-dispensing practices, but I thought it was worth sharing in any case. As a dispensing practice, we certainly get our fair share of returned meds and the cost drives me nuts but that’s a rant I’ve already had and failed to win!
I recently met an ex-GP who was very open with me about his addiction to prescription drugs and his very quick return to drug abuse following a long period of being clean. It turned out that his swift decline was afforded by a bag of returned medication, left in his consulting room by an unsuspecting patient. Drugs have an audit trail – that includes the order we place with our wholesaler, the deliveries we receive… then the prescription written by the GP and the dispensing of that medication by our dispensary teams. If that medication includes controlled drugs, there’s an even greater level of ‘trail’… an entry into a register in and out, signed by two people, with medication counted in and out and balanced.
If controlled drugs are returned to our dispensary, they are logged in a register for destruction. That destruction takes place with a member of our Meds Management team from the CCG, when that destruction is also recorded in the register. However, IF controlled drugs are sat in a shopping bag underneath someone’s desk, they haven’t technically been registered as ‘received’. Thus, they don’t technically exist in the audit trail – as far as the trail is concerned, they’re still the patient’s property. The doctor accessed medication in that shopping bag and nobody was any the wiser. As you can imagine, it all went very horribly wrong very, very quickly.
This has made me question our protocols, making sure that everyone (not just the dispensers) is aware of the need to deal with returned medication quickly. I even did a process map of the whole job, just to double-check for the weak spots! I’m not for one minute suggesting that we’ve got people sitting and waiting on meds coming back in to nab something for their own use. However, I was at a point where I thought everything was as ‘tight’ as it could possibly be, and this highlighted to me, even when we think we’ve got everything covered, there’s always a ‘curve ball’ to deal with.
So, as my aim to start the new decade is to revisit protocols and policies, tidy them up, stick a new date on the bottom of the document etc. I’ve written myself a note (yes, another sticky one for the desk) to make sure I don’t get complacent. We’re always learning in our job, regardless of how many years we’ve been doing it and we ought never to forget, that every now and then, something WILL undoubtedly catch us out!
Here’s to a very happy and healthy 2020. Stay sane, keep the CQC wolf from your door and have a good one, whatever you’re up to!
Useful document: Controlled Drugs Policy [PLUS]
See sections 3.3, 3.4, 3.11 and 3.12 for new updates.