Controlled Drugs: How Nurses Check, Give and Record Them Safely

Controlled drugs, such as morphine and fentanyl, need extra checks because of the risk of harm, misuse and diversion. Here is how nurses keep them safe.

Imagine the evening controlled drug count is one ampoule short. Everyone looks at each other. Clear processes and careful records are what protect both patients and staff in moments like this.

Why controlled drugs are different

Controlled drugs are regulated by law because they can cause dependence and harm. Countries set their own rules, for example under the Misuse of Drugs regulations in the UK and the Controlled Substances Act in the US.

Safe storage

• Locked cupboard or automated cabinet
• Keys or access held by authorised staff
• Regular stock checks, often at every shift change

Giving a controlled drug

1. Check the prescription carefully
2. Many organisations require two staff to check and witness
3. Check the patient’s identity and allergies
4. Record in the controlled drug register with signatures
5. Document in the patient’s record
6. Dispose of unused doses as policy requires, with a witness

If a count is wrong

• Stop and recount
• Check records for errors
• Inform the nurse in charge and pharmacy immediately
• Complete an incident report
• Do not leave the shift until it is escalated

Frequently asked questions

Can a student nurse witness?

Policies vary. Many allow students to observe but require registered staff to witness.

But the checks slow us down

They do, slightly. They also protect patients from errors and protect you if anything is questioned later.

Related: What to do after a medication error

Sources: UK Misuse of Drugs Regulations and NICE controlled drugs guidance, US Drug Enforcement Administration, Royal Pharmaceutical Society, national nursing regulators.