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CHHS18/210 Canberra Hospital and Health Services Operational Procedure Manual Methadone Dispensing: Manual Pumps – Justice Health Services Contents Contents..................................................... 1 Purpose...................................................... 2 Alerts....................................................... 2 Scope........................................................ 2 Section 1 – Methadone Dispensing.............................2 Section 2 – Methadone Reconciliation.........................3 Section 3 – In the event of iDose failure....................4 Section 4 – Methadone Storage................................5 Section 5 – Maintenance and Disposal.........................6 Implementation............................................... 6 Related Policies, Procedures, Guidelines and Legislation.....6 References................................................... 7 Search Terms................................................. 7 Attachments.................................................. 7 Attachment 1 – Methadone conversion chart...................8 Attachment 2 – Question and Answer.........................10 Doc Number Version Issued Review Date Area Responsible Page CHHS18/210 1 08/08/2018 01/08/2019 MHJHADS - JHS 1 of 13 Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
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CHHS18/210
Canberra Hospital and Health ServicesOperational Procedure Manual Methadone Dispensing: Manual Pumps – Justice Health ServicesContents
Contents....................................................................................................................................1
Purpose.....................................................................................................................................2
Alerts.........................................................................................................................................2
Scope........................................................................................................................................ 2
Section 1 – Methadone Dispensing...........................................................................................2
Section 2 – Methadone Reconciliation......................................................................................3
Section 3 – In the event of iDose failure...................................................................................4
Section 4 – Methadone Storage................................................................................................5
Section 5 – Maintenance and Disposal.....................................................................................6
Implementation........................................................................................................................ 6
Related Policies, Procedures, Guidelines and Legislation.........................................................6
References................................................................................................................................ 7
Search Terms............................................................................................................................ 7
Attachments..............................................................................................................................7
Attachment 1 – Methadone conversion chart......................................................................8
Attachment 2 – Question and Answer................................................................................10
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Purpose
This procedure provides guidance when manual dosing for methadone (using Socorex pumps) is to be used. It outlines the requirements for manual methadone dosing and outlines how to use the Socorex pumps.
This procedure relates to the dispensing, reconciliation and recording of methadone liquid 1mL/5mg Biodone Forte only.
Alerts
Nurses must be trained in use of the manual pump system before they can administer using the Socorex pump.
Socorex Manual pumps should only be used in the event of: ICT failure iDose system malfunction e.g. not calibrating accurately. Where a client has mobility issues or is too unwell to move to a dosing point with an iris
scanner. The RN must discuss this with the nurse in charge. The nurse in charge will decide whether the client should not be moved or dosed manually in the client’s accommodation unit.
Note: In accommodation areas where iDose is not yet installed e.g. Management Unit and WCC, ACT Corrective Services (ACTCS) escort clients to the Hume Health Centre to be dosed.
0.25-2.5mL Socorex pumps should be used at all times to ensure accurate dose is delivered.
Scope
This document applies to all CHHS Registered Nurses and Enrolled Nurses working within Justice Health Services (JHS).
Section 1 – Methadone Dispensing
Equipment Socorex Pumps Methadone Mydrochloride –(Biodone Forte Solution) Schedule 8 book Biodone conversion chart
Procedure Volume setting
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1. Turn setting wheel in one or the other direction until correct volume is aligned with the pointer. A click-stop mechanism prevents unexpected volume alteration.
2. When setting up the dose, please ensure to state the clients’ correct dose in the following manner; “Patient X is on methadone 4mL/20mg”. Please refer to attachment 1 for the methadone mL/mg conversion chart
Priming3. To prime the unit, activate the plunger fully at least once until there is an even flow and
to eliminate air bubbles in the delivery jet. Liquid must be collected in a clean vessel and can be recycled.
Dispensing4. Remove tip cap before dosing. Raising the plunger fills the dispenser barrel. 5. Depress to dispense the liquid. Best results are obtained by moving the plunger gently.
Liquid density or viscosity may change dosing speed and instrument’s performance. 6. The 0.25-2.5mL Socorex pumps is to be used at all times. The 1-10mL Socorex pumps
cannot be used to dispense 0.5ml doses. This is to ensure that the accurate dose is delivered.
End of dosing7. After use, place tip cap on delivery jet to prevent fluid from leaking back and valves to
dry out.
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Section 2 – Methadone Reconciliation
1. To complete a reconciliation of methadone prior to commencing a dosing schedule, first check and count all unopened bottles and record them as 1000mL.
2. If the quantity of methadone left in the bottle does not correspond to the quantity documented in the register re-check all doses administered and note loss of S8 on the S8 register and notify CNC/ADON.
3. Document in the transport log the number of methadone bottles removed from the safe. 4. Discrepancies of greater than 4% must be reported to the CNC/ADON and Canberra
Hospital Pharmacy. Please refer to Medication Handling Policy. 5. At the completion of a dosing schedule, there is a requirement to reconcile volume of
methadone remaining in the opened bottle and to count the number of unopened methadone bottles and complete a methadone reconciliation.
6. If a new bottle of methadone is opened in the middle of a dosing schedule, a true balance check is required at the end of each bottle before opening the new one. This is to be measured in mL. Pour the methadone into a measuring cylinder and record remaining volume. The remaining volume can be either discarded or poured back into the new bottle if it is from the same batch.
7. Methadone must be measured on every shift and in high usage areas a balance check must be done during, or at the change of, each shift. Two staff are required to count all
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sealed and unsealed bottles of methadone. If a discrepancy occurs the CNC/ADON must be informed for further follow up.
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Section 3 – In the event of iDose failure
When iDose is offlineWhen iDose is offline, methadone must be recorded in the S8 Register.1. At the dosing point, the client is to be identified by name and date of birth as shown on
the prescription and Prisoner Identification Card (Alexander Maconochie Centre) or photo identification (Dhulwa Mental Health Unit).
2. The current prescription must be checked for validity.3. Doses are NOT to be increased during manual dosing without the authority of the
prescribing doctor. Increased doses are only permitted when the prescription specifies that the client is being inducted, or if the prescription allows for an increase or other records show that the client dose has been the same for the previous seven days in the case of methadone treatment.
4. All pharmacotherapy manual dosing details must be entered into the appropriate Controlled Medicines Register. These details include the: date, client’s name, dose, details of the nurses administering and checking the dose, time of administration and name of prescribing doctor. The controlled medicines running balance must also be specified. All entries must be legible.
5. At the end of the dosing session all controlled medicine stock must be measured and counted. The actual stock figure must be entered into the appropriate Controlled Medicines Register and reconciled with the running balance. Once reconciled, the administering and checking nurse must sign the register entries. When the IT failure of iDose malfunction resolves, staff must enter all doses (as listed in the Controlled Medicines Registers) into iDose. The drug usage report printed must be notated with “Also documented in CM register due to (applicable IT failure of iDose malfunction) on (specify date)” and signed by the Registered Nurse in charge and the checking nurse (RN or EN). The drug usage report is stored in a locked cabinet.
6. A RiskMan report must be completed within 24 hours by nursing staff present at the time of IT failure or iDose malfunction.
Failure of iDoseIf iDose fails to electronically dose, methadone must be documented in iDose.1. Login to iDose as usual2. Initialise the pump3. Click that the tubing is full. 4. Do not calibrate5. Bring up the client on iDose6. Click the dispense pre-prepared dose7. Go through as normal and check the script8. At the end, a box will open up untick the “dispense via pump”9. In the box with “enter the number of doses” put 1
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10. Click dispense
Recording of methadone on iDose when iDose software available but use of manual pump required (e.g. not calibrating)1. Login to iDose as usual2. Initialise the pump3. Click that the tubing is full. 4. Do not calibrate5. Scan iris to identify client6. Click the dispense pre-prepared dose7. Go through as normal and check the script8. At the end, a box will open up untick the “dispense via pump”9. In the box with “enter the number of doses” put 110. Click dispense11. Dispense the appropriate amount in mg/mL (see conversion table attached)
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Section 4 – Methadone Storage
On receipt of methadone, the order should be checked to ensure: Tamper evident seals are intact Quantity received is as shown on invoice After checking arrangements should then be made to immediately transfer the
methadone received into a securely locked safe The safe must be securely affixed to the premises of the building. The safe must be securely locked except when in immediate use. The safe must be of sufficient size to be able to store the methadone received All methadone, including measuring devices must be securely locked in a safe, except
when in immediate use.
The above procedures and requirements are in order to minimise loss and/or misappropriation of methadone.
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Section 5 – Maintenance and Disposal
Pump change and cleaningPump cleaning is to occur at bottle change. This involves rinsing the pump through with hot water.
Discarding of used methadone bottlesBefore empty bottles of methadone hydrochloride are discarded they should be rinsed out and the labels removed or defaced (for security purposes and to avoid them being used illegally). Bottles are to be discarded in the “clinical waste bins” (yellow) as per the waste management policy.
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Implementation
This procedure will be communicated to nurses working within Justice Health Services via the following methods: Individual sessions on how to use the manual pump and recorded on training record. Implementation to be discussed within the team Pharmacy to be informed Individuals to become familiar with the National Guidelines for Medication-Assisted
Treatment of Opioid Dependence 2014 Opioid Replacement Therapy Policy and Procedures Completion of a competency assessment and quiz (Attachment 2)
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Related Policies, Procedures, Guidelines and Legislation
Policies Medication Handling Policy Opioid Replacement Treatment – Justice Health Services Patient Identification and Procedure Matching Policy
Procedures Waste Management Patient Identification and Procedure Matching Procedure Healthcare Associated Infections Procedure
Legislation Medicines, Poisons and Therapeutic Goods Act 2008 Human Rights Act 2004 Work Health and Safety Act 2011 Health Records Privacy and Access Act 1997
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References
1. Opioid Maintenance Treatment in the ACT: Local Policies and Procedures2. National Guidelines for Medication-Assisted Treatment of Opioid Dependence 2014 3. NSW Government, Health, Justice Health Forensic Health Network. Standard Operating
Procedure (SOP) Reconciliation of Methadone using the Biomed Calibrated Ruler.4. Medicines, Poisons and Therapeutic Goods Act 20085. Socorex Calibrex 525/530 Operating Instructions 6. Cleaning protocol Socorex 525/530 Calibrex Dispenser
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Search Terms
Methadone, socorex, ORT, opiate replacement therapy, justice health
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Attachments
Attachment 1 – Methadone conversion chartAttachment 2 – Question and Answer
Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.
Policy Team ONLY to complete the following:Date Amended Section Amended Divisional Approval Final Approval 18 July 2018 New Document Tina Bracher, ED,
MHJHADSCHHS Policy Committee
This document supersedes the following: Document Number Document Name
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Attachment 1 – Methadone conversion chart
Methadone mg/mL conversion chartMillilitres (mL) Milligram dose
(mg)0.5 2.51 5
1.5 7.52 10
2.5 12.53 15
3.5 17.54 20
22.5 4.55 25
5.5 27.56 30
6.5 32.57 35
7.5 37.58 40
8.5 42.59 45
9.5 47.510 50
10.5 52.511 55
11.5 57.512 60
12.5 62.513 65
13.5 67.514 70
14.5 72.515 75
15.5 77.516 80
16.5 82.517 85
17.5 87.518 90
18.5 92.5
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Millilitres (mL) Milligram dose (mg)
19 9519.5 97.520 100
20.5 102.521 105
21.5 105.522 110
22.5 112.523 115
23.5 117.524 120
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Attachment 2 – Question and Answer
When should a manual pump be used? Manual pumps should only be used in the event of: An electrical failure iDose malfunction e.g. not calibrating accurately. If a client has mobility issues or is too unwell to move to a dosing point with an iris
scanner, the RN must discuss this with the nurse in charge. The nurse in charge will decide whether the client should not be moved or dosed manually in the client’s accommodation unit.
Can I use the 1-10mL Socorex pumps to dispense .5mL doses?No, you must use the 0.25-2.5mL Socorex pumps at all times. This is to ensure that the accurate dose is delivered.
What if iDose has been reconciled and shut down for the day, can I use the pump?No, the system must be restarted. However, in the event of constricted timeframes it is at the discretion of the nurse in change as the whether the pump should be used.
If a client has mobility issues or is too unwell to move to a dosing point with an iris scanner, the RN must discuss this with the nurse in charge.
Do I need to measure the dispensed dose prior to administering it to the client?No, if the correct Socorex pumps are used, no further measurement is required.
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