Week 5

Week 5 Overview in PHRM100

  • Topic: Controlled Drugs and Substances Act (CDSA) and Narcotic Safety and Awareness Act

  • Tasks:

    • Continue learning about the CDSA

    • Continue working on your Study Guide

    • Important Dates:

    • Group Assignment due: October 19th

    • CE Tech Talk due: October 5th

Record Keeping for Narcotics and Controlled Drugs

  • Filing Systems:

    • Narcotic and controlled drugs (N&C) must be filed separately from regular prescription items (Pr)

    • Electronic filing accomplished by assigning different prescription numbers:

    • N&C numbers start at 900000

    • Regular Pr numbers start at 100000

    • Targeted controlled (T/C) drugs can be filed in either the N&C or Pr files, though most pharmacies opt for regular Pr files

    • If a prescription includes both an N/C and a Pr drug, the paper copy is filed with the N/C and a copy is filed with the Pr file

    • Prescription scanners facilitate management of paper copies

Record Retention Guidelines

  • CDSA Requirements: Prescriptions must be kept for 2 years

  • Provincial Legislation: Mandates retention for 10 years

    • Stricter regulations take precedence

  • Business records (invoices and statements) must be retained for 7 years

Narcotic & Controlled Drug Register

  • Sections in the Register:

    1. Record of sale (dispensing) of narcotics and controlled drugs to patients, pharmacies, and physician's offices

    2. Record of purchase from suppliers (e.g., McKesson, K&F)

    3. Record of sale of methadone

  • Purchase Record Requirements: All N&C purchase must be recorded

    • Formats:

    • Manual (book/register)

    • Invoice-based (chronological filings of receipts)

    • Computer-based (using software for generating reports)

    • Invoice retention: A copy of the invoice in chronological order is sufficient for purchase records

Specifics of Purchase Records

  • Required information for each received narcotic or controlled drug includes:

    • Name and strength of the drug

    • Quantity (units per package and number of packages)

    • Date on which it was received

    • Name and address of the source (licensed dealer, pharmacist, or hospital)

Sales Record Requirements

  • All reportable narcotics and controlled drugs must be documented in the sales record

    • Most pharmacy computers automate this process

    • Manual documentation is also practiced for educational purposes

  • Elements of Sales Record:

    • All narcotics meeting the reportable definition are entered, while narcotic preparations are generally not reportable

    • Reportable categories:

    • Controlled Part I are reportable

    • Controlled Part II and III are not reportable

  • Information to be documented includes:

    • Pharmacist's name or initials

    • Prescriber's name, initials, and address

    • Patient's name and address

    • Name, form, and quantity of the drug

    • Date of dispensing

    • Assigned order or prescription number

Special Cases in Sales Records

  • Special cases requiring documentation include:

    1. Physician orders of narcotics or controlled drugs for office use

    2. Emergency supply purchases between pharmacies

    • A valid prescription from a pharmacist is required, specifying the necessary quantity

Emergency Supply Procedures

  • The purchasing pharmacy must write a prescription for the exact quantity required

  • Both purchasing and selling pharmacies must record all N, C, and T/C substances involved

Loss, Theft, and Forgery Reports

  • Protocols:

    • Loss of narcotics during a spill or theft must be documented and reported

    • Any forgery-related incidents must be reported

Identifying and Reporting Prescription Fraud

  • Detecting Forged Prescriptions:

    • Familiarization with typical characteristics of legitimate prescriptions

    • Analysis of suspicious situations, avoiding reliance solely on computerized verification

    • Secure positive identification of patients

  • Tips for Identifying Forgeries:

    • Evaluate patient profiles (familiarity, medication fit)

    • Scrutinize prescriber details (handwriting recognition, locality, practices)

    • Check for excessive polish in the Rx presentation (quantity, symbols, alterations)

  • Situational Awareness:

    • Recognize pressure situations (e.g., urgency, insurance pressures) that may lead to quickly filled prescriptions

Call to Action Upon Identifying Suspected Forgeries

  • Verification Steps:

    • Use the CPSO website for prescriber verification instead of prescription contacts

    • Maintain scrutiny towards insurance documentation

    • Utilize store stamps for Rx validation

    • Request identification legally required for monitored substances

    • Delay processing if fraud is suspected, but avoid detainment

    • Notify law enforcement and report to relevant authorities

    • Preserve any evidence for investigation

Reporting Loss and Theft

  • Any loss of controlled substances must be reported within 10 days of discovery

  • Complete a Loss & Theft Form, accessible via the Health Canada website

Narcotic Reconciliation Procedures

  • Inventory Counts:

    • Required at least twice a year, though many pharmacies conduct counts monthly or weekly

    • Counts should balance, with any discrepancies investigated thoroughly

Example Scenario

  • Inventory Tracking:

    • Tylenol #3 Example:

    • Purchased: 100 tablets (February 1)

    • Dispensed: 40 tablets (February 3)

    • On hand: 55 tablets (February 10)

Check Your Understanding

  • Questions for self-assessment:

    1. How are narcotic prescription dispensing records filed?

    2. What is required in the maintenance of purchase records?

    3. For emergency supplies, what quantity can the ordering pharmacist request?

    4. Provide an example of a loss of a narcotic.

Group Assignment Overview

  • Recommended actions for collaboration:

    • Engage early with group members

    • Utilize various means of communication (in-person, online)

    • Leverage available platforms (e.g., Teams) for discussions

Effective Group Work Reminders

  • Encourage open communication and mutual support

  • Share responsibility for agreed tasks

  • Stay organized and follow up on group progress

  • Submit assignments early to avoid last-minute issues

  • Note that each group submission allows only one attempt in Blackboard

Important Dates and Reminders

  • Due Dates:

    • Group Assignment: October 19th

    • Tech Talk CE Assignment: October 5th

Questions

  • Open floor for any questions about the topics discussed.