Controlled Drug Prescribing
The legislation of Controlled Drugs (CDs) in the UK has recently been changed to improve patient and staff safety in relation to CDs. It is essential that a complete audit trail for CDs, from their procurement by pharmacy to administration / supply to patients or their return to pharmacy and/or destruction, is maintained.
Prescription requirements for schedule 2 and schedule 3 CDs
On the discharge prescription the prescriber must ensure the following:
- Check with pharmacy for local procedure for provision of CD prescriptions. See Appendix 6 for contact details.
- On the discharge prescription the following details must be included (N.B. addressograph adhesive labels not allowed):
- The patient's name, unit or CHI number and address.
- The name, strength of the drug and form (tablets, mixture, vial, patch, etc.).
- The total quantity of dose units (i.e. number of tablets, unit dose vials, injections, patches or volume (ml) of liquids) in words and figures.
- The dose / time to be taken by the patient.
- The date of the prescription.
- The prescriber's signature.
Example: CD prescribing on discharge prescription
||Mr A. Patient
||1 Roadside Ave, District, Glasgow
||Times of administration
|Please supply 14 (fourteen) 30 mg capsules and 28 (twenty-eight) 10 mg capsules of Zomorph
|DR's NAME (in capitals): THE DOCTOR
||Signature: The Doctor
- Zomorph 10mg capsules: take one every four hours if required for breakthrough pain. Please supply 28 (twenty-eight) 10mg capsules.
- Fentanyl 25microgram/hour patch: apply one patch every 72 hours. Please supply 3 (three) 25microgram patches.
- Morphine 50mg subcutaneously via a syringe driver over 24 hours. Supply 10 (ten) morphine 10mg/ml amp and 5 (five) morphine 30mg/ml amp.
- Tramadol 50mg capsules: take two capsules four times a day. Supply 56 (fifty-six) 50mg capsules.
- Temazepam 10mg tablets: take one tablet at night. Supply 7 (seven) 10mg tablets.
Prescribers must clearly state on the prescription the quantity to be supplied of each different formulation.
The following strengths of CDs are available:
Zomorph®(Morphine MR) capsules 10mg, 30mg, 60mg, 100mg, 200mg
MST® (Morphine MR) tablets 5mg, 15mg
MST® (Morphine MR) sachets 20mg, 30mg, 60mg, 100mg, 200mg
Morphine tablets 10mg, 20mg, 50mg
Morphine injection 10mg/ml, 15mg/ml, 30mg/ml
Longtec® (Oxycodone MR) tablets 5mg, 10mg, 20mg, 40mg, 80mg
Shortec® (Oxycodone immediate release) capsules 5mg, 10mg, 20mg
Oxycodone liquid 5mg/5ml
Matrifen® (Fentanyl transdermal) patches 12, 25, 50, 75, 100micrograms
Diamorphine injection 5mg, 10mg, 30mg, 100mg, 500mg
CD prescribing – important notes
Take care with prescribing and ensure:
- Similar sounding drugs and standard versus modified release (MR) products are written clearly to avoid misinterpretation. Common errors occur due to confusion between:
- Oramorph® liquid and OxyNorm® liquid
- Morphine tablets and Morphine MR tablets
- Prescribe MR products by brand.
- Dose prescribed is clear: E.g. 'Methadone 40ml daily' does not indicate the dose to be given.
- On the kardex prescribe: 'Methadone 40mg daily'
- On discharge prescription write as: 'Methadone oral solution 1mg/ml, 40ml daily'
DATIX reports show a number of incidents where millilitres and milligrams have been confused in liquid preparations.