WAC 246-865-060 Section 6
Controlled substances (narcotics) require special storage, destruction/release and accountability. Section 6 of this WAC outlines the minimum standards for how to follow each of these requirements.
Schedule ll and III substances, including refrigerated drugs, may be stored together but must be kept under double lock and stored separately from other medications. This can be accomplished by keeping these narcotics on their own separate shelf, drawer or compartment as long as this shelf, drawer or compartment is locked and only accessible with a different key than is used for the cart, cabinet or room they share with non-Schedule II or III drugs.
All records of the receipt and withdrawal of these narcotics needs to be maintained. An inventory of the controlled substances must be kept in a bound book with consecutively numbered pages. This book is an inventory only—it does not necessarily indicate that a resident took a medication.
This WAC requires Schedule ll controlled substances be counted at least once every 24 hours and Schedule lll substances every week, but most communities already have a process in place to reconcile narcotics at the end of each shift. This reconciliation must be conducted by at least two persons authorized to administer the narcotics. Each community/company needs to have a discrepancy policy in place. Any inconsistency in the count needs to be reported to the responsible supervisor immediately and resolved within seven days. If the discrepancy is not resolved within the week, it is to be reported to the consultant pharmacist and the Washington state board of pharmacy.
Discontinued and expired medications are to be destroyed at the community within 30 days by two of the following:
· A licensed pharmacist
· The director of nursing or a registered nurse designee
· A registered nurse employed by the nursing home
Appropriate documentation must be maintained when destroying these substances.
When a resident is discharged, a record of release for any Schedule II or III controlled substances released shall be entered on the appropriate page for the given drug in the controlled substances record book.
The final portion of the WAC states that "a nursing home may establish procedures which vary from those paragraphs (6)(a)(g) if they are using a unit dose drug distribution system and if that system provides for the accurate accounting, by the nursing home and the supplying pharmacy, of the receipt and disposition of all Schedule II and III controlled substances." This portion can be applied to the emergency kit. A policy needs to be in place to address any discrepancies and how to properly destroy any medications that were refused, removed and opened in error, contaminated, etc.