Post-Shipman controlled drug safety rules are working

Rules to ensure the safe management of controlled drugs introduced following the inquiry into mass-murderer Dr Harold Shipman are working according to a new report.

But the Care Quality Commission says that improvements in the monitoring, storage, prescription and disposal of drugs such as diamorphine, anabolic steroids and growth hormone, should not be sacrificed in the latest round of spending cuts.

The report recommends that:

    * The safe management of controlled drugs should remain a high priority for organisations.
    * The Royal Colleges should develop guidance on the appropriate use of opioids and amphetamines for all sectors.
    * The Department of Health should revisit requisition regulations and guidance to better capture data in line with the original policy intent to monitor individual practitioners ordering patterns.

The Shipman inquiry found ineffective monitoring had allowed Dr Harold Shipman to divert supplies of diamorphine to kill at least 15 and possibly up to 200 patients without detection. The Controlled Drugs (Supervision of Management and Use) Regulations 2006 were then introduced in 2007.

The CQC found the role of the accountable officer, responsible for monitoring controlled drugs, is now embedded in healthcare organisations. But the report warns: “it is particularly important, considering the current economic cutbacks, that gains such as these are not lost”.

Prescribing by nurses and pharmacists continued to increase in line with policy to increase people’s access to medicines through the introduction of non-medical prescribers.

It says current requisition regulations do not allow the collection of a consistent data set to monitor orders by individual practitioners.

But local intelligence networks (LINs) – comprised of accountable officers from local providers as well as regulators and agencies - have developed an improved understanding of their intelligence-sharing function.

CQC found evidence of good practice including a development to show how LINs are developing reporting arrangements for concerns about the management of controlled drugs.

For example, NHS Tees’ LIN has developed an online reporting tool that allows accountable officers to report any concerns directly and permits others in the LIN a view-only access. This allows real time rather than retrospective reporting of concerns.

The report concludes that managing and monitoring systems for controlled drugs will require ongoing activity and vigilance to sustain the developments achieved in the past three years.

CQC chief executive, Cynthia Bower, said: “We’re greatly encouraged by the progress made by provider organisations in improving and embedding the systems and processes necessary to support frontline managers in managing controlled drugs and to pick up concerns. Coupled with the good work done to share intelligence at a local and national level, this shows we are all better equipped to identify inappropriate or unusual prescribing and that patient safety remains top of the agenda for health care organisations.

“Despite this progress, we still feel there are improvements to be made and will be asking for improved regulation of controlled drugs to capture data on requisitions and for further guidance on prescribing of opioids and amphetamines across all settings.”