TITLE: GUIDELINE FOR USE OF CONTROLLED DRUG ADMINISTRATION RECORD

(for units who do not get controlled drugs out of Pyxis)

1. The Controlled Drug Administration Record is a single sheet printed to account for the number of doses received.
2. When a controlled drug is administered, the patient information required is completed on the sheet.
3. The sheet is the legal copy. All explanations and documentation should be legible on it.
4. These forms must be filled out with a ball-point pen.

1. Date of drug removal
2. Time of drug given using 24 hour clock
3. Printed name of the patient
4. Patient’s location
5. Record dosage given in given column
6. Record balance remaining
7. Record prescribing physician’s name
8. Record legible name of the nurse administering the drug. First initial, last name and title.

KEYPOINT: Each dosage must be recorded on a separate line even if several units are administered to the same patient, at the same time, i.e., 2 tablets of Percocet require 2 lines on the record.

9. a. If the prescribed dose is for less than the full amount of one dosage unit, (i.e. Morphine 8mg) the dose is recorded in the given column.
   b. 2mg is recorded in waste column.
10. The first time the waste occurs on a particular patient, the waste must be documented at the bottom of the sheet under "RECORD OF WASTE AND SPOILAGE." Two nurses are to sign.
11. If other partial doses are wasted on the same patient on the same sheet, the witnessing signature may be written in the space allotted for the physician’s name.
12. If the entire dose is wasted in the W. column, it must also be entered at the bottom of the sheet under "RECORD OF WASTE AND SPOILAGE," giving the specific reason the drug was wasted (i.e., dropped, patient refused, etc.). Two nurses must sign in Sig #1 and Sig #2.
13. If a drug is returned to the pharmacy before all of the doses are used, the nurse must record the return at the bottom of the sheet in "RECORD OF WASTE AND SPOILAGE." The date, number returned and the signature of the returning nurse must be on the form when it is brought to pharmacy.

RESOURCE PERSON(S): Jo Ellen Austin, PharmD; Joyce Randof, RN, MNSc, BC