AFAMS EO 005.01 Undercontrol/ Controlled Medications (Dari) 01/09/2013

AFAMS

EO 005.01 Undercontrol/ Controlled Medications(Dari)

01/09/2013

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Importance of Lesson(Dari)

• Undercontrol/ Controlled Medications are a group of medications that require more stringent controls due to the potential for their misuse (e.g. diversion and abuse).

• More stringent controls include increased steps when:– Storing;– Ordering;– Receiving;– Accounting; and– Dispensing.

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Importance of Lesson(Dari)

• These increased requirements exist at all medical facilities:– Hospitals– Polyclinic– Class VIII Warehouse

• These requirements extend beyond pharmacy to all occupations.

• The purpose of this lecture is make you familiar with these requirements.

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Overview EO 005.01(Dari)

• Define and list under control/controlled medications

• Define and group according to MEDCOM

• Review more indepth MEDCOM and NMH policies.

• Review• Game (not graded)

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DefinitionsDari

Undercontrol/ Controlled Medications

“A group of medications which their usage can cause drug tolerance and drug addiction, drug toxicity, and some neurological effects like excitation, unable to concentrate, euphoria, unconsciousness, dizziness, also some patient can misuse the medications.”

“Inconsequential use…may cause drug dependence and addiction.”

MEDCOM Policy on Undercontrol/ Controlled Medications

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DefinitionsDari

Drug Dependence:

A physical dependence which is an adaptive physiological state that occurs with regular drug use and results in a withdrawal syndrome when drug use is stopped. It is usually associated with increased tolerance. Physical dependence alone does not imply addiction.

Addiction:

“It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving”

CAMH

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DefinitionsDari

Withdrawal:• With regular use of a substance,

biochemical and structural adaptations take place in the brain.

• Withdrawal is the group of unpleasant symptoms and signs that a person experiences when, after a period of regular use, the quantity of available substance in the brain is reduced.

• Upon stopping use, the brain takes days or weeks to return to normal. During this time withdrawal is experienced.

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DefinitionsDari

Withdrawal Continued:• Symptoms and signs of withdrawal are

opposite to the main effect of the drug. • For example:

– Sedative withdrawal creates hyperactivity with dangerous medical complications.

– Opioid withdrawal is accompanied by anxiety, powerful cravings and flu-like symptoms.

– Stimulant withdrawal consists of depression, insomnia and cravings.

• Withdrawal symptoms are relieved by

giving the same or similar drug.

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DefinitionsDari

Tolerance:• Tolerance is a condition in which higher

doses of a drug are required to produce the same effect experienced during initial use.

• Tolerance is often associated with physical dependence.

• In therapeutic use of a drug with psychoactive effects (e.g., morphine for chronic pain relief), patients tend to become tolerant to the psychoactive effects (e.g., euphoria, reduced anxiety or sleep inducement), but not the therapeutic effects.

• A patient seeking higher doses of, for example, a narcotic may be seeking the euphoria, relaxation, increased concentration to which they have hdeveloped tolerance.

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Why are some drugs more addictive than others? (DARI)

•Drugs are potentially addicting in that they produce a marked difference between altered and drug-free psychic states. •A drug’s addictive potential is determined by its ability to produce:– a rapid onset of action – a powerful euphoric effect – a short duration of action – tolerance and withdrawal.

•The more of the above features, the greater a drug’s addictive potential.•Tolerance and withdrawal increase the addictive potential of a drug by making it difficult for a person to stop using it without experiencing discomfort.

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Under Control/ Controlled DrugsDari

The British National Formulary Groups Undercontrol/ Controlled Medications into Three Groups.

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MoD Under Control/ Controlled Drugs (Dari)

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Hint to Help Indentify(Dari)

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PoliciesDari

• OTSG Policy18 – Management of Controlled Substances

• MEDCOM Policy regarding Under Control Medication

Click icon to add clip art

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Review OTSG 18 PolicyDari

Purpose: • To provide guidance and minimum

physical security standards for the safeguarding and maintenance of controlled medical substances.

• Puts requirements of Counter Narcotics Drug Law in place within ANA

• Only units authorized by OSTG G-4 can request controlled substances from the Medical Stocks Command.

• Otherwise the unit must request permission from the OSTG.

• Orders are done on MOD 14 Forms

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دستورالعملها: هدفاستندردهای وکمترینرا تاسیسات امنیتیو حفظ و نگهداری برایجات ادویه مراقبتفراهم را طبی نارکوتیک .مینماید

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Review OTSG 18 Policy Dari

Key Points:

The following personnel may administer controlled substances upon the order of an authorized prescriber:

1. Professional nurses, including RNs, Practical Nurses, and Medical Technicians personnel.

2. Veterinary technicians for the treatment of animals.

3. A prescriber authorized to prescribe the substance being administered.

Pharmacy is responsible to check narcotic usage in the facility.

Fix Dariجات 5.4 • ادویه توزیع صالحیت

جات: ادویه آتی پرسئونل نارکوتیکمقام حکم به نظر را نارکوتیک: نمود خواهد توزیع ان باصالحیت

شامل 1.4.5• که مسلکی، نرسهایو نرس، معاون ، مسجل نرسهایمیباشد . صحیه تکنیشن پرسئونل

برای 2.4.5• وترنری های تکنیشنموظئف توسط حیوانات معالجه. میشود داده اجازه وترنری

داده 3.4.5• اجازه کننده تجویز برایشده توصیه یکه ادویه که است شده. نمایند تجویز است

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Authority for access to, or possession of, controlled substances is limited to:

1.Medical Treatment Facilities: Medical, dental and veterinary personnel commissioned officers, NCOs, or ANA Civilians, if qualified to administer controlled substances while administering.

2.Medical Supply Personnel: Individuals whose duties include receipt, storage, transportation, inventory, or issue of controlled substances. (e.g Quartermaster)

•Fix Dariصحیه : 6.4.• اکماالت پرسئونل

دریافت شامل شان وظایف افرادیکهتوذیع و موجودی ، انتقال ، ،ذخیره. میباشد نارکوتیک جات ادویه

•3.6.4 : افرادیکه البراطوار پرسئونلجریان در نارکوتیک جات ادویه بایداستعمال شان البراطواری وظایفمینمایند.

•4.6.4 : دواخانه خدمات پرسئونلشامل انها وظایف افرادیکه،صدور، ،توذیع ترکیبموجودی ویا انتقال دریافت،ذخیره،. میباشد نارکوتیک جات ادویه

توسط : 5.6.4• افرادیکه امربرهاشان وظیفه جریان در قومندان. میشود داده صالحیت برایشان• ها : 6.6.4 تجویزکننده صالحیت

های مسئولیت اجرای درهنگامشان .مسلکی


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3.Laboratory Personnel: Individuals who are required to handle controlled substances in the course of their laboratory duties.

4.Pharmacy Service Personnel: Individuals whose duties include compounding, dispensing, issuing, receiving, storage, transportation or inventory of controlled substances.

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5.Couriers: Individuals as authorized by the Commander in the course of their courier duties.

6.Authorized Prescribers: When in the course of their professional responsibilities

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Stock levels: Hospital pharmacies: 30-day stock level Units and clinics: 15-day stock level.

Loss or Theft Reported with OTSG Policy Letter - 16 Serious Incident Report.

Inventory shortages from Pharmacy or Logistics require serious incident reporting when theft is suspected and/or the shortage exceeds normally experienced operational losses

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Documentation:• Each time a controlled substance is

administered, record: – day– hour– patient’s name– initial and last name of the

prescriber – signature of the individual

administering the medication– amount of the substance

administered– new balance recorded

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MEDCOM: Under Control MedicationDari

• Provides a detailed list of Under Control Medications and how they should be managed within ANA.

• Drafted by NMH staff for OTSG approval.

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Key Aspects of Policy: • Insert Dari

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Key Aspects of Policy: • Insert Dari

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Key Aspects of Policy:

• These 8 points form the basis of how Under Control medications are ordered, received, stored, issued, and disposed of within the ANA.

• The processes developed from these points will be reviewed in the next couple lectures.

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Questions?

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Review(Dari)

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Insert DariCommonly Used

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Game (Assessment)Dari

Formative Assessment:• Not marked•Used to assess the students understanding of lectures material.•Instructors will provide drug names which students must correctly identify as being Under Control/ Controlled Medications. •Instructor will provide a debrief at the end of the quiz.•Time estimate (including debrief): 20-30 mins

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Game

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End of LectureDari

Documents

AFAMS EO 005.01 Undercontrol/ Controlled Medications (Dari) 01/09/2013