It is important for patients’ medications to be reviewed periodically to ensure that essential laboratory tests are undertaken; side-effects are detected; patients are involved in decisions about their medicines; and therapy is optimised, says Professor Avery, although he notes that this can be challenging.
In August 2013, the Care Quality Commission (CQC) released its report, The safer management of controlled drugs: Annual Report 2012, which revealed a 1% rise in 2012 – compared to 2011 – in the number of prescriptions issued in primary care for controlled drugs.
Except for a steady fall in prescriptions of temazepam since 2007, the use of buprenorphine, morphine sulphate, oxycodone, fentanyl, midazolam and diamorphine is on the rise.
Effective systems developed at the local level for secure gathering, sharing and recording of intelligence relating to concerns about safe management of controlled drugs should be preserved and transferred into the new NHS structure
As a result, CQC chief executive David Behan called for “vigilance” around the prescription of controlled drugs – adding that the CQC would be including governance arrangements around controlled drugs as part of their inspections.
The recommendations of the report included:
- Health and social care professionals must ensure they know how to contact their local controlled drugs accountable officer (CDAO) and know the mechanism for reporting controlled drug concerns.
- CDAOs need to ensure they are following the guidance on the CQC’s website to update contact details promptly to ensure the CDAO register is accurate.
- Effective systems developed at the local level for secure gathering, sharing and recording of intelligence relating to concerns about safe management of controlled drugs should be preserved and transferred into the new NHS structure.
- CDAOs, clinical commissioning groups and controlled drugs leads must be mindful of their continuing responsibilities for good governance and safe use of controlled drugs to ensure ongoing monitoring and vigilance.
The importance of ongoing monitoring was underlined in a response to the report that was issued by NICE, specifically with regard to the use of drugs to treat moderate attention deficit hyperactivity disorder (ADHD).
Reiterating standards recommended in its recent quality standard on ADHD, a press release by NICE said: “The quality standard calls for people with ADHD who are taking drug treatment to be given a specialist review at least annually to assess their need for continued treatment… people taking the drugs need to be monitored regularly due to the number of side effects associated with drug treatment for ADHD, which can also have the effect of reducing adherence to treatment.
“Furthermore, without regular monitoring there is a greater risk that drugs prescribed to treat ADHD will be misused.”
In 2004 Sir Liam Donaldson said: “To err is human, to cover up is unforgiveable, and to fail to learn is inexcusable.” Errors are the product of multiple factors and clinicians have a duty to ward off error by employing defences to prevent it occurring in the first place. By being vigilant and making small changes medicines management can become safer.
- GMC, University of Nottingham, The PRACtICe Study: Prevalence and causes of prescribing errors in general practice (May 2012)
- MPS factsheet, Safe prescribing (April 2013)
- CQC, Controlled Drugs – www.cqc.org.uk
- GMC, Good Practice in Prescribing and Managing Medicines and Devices (2013)
- National Institute of Health and Clinical Excellence – www.nice.org.uk
- MHRA – www.mhra.gov.uk