Questions on medicines, procedures and practice from hospice staff
1. Do we have to crush solid dose forms of CDs before destruction?
Destruction of Controlled Drugs involves rendering them ‘irretrievable’. We generally use a commercial product that turns to a solid gel when mixed with the liquid contents of ampoules and oral medicines. This does not actually ‘denature’ the drugs in a chemical way but would make it impossible for them to be re-used. Adding tablets and capsules to these destruction kits does not chemically change them whether they are crushed or not and crushing and grinding them carries a risk to the healthcare professionals of inhaling the resultant dust.
Ashtons recommends solid doses are added to kits for destruction and the kits sealed securely at the end of each destruction session.
2. Which form of ketamine should be kept for emergency use?
Ketamine is used as a third of fourth line analgesic in some hospices for challenging pain, usually with a neuropathic component. It is available commercially as an injection in a variety of strengths and as an oral solution. The oral solution is a ‘special’ product and has a relatively short shelf life so it doesn’t make sense to keep one sitting in a CD cupboard or dispensary just in case. It can usually be ordered and dispatched within 24 hours.
In the meantime, if the situation demands prompt action, keeping a vial of the injection for emergencies is more logical as the solution can be used orally. It has a bitter taste which can be masked by adding the dose to a flavoured liquid just before administration. This is recommended in the Palliative Care Formulary. As the contents of the injection vial are not being used parenterally, in such cases, it would be considered safe to use the same vial for up to 72 hours to cover emergency use over a weekend, if needed. If using an injection vial for oral administration, it must be labelled clearly to show the date of first use and the expiry date.
Do you have a query about medicines or procedures in your hospice? Contact us and it could appear in our next issue!