Medicines Management and controlled drugs disposals – you asked, we answer

We get a lot of questions about disposing controlled drugs (CDs), so we thought we’d share some of the top Q&As here for you. 

1. Q: I have out of date morphine ampoule in my pouch, what should I do with it?
   
   A: You should give it to your duty locality officer (DLO)  or supervisor, who will then sign it out from your red book and place in a safe for witnessed destruction.

2. Q: What does witnessed destruction mean?
   
   A: Controlled drugs (CDs) like morphine, oramorph, midazolam and ketamine need to be disposed at station by a DLO, with a Trust approved witness of CDs disposal also present.

3. Q: Who is the Trust approved witness of CD disposal?
   
   A: Every station has a specially trained approved witness, who will be someone not routinely involved in the supply or administration of CDs; please ask your DLO to find out who yours in.

4. Q: I am a paramedic; can I be a Trust approved witness of CD disposal?
   
   A: No; as those persons should not be involved in the routine supply or administration of CDs.

5. Q: Why does morphine, oramorph, midazolam and ketamine have to be put in a DOOP jar when all other drugs are put into pharmaceutical bins?
   
   A: Controlled drugs need to be rendered ‘irretrievable’ as part of their disposal. This is most commonly done using a DOOP container or other denaturing kit.

6. Q: Why don’t diazemuls or diazepam go into a DOOP jar, as controlled drugs?
   
   A: Diazemuls are oil based, and DOOP jars are designed to denature water-based drugs. Here at EEAST, it’s been approved that all forms of diazepam (rectal and injection) can be put in normal pharmaceutical bins.

7. Q: What should I do if, after administering morphine to a patient, there is some unused morphine left in the syringe?
   
   A: You should dispose of any unused morphine by emptying it, along with the ampoule, into a sharps bin. The amount disposed should be recorded on the patient record form and in the CD record book. When the bin is sent for destruction, it should be labelled clearly, e.g. ‘mixed pharmaceutical waste and sharps (for incineration)’.

9. Can I hand a partially used syringe to another crew or other practitioner taking over care of the patient?
   
   A: No; under no circumstances should a partially used syringe be handed to another crew or other practitioner. This is because you, as the original healthcare professional, won’t be able to account for any further amounts administered or disposed of.
10. Q: Can we keep out-of-date drugs stored together with in date drugs?
    
    A: Out-of-date drugs stock should be stored separately from other drugs, and clearly marked (e.g. ‘expired not for use’), to minimise any risks of accidentally administering an out-of-date drug to a patient.
    
    
11. Q: As a DLO, do I have to treat out-of-date CDs the same way as in date CDs at the station?
    
    A: Yes; you should treat them both the same, from recording the stock balance to when out-of-date CDs are removed for destruction. Audits should be carried out once a week.
12. Q: How often do I have to dispose CDs at the station?
    
    A: As soon as you can.
    
    
13. Q: Can we use out-of-date medications for training purposes in the Trust?
    
    A: No, out-of-date CD stock should never be used for training purposes. Non-CDs can be used in Trust training centres accordingly with CSOP11 (Out of date drugs & fluids for training purposes). 
    
    
14. Q: What should I do if I have broken a controlled drug ampoule?
    
    A: The stock should be checked immediately after the broken or damaged ampoules have been disposed of in a sharps bin. If the ampoule is broken, it should be reported to a line manager and a Datix should be submitted. It should be recorded in the relevant CD record book by the paramedic or healthcare professional in possession of the CD and, where possible, witnessed by another member of staff.

Published 24th March, 2016