Op-5 Controlled Substances

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Drugs and other substances that are considered controlled substances under the controlled substances act are divided into five schedules. Substances are placed in their respective schedules based on whether they have a currently accepted

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medical use in treatment in the United States, the relative abuse potential, and likelihood of causing dependence when abused.

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Substances in the schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.

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Schedule 1 controlled substances

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Substances in this schedule have a high potential for abuse which may lead to severe psychological or physical dependence. Examples include morphine, fentanyl, and oxycodone.

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Schedule II controlled substances

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Substances in the schedule have a potential for abuse less than substances in schedule 1 or schedule 2, and abuse may lead to moderate or low physical dependence or high physiological dependence. Examples include combination products containing less than 15 mg of hydrocodone per dosage unit, products containing not more than 90 mg of codeine per unit examples Tylenol with codeine, ketamine.

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Schedule 3, 3n controlled substances

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Substances in the schedule have a low potential for abuse relative to substances and schedule three. Examples include Xanax, Klonopin, Valium, and Versed.

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Schedule 4 controlled substances

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Substances in this schedule have a low potential for abuse relative to substances in schedule 4 and consists primarily on preparations containing limited quantities of certain narcotics.

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Schedule 5 controlled substances

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The substance is identified as controlled medications by the DEA, Texas department of public safety and EMS are:

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-fentanyl, schedule 2

-versed, schedule 4

-ketamine , schedule 3

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The EMS supply warehouse supervisor will complete a ___________form for the amount of schedule 2 medications requested on the official purchasing record that is to be submitted to the vendor.

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DEA 222

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The EMS supply warehouse supervisor will maintain copies of the following documents:

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-The purchase order, and any accompanying required purchasing documents.

-DEA 222

-Shipping receipt

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The original completed blue DEA 222 and any accompanying purchasing and shipping documents shall be maintained at Central Supply. Originals will be maintained in accordance with the city of Austin record attention requirement which is a minimum of

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5 years.

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The ordering of schedule 3,4,and 5 substances does not require __________ to process the order.

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DEA forms.

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receipt of the substances from the shipper will require verification of the shipment by _________________ individuals, prior to adding to the stock. Once the shipment has been verified, it will be secured and the designated storage safe. The shipment will be added into stock and documented on the controlled substances storage accounting log.

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2 EMS Supply approved

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The invoice for shipping documents shall be cross-referenced with the purchase order and DEA 222 to ensure accuracy. In the event of a discrepancy, the vendor shall be notified immediately. It will be the ____________ responsibility to rectify any discrepancy. The supply warehouse supervisor will complete the DEA Form 106 "report of theft or loss of controlled substances, specificlly the section related to Lost in transit."

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vendor's

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Controlled substances will be stored in an area with a minimum of two locking mechanisms, at least one of which will be a combination lock and one of which may be

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Keyed.

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Knowledge of the combination will be limited to the supply warehouse supervisor, operations division chiefs and the chief of staff of the office of the medical director.

A ____________ agreement shall be signed by all persons with knowledge of such combination and placed in their respective personnel file.

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a confidentiality

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Schedule __________ substances shall not be stored on the same shelf with a schedule 3, 4 or 5. They may be in the same location but must have a physical separation.

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2

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Anytime the safe is opened by authorized personnel they are required to verify the existing controlled _________, including any changes to the inventory and document these counts on the controlled substance storage accounting log. The log will be then be signed along with employee number and witnessed.

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substance counts

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In the event that the account cannot be reconciled the assistant director of administration, EMS assistant chief of operations and OMD Chief of staff will be notified. All persons involved will report for a____________________. If the department is unable to make contact with an individual for account verification the provider will be required to report immediately upon returning to work.

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Mandatory drug screen

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IMP

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Individual medication pouch

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All controlled substances will be issued to staff in an EMS department approved container called an IMP, each container shall have a permanent unique identification number. The following controlled substances and amounts will be in each container:

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600 mcg fentanyl

15 mg versed

1000 mg ketamine

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In the event of an unresolved discrepancy all persons having transacted with controlled substances since the last ____________ will report to the respective division Chief to rectify the account.

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verification

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In the event that the account cannot be reconciled, the assistant director of administration, EMS assistant chief of operations and the OMD chief of staff will be notified and all persons involved will report for a mandatory drug screen. They will also decide as to what level of

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investigation will occur to reconcile any discrepancies.

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In the event a controlled substance container is broken the persons responsible for the breakage should immediately notify his or her partner and the assigned Commander. The responsible party should complete an ___________ detailing the events leading up to the breakage and the disposal of the container and remaining substance.

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incident report

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Following the establishment, by the commander, that breakage was the cause, in the presence of the commander and both crew members the controlled substances that were damaged shall be

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Immediately wasted.

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The controlled substance that was damaged will be replaced by The Warehouse Supply supervisor consistent with the controlled substance inventory management practices. Controlled substance breakage will be documented on the controlled substance log as

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"breakage"

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When controlled substances have expired the medication and quantity shall be documented on the controlled substance log of the location of the expired controlled substance as controlled substances shall be returned to Central Supply supervisor and inventoried and entered as

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"expired".

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In the event of a controlled substance is lost or cannot be accounted for. The persons accountable for the loss shall immediately

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notify the assigned commander and the on-call division Chief. The responsible party shall complete an incident report detailing the events leading up to the loss.

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The suspected lost controlled substance will be replaced by the supply warehouse supervisor. They controlled substance loss will be documented as

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"loss".

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The suspected tampered medication will be replaced by the supply warehouse supervisor the controlled medication loss will be documented as ______________on the controlled substance log.

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"tampered"

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When a controlled substance stocking level on the unit assigned reaches the minimum accepted level staff will notify the appropriate field commander for clearance to Central Supply for the restocking of the controlled substance.

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PAR

1000mcg fentanyl

25mg Versed

2000mg ketamine

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For narcotic resupply, the unit will be placed in priority status for direct transit to Central Supply. Upon arrival to Central Supply the unit will be authorized

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20 minutes to accommodate the requisition and resupply process. If this transaction requires additional time the communications Commander will be notified immediately by Supply personnel or the unit staff. The unit will remain in priority status until returning to their primary response district.

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The system credentialed paramedic will present to the designated Supply staff a completed requisition form, IMP, unit controlled medication cache, and the current system

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credential badge.

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EMS Supply staff will verify system credentials certification and review the requisitions and controlled substance count for accuracy. The total count of substances on hand (cache+IMP) should total

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31 fentanyl, 13 versed, and 13 ketamine.

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Upon opening the safe, the supply staff member will confirm the controlled substance count in the safe, __________ to removing any controlled substance. the count must be confirmed on the safe controlled substance storage accounting log to ensure the account is correct.

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Prior

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Commanders shall frequently audit their units __________ logs to confirm that the amount administered, and amount wasted, equals the amount packaged, per unit dose carried on each line of the controlled substance logs.

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controlled substance

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Verification of these random unit audits by the commander will be reflected by a ______________ at the bottom of the controlled substance logs.

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commander signature and date

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EMS supply warehouse supervisor with the division Chief assigned to controlled substance management, will audit all the controlled substances at the end of each

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month. This audit will be accomplished by comparing the amount of each controlled substance requisitioned by each provider to the amount documented in the epcr.

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Fentanyl / fentanyl citrate is a schedule

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2 drug.

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Versed / Midazolam is a schedule

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4 drug.

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Ketamine is a schedule

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3 drug.

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PAR level of Fentanyl in the IMP.

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1000mcg Fentanyl

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PAR level of Versed in the IMP

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25mg Versed

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PAR level of Ketamine in the IMP

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2000mg