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Practice dilemma: Missing diamorphine

A routine audit shows several ampoules of diamorphine are missing. The last entry in the controlled drugs register was made by the senior partner, who is well-known for his somewhat erratic record keeping, but also suffers from chronic low back pain. What should you do?

Although it is important not to jump to conclusions, the nature of the drug involved means that the situation must be dealt with appropriately.

You will need to make sure that the practice investigation is extended to check the details, and to look for any other discrepancies. All partners (including the senior partner) must be made aware of the situation. A key point will be the senior partner's explanation for any discrepancies in his register entries.

A careful record of the process and findings, must be kept in writing. Short of an obvious and straightforward explanation (for example a simple miscount, with no drugs actually being missing), there must be concerns that the senior partner may be appropriating drugs for his own use, whether clinically indicated or otherwise. This will be difficult for the practice to adequately investigate or deal with, and the PCT should be informed and involved in the process.

Depending on the circumstances, the PCT, the practice, or both, may consider it necessary for the senior partner to refrain from work pending the outcome. This could be by mutual agreement, or as a result of sick leave, or even suspension from the performers list by the PCT.

The senior partner will need help and support through the process and should speak to his medical defence organisation. He should also consider speaking to his own medical adviser, the occupational health service and the LMC.

The process may be longer than you think, and may ultimately involve other bodies, such as the GMC. Make sure that you and your staff are also supported through the process.

Dr Nick Clements is head of medical services at the Medical Protection Society (Leeds)

Dr Nick Clements


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