CD Register

PTS 5 now 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 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 functionality to perform CD key handovers and balance checks.

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. The default view for each Ward 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 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:

• 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.

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.

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:

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 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:

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

An existing role will usually exist for the generic ward users (Ward Staff). Two additional roles will need to be created for the other users. You can use the existing ward staff role as the basis for the new roles. It is recommended that the Nurse Associates (i.e. witness only) role is the role used in the CDNEWROLE application setting.

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: