19 February 2018
Impairment Committee Report: Management of controlled medicines/substances in healthcare establishments to minimise errors and abuse cause by improper control
In healthcare establishments, registered nurses have a duty to control various medications, including controlled scheduled medicines and substances, i.e. those scheduled 5, 6 and 7.
The shortage of qualified professional nurses in wards has the implication that ‘other categories’ of nurses are expected to participate in the co-checking of these medicines or substances. This has at times led to a departure from the policies and procedures governing the control of medicines and as such, lower categories of nurses and unauthorised personnel are sometimes left to check and administer these drugs on their own, without supervision.
This Impairment Committee Report serves to reaffirm that nursing management has a duty to ensure that controlled scheduled medicines are properly managed, from the time these are ordered until they are administered to patients as prescribed by a medical practitioner, following proper policies and procedures.
The Impairment Committee of the South African Nursing Council (SANC) has noted with concern a degree of negligence in the manner in which controlled scheduled medicines are managed in some healthcare establishments (both public and private).
4. Management of controlled medicines, schedules 5,6 and 7, in hospital departments and wards:
4.1 Hospitals must adhere to policies and procedures in place to:
4.2 It remains the obligation of the registered nurse/midwife to ensure that all controlled scheduled medicines are ordered, controlled, administered and disposed of in terms of the given protocols, policies and procedures of the institution.
4.3 The registered nurse in charge of a nursing unit and/or shift remains accountable and responsible.
4.4 Enrolled nurses/nursing auxiliaries MUST NOT be allowed to keep the keys to the controlled medicines and substance cupboard and to check and administer scheduled medicines alone.
4.5 Unregistered staff (care workers and general workers) should not be involved in the administration of controlled scheduled medicines, or any medication.
4.6 Without a prescription by a doctor, there can be no administration of controlled scheduled medicines, except where a protocol is followed and in an emergency situation. The person in charge will remain accountable.
Note that the following are warning signs of nurses who may be abusing medicines and substances:
5. Legal obligations of the nursing service manager/ unit manager
Nursing service management must oversee the scheduled medicine control processes or procedures to ensure that all healthcare providers working in their healthcare establishment are strictly following these in terms of the given legislation.
It is therefore important that nursing management ensure adherence to the standards as laid down by:
Behaviours indicative of Controlled Medicine abuse
These may include, but are not limited to the following:
Common group of Controlled Scheduled Medicines abused by health practitioners
Like anyone, nurses can and do use many different types of medication. Some are legitimate prescriptions issued after consultation with medical doctors. Some, like pain or allergy medication can be bought over the counter.
Those used in health establishments fall within the following categories:
A LIST OF SCHEDULED SUSTANCES IS AVAILABLE IN THE MEDICINES AND RELATED SUBSTANCES ACT NO. 101 OF 1965.
Some SUBSTANCES are recreational, such as:
Most public and private health establishments have Employee Assisted Programs to support their staff, including assistance for nurses with substance abuse problems.
The South African Nursing Council, like other health statutory bodies, offers an alternative to discipline program for nurse practitioners who demonstrate signs of impairment in terms of section 51 of the Nursing Act, 2005 (Act 33 of 2005).
To contact the SANC please use the following information: