VMSC Controlled Substances Use & Management (with Cubex)

Implementation Date: 10/2021

Date of Last Revision: 10/2021

Next Review Due: 10/2024

 

Reviewed by VTH Administrative Team: 10/2021

Reviewed by VTH Board: N/A

 

Approved by VTH Director: 10/2021

Reviewed by Biosecurity Subcommittee: N/A

Subject to modification by the VTH Director without approval.

Policy

This document outlines the requirements for using Cubex and which to procedures to follow to manage, use and dispense controlled substances in the VMSC. This applies to all controlled substances schedule II-V that are stored and/or used in the VMSC.Controlled substances dispensed at VMSC must follow appropriate guidelines when dispensing for in-house or outpatient use. Controlled drugs must be stored in the Cubex machine and removed on a dose-by-dose basis for inpatient use. When being dispensed to go home with the animal, the drugs must not be removed from the Cubex for prescription filling until the owner is present. Veterinarians and veterinary technicians will be given access to Cubex. WMC Team Leaders will be given Cubex access to the bins holding WMC drugs. The person removing the medication from the Cubex is responsible for the final disposition of the drug. Once medications are taken out, please verify client charges are correct prior to checking out. Dispose of any unused medications following the appropriate procedures and documentation of discarding controlled substances.

Guidelines

Controlled drugs must not be stored anywhere in the clinic besides in the Cubex machine and a countback will be required when removing a medication. Medications must be removed dose-by-dose when needed or immediately before providing the medication to the owner when dispensing. In-house medications will be obtained from Cubex per dose when needed. Cubex will send over charge to SANDI within appropriate timeframe. Outpatient medications being sent home with the client will be entered in SANDI first, then obtaining medication in Cubex using the “Non-billable” drug code.

Procedure (if applicable)

Controlled Drugs for Inpatient Use

1. The drug administration directions and timing must also be written on the treatment sheet. 
2. Once the drug is recorded on the treatment sheet, it is eligible to be removed from Cubex. This should occur immediately prior to administration. The Cubex will require a countback which must be completed prior to removing the dose.
3. In-hospital Injectable doses: Log into Cubex with fingerprint or username and passcode. Search for your patient, hit “next” then search and select the Doctor. Hit “next” then search for the drug needed. Verify drug, strength, and look at “Description 2” (if applicable). Enter dose needed, hit “next” and Cubex will automatically open drawer and Cubie bin. Screen will ask user to verify amount in bin is correct – hit “next” if correct. If amount is incorrect, enter the amount found. This will create a discrepancy that Medication Dispensary staff will follow up on later. Take out your drug and draw up the amount needed. Put the vial back, close the Cubie bin and close drawer. Verify on Cubex screen the amount you have taken out, hit “next” if applicable, or log out of Cubex when finished. Extra controlled substances must NOT be stored in patient bins for later use!
4. In-Hospital Oral doses (Tramadol Suspension): Same process as In-hospital Injectable doses, search for patient, doctor and drug. When selecting Tramadol Suspension, choose code with “Billable” description. Enter your single dose needed and take out amount needed. If patient will be in-hospital and will need several doses, take only one dose every time. Discard any unused mediation that will not be needed. 
   
   

Controlled Drugs for Outpatient Dispensing

1. When a controlled substance needs to be dispensed to go home with a patient, it must be entered into Cubex as an out-of-hospital prescription and all dispensing procedures must be followed. The medication should only be filled when the owner is present. Then appropriate amount will be entered in Cubex and obtained. It will then be placed in an appropriately labeled bottle. The medication must be double counted and the quantity on the label circled to verify that the correct amount was counted. An auxiliary sticker bearing the federal controlled substances statement must be placed on the bottle of all outpatient controlled substances.
2. Out-Patient Medication (Tramadol Suspension and Buprenorphine): Enter the prescription in SANDI first, pin off and print labels. Go to Cubex, and search for patient, doctor, and drug. Select the drug with the Alternative Description “South Clinic Use -Non-Billable”. This will allow you to take the drug out of Cubex for dispensing but will not transfer any charges over to Cubex . 
3. The doctor must initial the label to verify that they checked the medication to make sure it was correct.
4. When dispensing oral buprenorphine, the injectable buprenorphine should be repacked into an oral dosing bottle and an expiration date sticker placed on it. Buprenorphine is good for 28 days after repackaging.
5. The medication should be given to the owner right after dispensing. Outpatient controlled substances must not be stored or used for inpatient treatment.
6. If Cubex is running low on an item, a report will generate for Medication Dispensary to restock. If more is needed sooner, please notify Dispensary staff. Please leave any empty vials or bottles of controlled substances in the Cubex for Dispensary staff to collect. 
7. As always, please verify all client charges prior to check out. Cubex charges may take 1 – 2 minutes to transfer over. Contact Medication Dispensary if assistance is needed, or if charges take longer than 2+ minutes.

Wasting Controlled Substances

1. If a controlled substance is removed for a patient and not administered, it must be wasted in an RxDestroyer container and recorded in the Cubex machine. 
2. When it is determined a medication needs wasted, log into the Cubex and follow the prompts to waste the medication under the patient for which it was removed.
3. Once the waste has been recorded in Cubex, dispose of the medication in the RxDestroyer container. Empty needles and syringes can then be placed in the sharps container.

Definitions (if applicable)

Veterinary Teaching Hospital (VTH): The collective clinical services of the Large Animal Clinic, Midwest Equine, the Small Animal Clinic, and the Veterinary Medicine South Clinic.