CHHS16/172

Canberra Hospital and Health ServicesClinical ProcedureContinuation of Pharmacotherapy dispensing in the event of IT failure or iDose malfunction – Alcohol and Drug ServicesContents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Alerts.........................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – Procedure in the event of IT failure or iDose malfunction......................................2

Related Policies, Procedures, Guidelines and Legislation.........................................................4

Definition of Terms...................................................................................................................4

Search Terms............................................................................................................................ 4

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS16/172

Purpose

This procedure ensures safe and ongoing pharmacotherapy dosing in the event of an IT failure or iDose shutdown or malfunction at the Alcohol and Drug Services (ADS) Opioid Treatment Service (OTS) clinic.

Scope

Alerts

iDose related shutdown or malfunctions may result in the implementation of the Opioid Treatment Service Building 7 Business Continuity Plan.

Scope

This procedure applies to Alcohol and Drug Services staff involved in pharmacotherapy client dosing at the OTS clinic.

Section 1 – Procedure in the event of IT failure or iDose malfunction

In the event of an IT failure or iDose shutdown or malfunction, OTS clinic staff will: Inform clients accessing the OTS clinic for dosing that the clinic will be temporarily

closed. Immediately contact CHHS security officers via switchboard or on 0418 726 253 to

attend the OTS clinic as required. A notice will be posted on the clinic door informing clients that the clinic will be

temporarily closed for up to 60 minutes and approximate time of re-opening. The Registered Nurse in Charge shall notify the OTS Clinical Nurse Consultant, Manager

of Clinical Services and Manager of Administration. The Registered Nurse in Charge will promptly contact the InTACT helpdesk to report the

IT failure or iDose malfunction. The second nurse will need to recruit an additional nurse (third nurse), who can be an Enrolled Nurse (EN), for assistance and should refer to the ADS nursing contact list held in the OTS clinic or the Withdrawal Unit “Blue Books”.

Within the next 60 minutes, the nurses will prepare for the re-opening of the OTS clinic:o Two nurses will reconcile all controlled medicines (Schedule 8) stock held at the

time and record the amount in the appropriate Controlled Medicines Register (formerly known as Drugs of Dependence Register or “Red Book”). Both nurses to sign the register entry. A line is drawn in the register under this entry and notation made that there was an IT failure or iDose malfunction.

o The manual pump is to be commissioned (primed) for methadone dosing. This must occur in accordance with mandatory training and credentialing requirements. All core nursing staff working in the OTS clinic MUST be competent in this procedure.

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS16/172

o Pharmacotherapy dosing records for the previous three days should be accessed from the Controlled Medicines Register. If Citrix access is still available, the third nurse will log onto iDose remotely and confirm the dosing history for clients as they present at the OTS clinic.

When the three nurses are ready to commence manual pharmacotherapy dosing the OTS clinic may re-open.o As each client enters the dosing area he/she is to be identified by name and date of

birth as shown on the prescription, supported by photo identification where possible.

o The current prescription must be checked for validity. Methadone prescriptions are coloured pink. Buprenorphine (Subutex) prescriptions are coloured yellow, and Buprenorphine/naloxone (Suboxone) are coloured blue.

o The client must be asked when he/she last dosed.o If a client has dosed within the last three days, and his/her response is confirmed

against the Controlled Medicines Register, he/she may be dosed.o If a client has not dosed for three days or more, he/she cannot be dosed without

an authority from the prescribing doctor.o Doses are NOT to be increased during manual dosing without the authority of the

prescribing doctor. Increased doses are only permitted when the prescription specifies that the client is being inducted, or if the prescription allows for an increase or other records show that the client dose has been the same for the previous three days in the case of methadone treatment. This is supported by the ACT Opioid Maintenance and Treatment Guidelines.

All pharmacotherapy manual dosing details must be entered into the appropriate Controlled Medicines Register. These details include the: date, client’s name and URN or address if no URN is available, dose, details of the nurses’ administering and checking the dose, time of administration and name of prescribing doctor. The controlled medicines running balance must also be specified. All entries must be legible.

At the end of the OTS clinic dosing session all controlled medicine stock must be measured and counted. The actual stock figure must be entered into the appropriate Controlled Medicines Register and reconciled with the running balance. Once reconciled, the administering and checking nurse must sign the register entries.When the IT failure or iDose malfunction resolves, staff must enter all doses (as listed in the Controlled Medicines Registers) into iDOse.The drug usage report printed must be notated with “Also documented in CM register due to (applicable IT failure or iDose malfunction) on (specify date)” and signed by the Registered Nurse in charge and the checking nurse (RN or EN). The drug usage report is stored in a locked cabinent at Building 7.

A RiskMan report must be completed within 24 hours by nursing staff present at the time of IT failure or iDose malfunction.

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS16/172

Related Policies, Procedures, Guidelines and Legislation

CHHS Clinical Policy Medication Handling

ACT Opioid Maintenance and Treatment Guidelines

Medicines, Poisons and Therapeutic Goods Act 2008Medicines, Poisons and Therapeutic Goods Regulation 2008

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Definition of Terms

Controlled medicine: Is a Schedule 8 medicine as defined under the Medicines, Poisons and Therapeutic Goods Act 2008. Methadone, buprenorphine and buprenorphine/naloxone are controlled medicines.

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Search Terms

iDose, IT, failure, malfunction, methadone, buprenorphine, buprenorphine/naloxone, naloxone, manual pump, controlled medicines register, dosing, pharmacotherapy, OTS, Opioid Treatment Service, OTS clinic,

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Disclaimer: This document has been developed by ACT Health, <Name of Division/ Branch/Unit> specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair

Doc Number Version Issued Review Date Area Responsible PageCHHS16/172 1 27/09/2016 01/05/2018 MHJHADS - ADS 4 of 4

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register