CONFIDENTIAL

Controlled Drugs Incident Report
to Controlled Drugs Accountable Officer (CDAO)

Complete the Report as much as possible. Please refer to 'Reporting Incidents, Near Misses and Concerns Involving Controlled Drugs: A Guide for NHS Staff and Contractors'.
Please note patient details should not routinely be sent with this form. Take care to forward this form to the CDAO through a secure route.

Reference number:	(office use)	Date:	
Premises name and address: 	
Post code:	Contractor or Practice code (if applicable):	

Responsible person in location:	Job title:	
Telephone no:	Email address:	

Person reporting incident:	Job title:	
Telephone no:	Email address:	

Locations involved in the incident (Check all applicable boxes)	

GP Practice	□	GP OOH
Centre	□	Dental Practice	□	Substance Misuse Service	□	
Hospital Ward	□	Hospital Theatre	□	Hospital Pharmacy	□	Hospital Other	□	

Care Home	□	Community Outpatient	□	Community Nursing	□	
Community Pharmacy	□	
Scottish Prison Service	□	
CDAO Network	□	Police Custody Suite	□	Other:	

Time of incident:

Date of incident:

Description of issue/concern:

Document ID: Originator:

SOP_Template_for_GPs_Non-dispensing_v.3.1_080621 NHS Tayside

Supersedes:	v.3.1_220818
Approved by:	CDAON Executive Group

Personnel involved (continue on separate sheet if necessary):	
Name	Job Title	Registration No	Contact Details	Role	

					

					

Incident	Check all boxes that apply	
Detail	
Prescribing incident:	□	Details of prescriber:	
Dispensing/supply incident:	□	Details of dispenser/supplier:	
CD register discrepancy against actual stock:	□	
Details of discrepancy:	
Administration incident:	□	Details of person administering :	
Missing CDs:	□	Details:	
Other (specify):	

Document ID: Originator:

SOP_Template_for_GPs_Non-dispensing_v.3.1_080621 NHS Tayside

Supersedes:	v.3.1_220818
Approved by:	CDAON Executive Group

Details of the actions taken, including immediate steps to prevent or reduce harm to patients and any investigations undertaken:

Person investigating:	Job title:	
Person investigating:	Job title:	
Person investigating:	Job title:	

Document ID: Originator:

SOP_Template_for_GPs_Non-dispensing_v.3.1_080621 NHS Tayside

Supersedes:	v.3.1_220818
Approved by:	CDAON Executive Group

Datix Number:

Issue reported on Datix? Y/N

Details of action taken to prevent a recurrence of this type of incident:

Action taken by CDAO (office use):

Signature of Responsible Person from CD Governance Team:

Date:

When an incident or near miss involving controlled drugs occurs this form should be completed electronically and returned to: gram.cdteam@nhs.scot

Local NHS Board to insert:
Controlled Drugs Team
Medicines Management
Pharmacy & Management Team
Pharmacy and Medicines Directorate
Westholme
Woodend Hospital 
Aberdeen AB15 6LS
tel: 01224 556601

Document ID: Originator:

SOP_Template_for_GPs_Non-dispensing_v.3.1_080621 NHS Tayside

Supersedes:	v.3.1_220818
Approved by:	CDAON Executive Group