CD Register

PTS includes an optional CD Register module that can be used to keep track of transactions relating to the movement of controlled drugs (CDs). It is designed to be an electronic implementation of the "CD books" that were previously hand-written.

Using the CD register, staff are able to create orders for CDs that are then tracked through the dispensing process and delivered back to the ward, where the transactions relating to the receipt and onward administration to a patient can be recorded and witnessed.

Patient’s own CDs can also be receipted and administered in the CD register as you can even record transactions for stock that is not being tracked in PTS.

The CD register module features a live summary of CD stock levels (ward and patients own) as well as a detailed list of transactions.

Additionally, the CD register module includes CD key handovers and balance check functionality.

Prerequisites

• Purchase a CD Register license key.
• Update to PTS 5.0.0.47+
• Configure Application Settings to allow use of CD Register module.
• A populated drugs table is required.

Setup

Application Settings

There are several settings that need to be configured in Application Settings:

1. CDLICKEY
   The entry of a valid licence key enables CD register functionality within the application. Please contact TMSi to obtain your licence key.
2. CDNEWROLE
   Staff using the CD Register can be given permission to register additional users. This is useful when a transaction needs to be witnessed but the witnessing nurse has not yet been set-up in PTS. When a user is created in this manner, the CDNEWROLE setting determines the role (and therefore default user views & permissions) that will be assigned to the new user.
3. CDPATID
   When administering CDs from the register, PTS will verify that the CD is being administered to a valid patient. This setting determines if the local ID (usually Hospital Number) or national ID (usually NHS Number) will be used to match the patient.
4. PWDEXPIRY, PWDLENGTH, PWDREQDIG, PWDREQLOW, PWDREQNON, PWDREQUPP, PWDREUSE
   Password complexity requirements, expiry interval and whether re-use of old passwords is permitted can be configured in line with your organisations security policies.

Populate initial ward stock lists

Adding drugs to a ward's CD register stock list. In this example the user is about to add an entire schedule of drugs.

A populated CD stock list.

Each ward that uses the CD register will have a stock list of CDs that can be tracked on that ward.

In order to build these lists, you need to be logged on to PTS as a user that has both the WARD and WARDSTOCKLIST permissions set to administer. You will need to log out and re-open PTS5 to have these changes accepted.

By creating a stock list, you are defining which drugs can be ordered and tracked using the register for each ward. This functionality should only be used when initially building these lists as this does not track the transactions like the live CD register does (hence the WARDSTOCKLIST = Administer permission).

To populate the initial ward stock list:

1. Go to the wards setup screen and tick the ward that you want to build the CD stock list for. Click the Show CD Register button that appears on the actions menu. The CD Register Ward Stock List screen will appear.
2. By default the stock list only displays drugs that are in stock. To ensure you are not adding duplicate drugs to a ward’s stock list, toggle the slider at the top right of the screen.
3. Open the actions menu and click the Add Drug to Ward Stock List button. The Add Drug to Ward Stock List dialog will appear. Drugs can be added individually by typing the name of the drug to add, selecting it and clicking the add button. Alternatively, all drugs of a given schedule can be added by selecting a schedule from the Add Drugs by Schedule button.
4. Once added the drugs will be displayed on the CD Register Ward Stock List. If no drugs appear, double check that the show items that are out of stock slider is set to display out of stock drugs.
5. Transactions can now be completed in the CD register for the ward.
6. Create a ward stock list for every ward that will be using the CD register.

Enable recording of CD key handovers

To enable CD key handovers to be recorded for the ward, select the ward from the Wards setup page and in the Ward Details tab of the ward popup set Using CD Key Handovers to Yes.

Create roles and set permissions

The CD Register module can be set up in various ways when it comes to accessing the register, but by far the most popular scenario is to allow the existing generic ward user accounts to view the register but require an appropriate username and password to be provided when actually instigating or witnessing transactions. This mitigates the need to continually log in and out of PTS using the main login screen.

To support this three different roles are needed (see role permissions section below for setup):

• Ward Staff
  Allow rudimentary, read-only access to the CD register.
• Nurse Associates
  Nurses that can witness CD transactions.
• Qualified Nurses
  Nurses that can instigate and witness transactions and create new CD user accounts.

You should use the Ward Staff role as the basis for the other two roles and make changes from there.

It is recommended that the Nurse Associates (i.e. witness only) role is the role used in the CDNEWROLE application setting. In effect this means senior nurses can create new user accounts at any time that can act as witnesses.

Role permissions

The permissions relevant to the CD register, their meaning and the suggested value for each of these three roles are summarised in the table below:

Permission	Definition	Ward Staff	Nurse Associate	Qualified Nurse
BOOKIN	Allows the user to create prescriptions using the booking-in screen.	Yes	Yes	No
BOOKINTARGET	Determines if a user is able to amend request & target completion times on the booking-in screen.	No	No	No
BOOKINUSER	Determines if a user is able to change the user that is creating a prescription on the booking-in screen.	No	No	No
CDADMINISTERPATIENTSTOCK	Determines if a user is able to Instigate and/or Witness administration of patient stock.	No	Instigate & Witness	Witness
CDADMINISTERWARDSTOCK	Determines if a user is able to Instigate and/or Witness administration of ward stock.	No	Instigate & Witness	Witness
CDAMENDPATIENTSTOCK	Determines if a user is able to Instigate and/or Witness amending patient stock.	No	Instigate & Witness	Witness
CDAMENDWARDSTOCK	Determines if a user is able to Instigate and/or Witness amending ward stock.	No	Instigate & Witness	Witness
CDBALANCE	Determines if a user is able to Instigate and/or Witness performing a balance check.	Instigate	Instigate & Witness	Witness
CDCREATEUSER	Determines if a user is able to create a new user (of the role defined in the CDNEWROLE application setting).	Instigate	Instigate & Witness	Witness
CDDESTROYPATIENTSTOCK	Determines if a user is able to Instigate and/or Witness destruction of patient stock.	No	Instigate & Witness	Witness
CDDESTROYWARDSTOCK	Determines if a user is able to Instigate and/or Witness destruction of ward stock.	No	Instigate & Witness	Witness
CDKEYHANDOVER	Determines if a user is able to Instigate and/or Witness performing a CD Key Handover.	Instigate	Instigate & Witness	Witness
CDREASONSFORAMENDMENT	Determines if a user is able to amend reasons for amendment &/or destruction.	No	No	No
CDRECEIVEFROMWARD	Determines if a user is able to Instigate and/or Witness receiving stock from a Ward.	No	No	No
CDRECEIVEPATIENTSTOCK	Determines if a user is able to Instigate and/or Witness receiving patient stock.	No	Instigate & Witness	Witness
CDRECEIVESUPPLIERSTOCK	Determines if a user is able to Instigate and/or Witness receiving stock from a supplier.	No	No	No
CDRECEIVEWARDSTOCK	Determines if a user is able to Instigate and/or Witness receiving ward stock.	No	Instigate & Witness	Witness
CDREMOVEPATIENTSTOCK	Determines if a user is able to Instigate and/or Witness removing patient stock.	No	Instigate & Witness	Witness
CDREMOVEWARDSTOCK	Determines if a user is able to Instigate and/or Witness removing ward stock.	No	Instigate & Witness	Witness
CDSELFWITNESS	Determines if a user can both Instigate and Witness a single transaction.	No	No (SNAD nurses sometimes).	No
ISGENERIC	Generic accounts (i.e. Ward Staff) can never book in prescriptions that prompt for a password.	Yes	No	No
WARDSTOCKLIST	Determines if a user can view and/or administer the CD Register Stock list screen.	View	View	View

Create "Order for Controlled Drugs" prescription type

A common scenario when using the CD Register is to allow nursing staff to create an order for a CD via PTS which can then be tracked through the dispensing process as normal and then delivered to the ward.

This part of the process is technically independent of the CD register and is similar in nature to the Ward Ordering procedure.

The setup process involves creating a uniquely configured prescription type for this purpose (in the full knowledge that this doesn't represent a prescription at all in reality), and making changes to the ward staff role so they can book in this prescription type themselves.

1. As a PTS administrator, create a new prescription type named "Order for Controlled Drugs" or similar.
2. Enter the prescription type details as appropriate for your needs, with the following specifics:
   1. Under demographic options, set everything to "no" except for drugs and dose units. Orders for CDs should be for individual drugs so set the Drugs field to Single Drug. Dose units should be set to "yes".
   2. Under booking-in options, set number of patients to 1. This might seem odd but this allows us to overcome a feature that normally prevents drugs being added to a prescription that has no patient. Turning off all of the demographic options has much the same effect as no patients.
   3. OPTIONAL: Set Start Type to Never Start to have the order begin in "pending" status and allow pharmacy to manually start the prescription rather than it have it start immediately.
   4. RECOMMENDED: Set Password when Created to Yes. This is especially important when using generic ward user accounts. See the next section for more.
   5. Set the label style to CD Form (A4).
   6. Under applicable dispensaries, remove everything automatically added to the list, and then add the applicable dispensaries back in whilst selecting the A4 printer as the automated printer.
   7. The scanning sequence, target times and so on can be set how you see fit. The prescription type is obviously compatible with collection and delivery if you choose to use those components.
3. Next go to the roles setup page and locate the ward staff role:
   1. Under permissions, set BOOKIN to Yes.
   2. Under type permissions, set everything to View except for the new Order for Controlled Drugs prescription type, which should be set to Create (meaning Book In). Although, note that wards may need permission to create a Ward Order prescription type too.
   3. Click save and confirm the options to apply the changes to existing ward users.
4. It's important not to make the mistake of trying to limit booking in permissions using the booking in activity.
5. RECOMMENDED: Make changes to your internal pharmacy user views to separate the new prescription type into its own dedicated section. Take care to specifically include Pending prescriptions.
6. Make similar changes to the ward's user views. See the next section for more.

Create users

Now that roles have been created and have had their default permissions and user views set, we can create users for nursing staff that will use the CD Register. This can done in the normal way on the Edit Users setup page, but depending on the number of staff that will be using the CD Register this may be a time-consuming process. Active Directory integration is a great fit for handling this more elegantly.

Usage

Ordering a controlled drug from the pharmacy as a ward nurse

Ordering a controlled drug as a ward user.

1. Log on to PTS using the generic account for the ward.
2. Open the actions menu and click the Create Order for Controlled Drugs button. The booking-in screen should appear.
3. Start typing your name in the your name field and then click on your name when PTS finds you. Next, enter your password into the your password field.
4. Start typing the name of the drug to be ordered. Select the drug to be ordered and enter the required number of doses. The number of doses must be greater than 1.
5. Click the create button to generate the order.

Receiving the order in pharmacy and commencing work

1. Log on to PTS as a user within the dispensary.
2. Assuming that a user view has been set up that can see these orders, they will appear as per any other prescription in PTS.
3. If the prescription is pending and the dispensary is ready to start work on it:
   1. Click on the prescription.
   2. Check the details of the prescription (on the details tab) if necessary.
   3. Click the start prescription button to book in the prescription and start it and produce a barcode label.
4. If the prescription is configured to start immediately/automatically:
   1. A barcode label will be produced automatically via the automated printer.
   2. The prescription will appear on any appropriate dispensary user views like a typical prescription.
5. Progress the order to completion.
6. OPTIONAL: Collect and deliver the order to the ward. The ward will be able to track the dispensing and delivery process through their CD register or own user views.

Accessing the CD Register and transaction histories as a ward nurse

1. Log on to PTS using the generic account for the ward.
2. Open the actions menu and click the CD Register button. The CD Register screen will be displayed.
   
   
   

   
   


Transaction history for a controlled drug.
3. The CD Register for the ward displays drugs that are in stock on the ward (to view items that are out of stock toggle the show items that are out of stock slider on the top right of the screen). The date and time of the last key handover is also displayed on this screen.
4. The CD Register will display information regarding the number of units for each drug and when each drug was last balance checked. If an order has been created for a drug, then the orders status will also be displayed.
   • Orders that are sent to pharmacy have been recorded but the pharmacy has yet to start work on them.
   • Orders that are received by pharmacy have been accepted by the pharmacy and work has commenced dispensing them.
   • Orders that are completed by pharmacy have been completed and are ready to be collected by a porter for delivery back to the Ward.
   • Orders that are in transit with porter have been collected by a porter and are waiting to be delivered back to the Ward.
   • Orders that are delivered to ward, awaiting receipt into CD Register are ready to be receipted.
5. To initiate the transaction, click on the drug that you wish to perform the transaction on. The Transaction History page for the drug will be displayed.
   • This page displays the last 20 transactions to have been performed on the drug. Transactions are colour coded (Receipts are green, Amendments are orange, Balance checks are yellow, Removals & Destructions are red and Administrations are blue).
   • If there are more than 20 transaction for a drug, there will be an option to page the results.
   • Details of the relevant requisition numbers or patient information are displayed for each transaction along with details of who performed the transaction and who witnessed it.
   • The transactions list shows the current stock balance and each transaction details if stock was added or removed.
   • Clicking on the ‘x allocated to specific patients’ subheading will display details of the patients that the stock is allocated to.

Initiating transactions

Recording the receipt of a CD.

Receiving into stock

1. Select the type of receipt that you are performing; either stock or patients own.
2. Enter the number of dose units that are being received.
3. For stock receipts enter the requisition number corresponding to the stock being received. If there is a corresponding completed order for the drug this field will be pre-populated with the serial number (prescription ID) that was assigned to the order.
4. For receipt of patients own drugs, enter the patient's ID. PTS will look up the patient and display their name when the cursor is moved away from this field. You will not be able to record receipt if the patient is not recognised.
5. Start typing your name in the your name field and then click on your name when PTS finds you. Next, enter your password into the your password field.
6. Similarly if the drug being receipted requires a witness, ask the witness to start typing their name in the witnessed by field. Have them click on their name when PTS finds them and then enter their password in the witness password field.
7. Click OK to finalise the transaction. If there are any errors a message will be displayed that explains the error and any associated fields will be highlighted in red. Otherwise the transaction will be recorded and added to the top of the transaction list for the drug.

Amending CD stock levels.

Amending stock levels

1. Indicate if you are amending ward stock or patient's own doses.
2. Enter the number of doses and if doses are being added or removed. Do not use a negative number to indicate doses being removed – use a positive number and ensure the decrease stock option is selected.
3. Select the reason for the amendment from the list of options presented to you.
4. For amendments of patients own drugs, enter the patient's ID. PTS will look up the patient and display their name when the cursor is moved away from this field. You will not be able to record the amendment if the patient is not recognised.
5. Start typing your name in the your name field and then click on your name when PTS finds you. Next, enter your password into the your password field.
6. Similarly if the drug being receipted requires a witness, ask the witness to start typing their name in the witnessed by field. Have them click on their name when PTS finds them and then enter their password in the witness password field.
7. Click OK to finalise the transaction. If there are any errors a message will be displayed that explains the error and any associated fields will be highlighted in red. Otherwise the transaction will be recorded and added to the top of the transaction list for the drug.

Checking the balance of the CD stock.

Balance check

1. If you are checking the balance of more than one drug, consider using the balance check / CD key handover screen. This will avoid having to open the transactions screen for each drug individually.
2. Check that the ward & patient stock quantities are correct. If something is wrong you will need to use the amend or remove functions to correct the CD register.
3. Start typing your name in the ‘Your name’ field. When your full name appears click on it to confirm, then enter your password into the ‘Your password’ field.
4. Start typing your name in the your name field and then click on your name when PTS finds you. Next, enter your password into the your password field.
5. Similarly if the drug being checked requires a witness, ask the witness to start typing their name in the witnessed by field. Have them click on their name when PTS finds them and then enter their password in the witness password field.
6. Click OK to finalise the transaction. If there are any errors a message will be displayed that explains the error and any associated fields will be highlighted in red. Otherwise the transaction will be recorded and added to the top of the transaction list for the drug.

Destroying a CD.

Remove or destroy

1. Indicate if you are removing or destroying ward stock or patient's own doses.
2. Enter the number of doses. Do not use a negative number to indicate doses being removed – use a positive number.
3. Select the reason for the removal from the list of options presented to you.
4. For removal of patients own drugs, enter the patient's ID. PTS will look up the patient and display their name when the cursor is moved away from this field. You will not be able to record the amendment if the patient is not recognised.
5. Start typing your name in the your name field and then click on your name when PTS finds you. Next, enter your password into the your password field.
6. Similarly if the drug being receipted requires a witness, ask the witness to start typing their name in the witnessed by field. Have them click on their name when PTS finds them and then enter their password in the witness password field.
7. Click OK to finalise the transaction. If there are any errors a message will be displayed that explains the error and any associated fields will be highlighted in red. Otherwise the transaction will be recorded and added to the top of the transaction list for the drug.

Administering a CD.

Administer to a patient

1. Indicate if you are administering from your ward stock or patient's own doses.
2. Enter the number of doses. Do not use a negative number to indicate doses being removed – use a positive number. For patient's own doses if the number of doses being administered exceeds the number of patient's own doses according to the register then the excess will be taken from ward stock.
3. Select the patient from the drop down list. The list should contain the list of patient's on the ward according to your PAS system. If - and only if - the list is inaccurate or out-of-date in some way, you can enter the patient's hospital number instead.
4. Start typing your name in the your name field and then click on your name when PTS finds you. Next, enter your password into the your password field.
5. Similarly if the drug being administered requires a witness, ask the witness to start typing their name in the witnessed by field. Have them click on their name when PTS finds them and then enter their password in the witness password field.
6. Click OK to finalise the transaction. If there are any errors a message will be displayed that explains the error and any associated fields will be highlighted in red. Otherwise the transaction will be recorded and added to the top of the transaction list for the drug.

Creating a new user (witness) as a ward nurse

There will be instances where a transaction needs to be witnessed but the witness does not yet have a PTS user account. In light of this inevitability it is possible to give ward nurses permission to create/register new users from the CD register without involving pharmacy. The relevant permission is CDCREATEUSER. Creating a new user in this way has itself got to be witnessed, so the permission can be set to either Instigate and/or Witness.

Typically the generic ward role is set to be able to instigate creating a CD user, and named users can witness it. In practice this means that a nurse would self witness creating the user, having previously logged in as the generic ward user, however you can make this stricter with additional roles.

Users created using this facility are always assigned the role that is stipulated in the CDNEWROLE application setting. This should be set to your Nurse Associate role or whatever appropriate CD witness role you have created.

It's considered preferable for pharmacy to be in complete control of the users list whenever this is manageable, so for this reason this feature is optional and can be disabled simply by not giving any users or roles the CDCREATEUSER permission.

If the facility is set up nurses can follow the following procedure to create a new witness:

1. Log in to PTS as the generic ward user.
2. Open the actions menu and click the create [user role] button. The button will include the name of the role configured in the CDNEWROLE application setting.
3. Complete all of the fields:
   1. EPrescribing ID
      A unique identifier for the new user. This is equivalent to the PTS username field; it is labelled differently because:
      • CD register users do not have to memorise their username like other PTS users.
      • To prompt the user to use the same ID that is used by the electronic prescribing system for organisational reasons.
      Consult with pharmacy to find out what they would prefer to be entered here.
   2. Full name
      Their name.
   3. Email address
      The email address must be unique.
   4. Professional registration number
      The professional registration number is used to validate the identify of the created user.
   5. Password
      The password field should be completed by the user being registered; they will use it when witnessing transactions.
   6. Witness name
      The person witnessing the user creation process should start typing their name and then click on their name when PTS finds them. Typically the user will self-witness.
   7. Witness password
      The person witnessing the user creation process should enter the password.

CD key handovers & balance checks

The CD register features a log of CD key handovers on a dedicated page. The same page can be used to record balance checks of the ward's CD register simultaneously, as opposed to checking each drug individually via the transactions view.

It's common to require ward staff to complete this form once per day.

1. Log in to PTS as the generic ward user.
2. Open the actions menu and click the CD key handover / balance check button.







3. Select whether you are performing a balance check, key handover, or both.
4. To complete a balance check, verify that the ward stock and patient dose numbers are correct for each drug and tick the balance checked? box.
5. To perform a key handover enter the correct user credentials into the key handover panel and click the confirm button:
   1. Nurse 1 (Key Giver)
      The nurse relinquishing the key should start typing their name and then click on their name when PTS finds them.
   2. Nurse 1 password
      The corresponding key giver password.
   3. Nurse 2 (Key Recipient)
      The nurse receiving the key should start typing their name and then click on their name when PTS finds them.
   4. Nurse 2 password
      The corresponding recipient password.