GGC Medicines


Adult Therapeutics Handbook

Controlled Drug Prescribing

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.

Note: Pregabalin and Gabapentin are now classified as Schedule 3 CDs and as such, come under the regulations governing CDs. Further information is available on www.ggcprescribing.org.uk and search for 'Gabapentin and Pregabalin - change to CD' for Medicines Update article and memo for acute sites.

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.

Examples 

  • Morphine 10mg tablets: take one every four hours if required for breakthrough pain. Please supply 28 (twenty-eight) 10mg tablets.
  • Fentanyl 25microgram/hour patch: apply one patch every 72 hours. Please supply 3 (three) 25microgram patches.
  • Morphine injection 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.

 

Content last updated August 2019