Cubex Competencies for Controlled Substance Access

Implementation Date: 10/2021

Date of Last Review: 3/27/2023

Next Review Due: 5/2023

 

Reviewed by VTH Administrative Team: 10/2021

Reviewed by VTH Board: N/A

 

Reviewed by Legal Counsel: N/A

Reviewed by Biosecurity Subcommittee: N/A

Subject to modification by the VTH Director without approval.

Policy

All technicians and doctors will be required to complete competencies prior to having access to Cubex controlled substances. All technicians and doctors are eligible to complete the competency check for medium-level controlled substances after they have completed the service-specific training period. Only doctors and Vet Tech IIs and Vet Tech IIIs are eligible to complete the written competency for high-level controlled substances.

Guidelines

• Controlled substances will be divided into 3 levels

• • Low: solid and oral liquid dosage forms
  • Medium: Injectable dosage forms excluding ketamine
  • High: Ketamine

• A competency check requiring accurately drawing up several volumes of saline will be required to obtain access to Medium-Level Controlled Substances. All doctors and veterinary technicians are eligible for this competency once they complete their service-specific orientation training.
• A written competency with ketamine dilution calculations will be required prior to gaining access to High-Level Controlled Substances. Only doctors, and technicians that are classified as Vet Tech II/IIIs OR have completed the anesthesia service training are eligible to complete this competency.
• Completing the competency testing is not required if a person’s role does not require access to those medications.
• A strike system will be used to monitor compliance with Cubex policies. Three major strikes or 10 minor strikes in a 2-month period will result in loss of all Cubex access for a 1-month period. Repeat competency testing will be required to reinstate access to Medium- and High-Level Controlled Substances at the end of the 1-month period.

Procedure (if applicable)

Part 1: Competency Checks

• Prior to being given access to any medium or high-level controlled substances, doctors and technicians must successfully complete a hands-on competency evaluation by a pharmacist. This evaluation will be done as follows:

1. 1. The pharmacist will provide a list of 10 volumes ranging from 0.02 – 1.2ml
   2. The doctor/technician will be asked to draw up 10 separate syringes containing the listed volumes from a single vial of saline with a 6-minute time limit
   3. Successful completion requires that all quantities be exact and in an appropriately sized syringe. This will be evaluated by the pharmacist.

• Prior to being given access to a high-level controlled substance, a doctor/technician must complete the competency for medium-level controlled substances as well as complete a written ketamine dilution calculation competency consisting of two scenario-based questions.

Part 2: Strike System

• Doctors/technicians that accumulate 3 major strikes or 10 minor strikes over a 2-month period will have their Cubex access to all drugs removed for a month. After one month, access to non-controlled medications and Low-Level Controlled Substances will be automatically reinstated. The doctor/technician will be required to repass the competency evaluations prior to regaining Medium- and High-Level Controlled Substance access. 

This policy only applies to obtaining drugs from Cubex. It does not apply to administration of drugs. 

Definitions (if applicable)

Low-Level Controlled Substances - Controlled substances that are in Cubex as solid and oral liquid dosage forms

Medium-Level Controlled Substances - Controlled substances that are in Cubex as injectable dosage forms excluding ketamine

High-Level Controlled Substances - Controlled substances that are in the Cubex and have been determined to require extra oversight. Currently, the only drug this applies to is ketamine.

Strikes - Strikes include the following when they occur with controlled substances
- Medication removed under an incorrect patient
- Transaction timeout 
- Wrong quantity of medication entered or obtained

Minor Strikes - Strikes where the doctor/technician completes an incident report and self-reports to dispensary staff to facilitate record keeping corrections.

Major Strikes - Strikes that are discovered by other staff (dispensary staff, charge auditor, doctor, etc.) prior to being self-reported

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.