Circular 4/2022: Impairment Committee findings
28 March 2022
To: National Department of Health
Provincial Departments of Health
Private Health Care Providers
SUBJECT: IMPAIRMENT COMMITTEE FINDINGS: POOR MANAGEMENT OF SCHEDULED SUBSTANCES/ MEDICINES IN HEALTH ESTABLISHMENTS
- Share the findings/trends of the Impairment Committee (IC) regarding mismanagement of scheduled substances/medicines with the National Department of Health, Provincial Departments of Health, Private Health Care Providers and other relevant stakeholders.
- To remind Registered Nurses and/or Midwives of their role in managing scheduled substances/ medicines in health establishments in line with relevant policies and protocols.
- The IC is one of the standing committees established by the South African Nursing Council (SANC) in terms of section 51 of the Nursing Act, 2005 (Act No.33 of 2005). The Committee is appointed to manage practitioners who are registered in terms of section 31 (1) of the Act, who are deemed unfit to practice nursing due to disability or impairment. Most of the cases received by IC relate to abuse of scheduled substances/medicines. In dealing with these cases, the Committee has noted with concern the deteriorating vigilance in the management of scheduled substances/medicines in healthcare establishments, both public and private, which leads to abuse of these substances/ medicines by Health Care Professionals.
- On analysis of the reported cases, the IC established that practitioners had access to these substances/ medicines in any of the following ways:
- When Registered Nurses and/or Midwives issue and administer prescribed scheduled substances/ medicines alone.
- Scheduled substances/ medicines cupboard keys not kept in line with applicable policies.
- Scheduled substances/ medicines not co-checked during hand over and in every shift change, leaving discrepancies to go unnoticed.
- Counting and recording of the quantities of scheduled substances/ medicines administered not done in line with applicable institutional policies or common best practices
- Prolonged use of prescribed scheduled substances/ medicines, which leads to dependency. For example, Registered Nurses and/or Midwives who were involved in car accidents or have had major operations which lead to addiction and abuse.
- TELL-TALE SIGNS OF NURSE PRACTITIONERS WHO MAY BE ABUSING SCHEDULED SUBSTANCES/ MEDICINES
The following are some of the warning signs that the nurse may be using or addicted to scheduled Substances or medicines:
- Scheduled substances/ medicines to be discarded kept in a syringe for no apparent reason;
- Registered Nurse and/or Midwife frequently borrowing scheduled substances/ medicines from other wards or visiting the wards/ healthcare establishments at awkward times;
- Registered Nurse and/or Midwife requesting colleagues to countersign in the register for scheduled substances/ medicines which they did not witness being dispensed;
- Inaccurate recording and questionable entries;
- Erasing or ‘overwriting’ of drug book entries, instead of following standard operating procedures;
- Registered Nurse and/or Midwife often volunteering to administer scheduled medications; and
- Registered Nurse and/or Midwife frequently offering to count scheduled substances/ medicines, to make sure the count is correct.
- ROLE OF PRACTITIONERS IN MANAGEMENT OF SCHEDULED SUBSTANCES/ MEDICATIONS
- It remains the obligation of the Registered Nurse and/or Midwife to ensure that all scheduled substances/medicines are ordered, controlled, administered and disposed of in terms of the given protocols, policies and procedures of the institution.
- Registered Nurses and/or Midwives must ensure that Enrolled Nurses/Nursing Auxiliaries ARE NOT allowed to keep the keys to the controlled medicines and substance cupboard and to check and administer scheduled medicines alone.
- Scheduled medicines must be prescribed by a doctor except in emergency situations as per institutional protocol.
- Registered Nurses and/or Midwives are personally liable for all unprofessional conduct while performing their duties.
- The person in charge of the ward or nursing unit will remain accountable for all nursing care provided.
- ROLE OF NURSE MANAGERS IN MANAGEMENT OF SCHEDULED SUBSTANCES/ MEDICATIONS
- Nurse Managers must develop and implement policies and procedures with regards to the ordering, safe keeping and administration of scheduled substances/ medicines.
- There should be strict monitoring of compliance to policies and procedures to assist Nurse Managers to prevent possible addiction and/or abuse.
- Nurse Managers must report incidences of alleged addiction or abuse to the SANC, so that the alleged practitioner is managed under the Impairment Programme, failure of which, the Nurse Manager will be charged for unprofessional conduct.
- The contents of this circular must be brought to the attention of all practitioners and all managers in all health establishments.
- For further information in respect of this circular, kindly contact Dr NJ Muswede, Senior Manager: Professional Practice at firstname.lastname@example.org or Tel: 012 420 1008.
MS SA MCHUNU DATE
REGISTRAR AND CEO
SOUTH AFRICAN NURSING COUNCIL