Controlling Controlled Substances
Federal and state laws regulate the dispensation, administration, and documentation of controlled substances. When these substances are issued to a unit, they're accompanied by a perpetual inventory record, commonly called a controlled inventory record.
A paper trail
If the doctor orders a controlled substance for your patient, document its administration on the administration record and the perpetual inventory record or controlled inventory record. When you remove a dose from the locked storage site, note this information on the perpetual inventory record:
date and time the dose is removed
amount of the drug remaining in the locked storage site
patient's full name
doctor's name
drug dose
your signature.
If you have to discard any amount of the dose, another nurse must verify the amount discarded and then sign the form, too.
Note that controlled substances should be kept under a double lock. In other words, medications are usually kept in some sort of locked cart or storage mechanism. Controlled substances could then be in a locked drawer of the locked cart. Get it? Yes, it's a big deal.
Paperless trail
Most facilities now have computerized drug dispensing systems such as a Pyxis on every unit. These systems may dispense controlled substances as well as other medications. Your username and password serve as your signature to access and withdraw medications. Sometimes a username and a fingerprint scan serve as your access to withdraw medications. You'll still need another nurse to witness any part of a controlled substance that you discard—the system will usually display a prompt screen for her to enter her username and password to serve as her signature.
Computerized drug dispensing systems provide you with access to medications that are commonly needed in the patient care area. So, when a new drug is ordered, you can obtain it from the computerized drug dispensing system instead of waiting for the pharmacy to deliver it. A safety feature allows the pharmacist to review and approve the medication before you can select and administer the medication from the system.
Computerized drug dispensing systems also have software that promotes patient safety by utilizing readable bar-codes for restocking and choosing medications, providing automated refilling systems, giving medication safety alerts, and linking to satellite pharmacies after hours so drugs can be verified and distributed.