Storage Of Narcotics

Storage of Narcotics.

Storage of narcotics:

Being a drug that is associated with addiction and tolerance , it is prone abuse and the government has to prevent this by properly storing in such away that people have limited access to it.

The following are the responsibilities in regard to storage of narcotics.

Storage in pharmacy.

• The drugs should be kept in a separate cupboard and the key handled by the pharmacist
• A register book should be keep up to date indicating total quality of each drug, the date and where to sign.
• During issuing of drugs, FEFO METHOD IS USED (First Expiry, First Out).
• The register book should be kept for 2 years from the last entry.

Storage on the ward:

• All narcotics must be stored in a double locked compartment or automated dispensing cabinet except refrigerated narcotic infusion bag
• The keys for locked compartment/cupboard must be carried by the nursing unit personnel especially ward I/C or stored in an approved lock box at all times and spare key with a pharmacist.
• Areas with more than one narcotic key, must account for all keys at end of each shift and document this in NCD(Narcotic Drug) administration record books
• Ampoules must be well labeled and separated
• Keys lost or removed from the hospital premises require a lock key replacement by physical plant personnel.
• There should be a register book for stock in and stock out
• Empty ampoules must be kept for replacement.
• Use the FEFO and keep the records for two years
• All narcotics received and issued out on nursing units must be documented in the NCD administration record book or in an automated dispensing system record. Issues must include the patients name physician name and dose.
• All wastage of NCD’S must be singled by a witness after observing the wastage into the sharps container on the units.
• Counts must be performed once per shift by two nurses. An incident report  must be completed for  discrepancies not resolved prior to shift change
• A count variance of less than 5% for oral narcotic solutions can be corrected without completion of an incident report. The patients services manager is responsible for ensuring discrepancies are  resolved and all required signature are obtained in the NCD administration book which must be returned to pharmacy within 2 weeks of completion.

Key Considerations in Narcotic Storage

The responsibility for the storage of narcotics typically falls on the Pharmacy staff, while on wards, storage falls on the nursing staff, who must ensure that the drugs are stored in a secure and controlled environment, and that their access is restricted only to authorized personnel. Nurses must be aware of the regulations and guidelines that govern the storage and handling of narcotics, and must follow strict protocols to ensure the safety and effectiveness of these drugs. By following these best practices, nurses can help prevent diversion, abuse, and misuse of narcotics, and ensure that they are used only for their intended therapeutic purposes.

1. Secure storage: Narcotics must be stored in a secure and locked cabinet or safe, which is only accessible to authorized personnel. The storage area should be located in a secure and well-lit area, away from public access and preferably near the nursing station for easy monitoring, for ward storage.

2. Proper labeling: All narcotics must be labeled with their generic name, strength, quantity, lot number, and expiration date. The labels must be legible and firmly affixed to the container, and any outdated or damaged labels should be replaced immediately.

3. Accurate inventory: An accurate inventory of all narcotics must be maintained at all times, with regular checks and reconciliations between the actual stock and the recorded inventory. The nursing staff must also document any discrepancies, losses, or incidents related to the use or storage of narcotics.

4. Temperature control: Some narcotics, such as fentanyl and hydromorphone, are particularly sensitive to temperature and humidity, and must be stored in a cool and dry environment to prevent degradation or loss of potency. The storage area must be monitored regularly for temperature and humidity levels, and any deviations from the recommended range must be promptly reported and addressed.

5. Access control: Access to the narcotics storage area must be strictly controlled and limited to authorized personnel, who have been trained and approved to handle and administer narcotics. The nursing staff must follow strict protocols for accessing and dispensing narcotics, including checking the patient’s identity, verifying the prescription and dosage, and documenting the administration.

6. Disposal: Narcotics that are expired, damaged, or no longer needed must be disposed of properly, in accordance with government regulations. The nursing staff must follow the prescribed procedures for disposing of narcotics.

Expired, rejected or returned Class A drugs

1. Unused drugs must be returned to the prescriber or dispenser.
2. If expired or rejected for any reason return to pharmacy in charge who will contact the drug inspector.
3. Expired drugs should be destroyed by the pharmacy in charge WITNESSED BY THE Drug inspector.
4. Destruction follows the WHO guidelines.
5. Details of quantity destroyed and reason must be written in the Class A register.

Importation of Class A drugs

1. Manufacture and wholesale of Class A drugs requires an annual import lincence.
2. Currently NDA allows only National Medical store (Government) and Joint Medical Stores (NGO) to import narcotics.
3. Private retail pharmacies and hospitals access through the above agencies.

Prescription practices of narcotics:

  This is a process of sending a written document from prescriber to the dispenser ordering for narcotics.

Ordering in the pharmacy to the  wards:

•   In the pharmacy, the person responsible obtains the drugs from the registered body as far as ordering is concerned, the pharmacist keeps the records of all entries of drugs.
•  Narcotics must be dispensed by a registered pharmacist or medical practitioners

Ordering on the ward:

• Being a group of drugs that can easily be abused, the prescription of narcotics has been limited to registered medical practitioners (doctors) who should prescribe it after evaluating  that other NSAIDS cannot relieve pain especially after surgery, cancer treatment e.t.c .
• The doctor makes 2 copies, one is retained in stores/ pharmacy and the other in the patients file. It has to be written clearly with full names of the prescriber and signature, drug, the patients name, route, duration e.t.c.
• The drug given must be indicated by empty ampoules  
• If the in charge orders the drug, she or he must sign the orders properly
• On collection, drugs must be checked
• After checking, the nurse who receives the drugs signs them to confirm that he/she has received the drug.

Prescription

Only the following are allowed to prescribe Class A drugs;

1. Registered medical doctor
2. Registered dentist
3. Registered veterinary Surgeon
4. Specialized palliative care nurse or Clinical officer

Prescription forms must have all the details because it is a legal document.

Prescription is valid for 14 days. Supply must not exceed 1 month. It must be in duplicate.

Prescription requirements

The following must be included:

1. Name, age, sex, address
2. Total dose of drugs prescribed in words and figures
3. Stipulated form of drug e.g. tablets, oral solution, injection.
4. Specify strength where possible e.g. 5mg/5mls or 50mg/5mls oral morphine.

Penalties

Any person in the possession of classified drugs unlawfully is liable to:-

1. A fine not exceeding Ug shs.2 million
2. Imprisonment for a term not exceeding 2 years
3. Both may be applied

Note:

1. NDA statute is under review
2. Pharmacists’ council is established
3. Guidelines for handling Class A drugs were established in 2001.

Legal Implications of Narcotics as stipulated in the Narcotic Drugs and Psychotropic Substances(control) Act.

The Narcotic Drugs and Psychotropic Substances (Control) Act, No. 3 of 2016 in Uganda has several legal implications for narcotics.

• Firstly, it criminalizes the possession, sale, manufacture, and trafficking of narcotics, including cocaine, heroin, and marijuana. Those found guilty of these offenses can face severe penalties, including imprisonment and fines.
• Secondly, the Act establishes the National Drug Authority, which is responsible for regulating the importation, exportation, and distribution of controlled substances in Uganda. The Authority has the power to issue licenses and permits for the manufacture, distribution, and sale of narcotics, and to conduct inspections to ensure compliance with the Act’s provisions.
• Thirdly, the Act creates a legal framework for the treatment and rehabilitation of individuals with substance abuse problems. It establishes a National Drug Policy and a National Drug Abuse Prevention and Control Program, which are designed to prevent drug abuse and promote public awareness of the dangers of narcotics.
• Those found guilty of these offenses can face severe penalties, including imprisonment and fines. For example, possession of narcotic drugs can result in up to 10 years’ imprisonment or a fine of up to 10 million Ugandan shillings (about 2,700 USD), or both. Trafficking, on the other hand, can result in life imprisonment or a fine of up to 20 billion Ugandan shillings (about 5.5 million USD), or both.

Overall, the Narcotic Drugs and Psychotropic Substances (Control) Act, No. 3 of 2016 in Uganda aims to combat drug abuse and trafficking while also providing for the treatment and rehabilitation of individuals struggling with addiction. It is important for individuals in Uganda to understand the legal implications of narcotics and to comply with the provisions of this Act to avoid facing serious legal consequences.

Administration of narcotics on the ward:

• The drug to be administered should be prescribed by the doctor.
• The drug must be administered by a qualified staff or a 3^rd year student under a supervision of a qualified staff.
• Both people must sign in the register after administration
• The drug must be administered according to the 5R’S i.e. right patient, right drug, right dose, right route, right time.
• Empty ampoules must be handed over to the in charge
• In case of any remainder, it should be taken back to the pharmacy
• The drug wasted must be recorded and signed for.

Precautions on narcotics:

• Dispensed by registered pharmacist or medical practitioner.
• Medical practitioners should not get the drug for personal use
• Keep the drug with an anti dote
• Order must be from a doctor/ medical practitioner with a prescribed form
• Transport should be legal (should be transported by legal means).
• Comply with the rules from NDA.
• Health inspector should be allowed to check on records and obtain sample
• Not allowed to export or import. Trade by licensed pharmacist, drug shop.