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Figure 1: Managing liquid controlled drug volume discrepancies — the HCA Healthcare process

Guidance notes: Discrepancies between the running balance of liquid controlled drugs (CDs) and the physical balance often occur owing to variation in individual measuring technique, losses owing to spillage, crystallisation and multiple manipulations of stock bottles. When evaluating a liquid CD discrepancy, it is necessary to conclude whether it is acceptable or if it is indicative of potential problems, such as diversion. This flow chart will help determine if discrepancies require further investigation. Regular physical balance checks are important to keep control over stock and enables identification of diversion or unusual activity with liquid CDs. Too many physical balance checks can also lead to increased loss of volume so it is important to maintain a balance. The following could be considered: The pharmacy team and/or nurses should undertake a physical balance check of residual volume before receipt of a new CD stock bottle; It is recommended that each site records each loss per manipulation and per bottle. This will allow each site to identify what their usual loss/manipulation trends are, and so will facilitate a more informed decision to be made regarding an acceptable discrepancy.

Source  Source: Reproduced with permission from HCA Healthcare UK