Section I Medicines Management Section
- Nov 18, 2025
- 8 min read
Index
Introduction: Why Medicines Governance Matters
Working Safely with Medics Issuing Protocols (MIPs)
Controlled and Accountable Drugs: Getting Musters Right
Safe Dispensing in Practice: From DMICP to Patient Counselling
Disposal of Returned, Out-of-Date and Controlled Drugs
Stock Control: The Hidden Backbone of Patient Safety
Demand, Supply and Complaints: Using JDTS and Robust Processes
Responding to CAS Alerts: Medicines, Documentation and Coordination
Managing Patients’ Own Drugs (PODs) Safely
Prescription Safety: Legal and Clinical Checks
Stores Demand and Unlicensed “Specials”
Using the BNF and Reference Sources for Evidence-Based Practice
Key Clinical Reflections and Practical Takeaways
Conclusion & How Kraken Medical Can Support You
1. Introduction: Why Medicines Governance Matters
Whether in a busy base medical centre, a ship’s sick bay, or a deployed environment, safe use of medicines underpins everything else we do in healthcare. In military and remote contexts, there is often no “second chance” – limited resources, restricted access to senior support and complex logistics mean systems have to be robust, and teams have to be highly competent.
These CPD reflections focus on medicines management in a defence setting, but the principles apply across clinical practice: rigorous protocols, clear accountability and a strong safety culture. At Kraken Medical, we champion this blend of operational realism and clinical excellence – turning policy and doctrine into everyday safe practice.
2. Working Safely with Medics Issuing Protocols (MIPs)
Medics Issuing Protocols (MIPs) are the backbone of safe non-prescriber medication administration. They provide:
Clear indications and contraindications
Correct dose and route
Monitoring requirements and potential side-effects
Following MIPs is not a bureaucratic exercise; it is a patient-safety intervention. When clinicians work strictly within these protocols:
Medication errors are reduced
Roles and responsibilities are clearly defined
Non-medical prescribers and medics can work at the top of their competence, safely
Equally important is ensuring the Medicines Bay Responsible (MBR) personnel are formally assessed and deemed competent to work with MIPs. Competency goes beyond knowledge of drug names:
Understanding of the protocol content and rationale
Accurate dose calculation
Recognition of interactions and red-flag contraindications
Safe preparation and administration skills
Regular updates, refreshers and reassessment ensure that MIPs remain a living framework, not just a document on a shelf.
3. Controlled and Accountable Drugs: Getting Musters Right
Controlled and accountable drugs carry high therapeutic benefit but also high risk for harm and diversion. Effective musters (stock checks) are critical. Good practice includes:
Secure storage – locked cupboards, restricted access, appropriate labelling
Meticulous documentation – every issue, administration, return and destruction logged
Regular musters – routine counts confirm that physical stock matches recorded stock
Robust destruction processes – expired or damaged items are disposed of under witness and recorded
Other key components in a defence environment include:
Issue and supply controls – only authorised personnel with adequate documentation
Ordering and demand forecasting – preventing both stockouts and excessive holdings
Temporary loan processes – clearly documented, accountable even during short-term movement of stock
Immediate action on loss or discrepancies – investigated promptly, escalated, and rectified
Using digital systems such as DMICP for accounting strengthens audit trails and supports a culture of transparency and accountability.
4. Safe Dispensing in Practice: From DMICP to Patient Counselling
Dispensing is more than handing over a box. It is a structured process with multiple safety checkpoints:
Correct use of DMICP
Every dispensed item recorded against the correct patient
Comprehensive, up-to-date medication history available to the clinical team
Legal and clinical check of the prescription
Prescriber details, patient identity, medication, dose, frequency, route and instructions all verified
Any ambiguities or omissions clarified before dispensing
Understanding cautions and contraindications
Considering allergies, co-morbidities and existing medication
Recognising when a drug may not be appropriate and when to escalate
Accurate labelling and documentation
Clear patient-friendly labels with name, drug, strength, dose, route, frequency and specific instructions
Patient information and counselling
Providing written leaflets where appropriate
Explaining how to take the medicine, possible side-effects and what to do if they occur
Checking understanding and encouraging questions
Double-checking and knowing when to refer
Second check for high-risk medications or complex regimes
Seeking a secondary opinion for unusual, unfamiliar or potentially hazardous prescribing decisions
This systematic approach turns dispensing into a key safeguard within the medication pathway.
5. Disposal of Returned, Out-of-Date and Controlled Drugs
Safe disposal of pharmaceuticals protects patients, staff and the wider community.
Returned medicines
Isolated from stock as soon as they are received
Assessed for integrity and expiry – only exceptionally returned to stock when fully compliant with policy
Non-usable medicines segregated and documented for destruction
Out-of-date (OOD) medicines
Identified via regular stock checks and expiry reviews
Removed from active stock immediately
Logged with quantities and batch/lot details before disposal
Controlled drugs and accountable items
Segregated from other returns
Destruction carried out according to strict policy, usually witnessed
Fully documented – what, how much, when and by whom
Proper disposal is a key part of medicines governance and environmental responsibility.
6. Stock Control: The Hidden Backbone of Patient Safety
Behind every safe prescription is a supply system that works. Effective stock control prevents both dangerous shortages and wasteful overstocking.
Key components include:
Regular stocktakes – identifying discrepancies early and adjusting holdings
Stock rotation – using “short-dated” items first to avoid expiry losses
Temperature control and monitoring – especially for cold-chain items, ensuring therapeutic integrity
Secure storage and segregation – clear organisation, reduced risk of selection errors, and protection against theft or tampering
In military settings, this is augmented by:
METSA scale/holdings – aligning stock levels with mission profile, threat assessment and casualty estimates
Asset management systems such as JAMES
Patient property tracking systems like CP&F, ensuring individuals’ own medications and belongings are accounted for
Well-run stock control is rarely visible to patients – and that’s exactly the point. When it works, care is seamless.
7. Demand, Supply and Complaints: Using JDTS and Robust Processes
The Joint Demand Tracking System (JDTS) provides real-time visibility of medical demands across deployed theatres. Effective use includes:
Raising accurate, timely requests based on clinical need and stock levels
Tracking orders from submission through processing, dispatch and receipt
Monitoring where delays arise and taking early action to mitigate risk to patient care
Even with well-designed systems, supply issues do occur. A clear complaints and incident process is essential:
Prompt reporting through agreed channels
Detailed documentation of the issue (dates, items, batch numbers, patient impact)
Investigation to identify root causes
Implementation of corrective actions (e.g. process changes, vendor review, adjustments to stock policies)
Sharing lessons learned to improve resilience across the system
This turns a logistical problem into an opportunity for quality improvement.
8. Responding to CAS Alerts: Medicines, Documentation and Coordination
A CAS (casualty) alert triggers a rapid, coordinated medical response. Medicines management sits within a wider clinical and operational framework:
Immediate assessment – understanding mechanism of injury, likely needs (e.g. analgesia, antibiotics, haemorrhage control)
Clear communication – within the medical team and up the chain of command
Preparedness – appropriate drugs, equipment and personnel deployed quickly and safely
On-scene care and ongoing management – treatments administered in line with protocols, accurately documented
Maintaining a detailed log of actions taken during and after a CAS alert is vital:
Supports continuity of care through handover
Provides an auditable trail for governance and legal purposes
Allows review of response times, decision-making and medicine use for training and improvement
In high-tempo environments, good documentation is as important as good decision-making.
9. Managing Patients’ Own Drugs (PODs) Safely
Patients often arrive with their own medications, especially in primary care, shipboard or deployed contexts. Managing patients’ own drugs (PODs) safely requires:
Verification and documentation
Checking each medicine against the patient’s list or prescription
Recording name, dose, frequency and indication in the medical record
Assessment of suitability
Are these medicines still appropriate in light of the current diagnosis?
Are there interactions with newly prescribed drugs?
Communication and education
Discussing with the patient the purpose of each medicine
Clarifying any changes, pauses or discontinuations made during their care
Safe storage and segregation
Preventing mix-ups with facility stock
Ensuring secure but accessible storage
Ongoing monitoring
Reviewing response and side-effects
Updating the primary care provider as needed
Handled well, PODs improve continuity of care and reinforce patient engagement in their own treatment.
10. Prescription Safety: Legal and Clinical Checks
Before any medicine reaches a patient, the prescription itself must be both legal and clinically complete.
Legal elements of a prescription
A safe, lawful prescription includes:
Correct patient details – identifiable by full name and date of birth as a minimum
Clear medication name – avoiding abbreviations that could be misread
Dose – appropriate to the condition, patient age, weight and clinical status
Frequency – how often the dose is to be given
Form – tablet, capsule, liquid, injection, etc.
Route – oral, IV, IM, topical, etc.
Prescriber’s signature and authority – signed by a professional legally authorised to prescribe
Elements of completeness
Alongside legality, we check that:
Medication name, dose, frequency, form and route are all documented clearly
There are no missing elements or ambiguous instructions
The prescription aligns with clinical guidelines and protocols
These layered checks create multiple safety nets before a drug is dispensed or administered.
11. Stores Demand and Unlicensed “Specials”
Stores demand process
From a medicines management perspective, effective stores demand means:
Recognising the type of customer (e.g. clinical unit vs support unit) to apply the correct process
Completing all required paperwork or electronic demand forms
Checking deliveries against the original request and resolving any discrepancies immediately
Entering received stock accurately into DMICP for tracking and audit
Obtaining unlicensed “special” medicines
Occasionally, a patient’s needs cannot be met by licensed products. In these cases, unlicensed “specials” may be required. Safe use involves:
Identifying and justifying the clinical need
Consulting the wider healthcare team to ensure no licensed alternative is suitable
Escalating appropriately – for example, to a Command Pharmacist at NCHQ or a Regional Pharmacist
Gaining formal approval and ensuring robust record-keeping
Ordering and storing the special product in line with guidance
The threshold for using specials should be high, and documentation meticulous.
12. Using the BNF and Reference Sources for Evidence-Based Practice
No clinician can hold every drug detail in their head – nor should they try. Effective practitioners know where and how to look things up.
The British National Formulary (BNF) remains a primary reference for:
Indications and contraindications
Dosage ranges and adjustments (e.g. renal or hepatic impairment)
Side-effects and cautions
Administration instructions
Alongside the BNF, digital drug databases, clinical guidelines and peer-reviewed literature provide additional depth.
Good practice includes:
Checking interactions when adding or changing medications
Verifying dose and route, especially for high-risk and paediatric drugs
Paying attention to special populations (elderly, pregnant, breastfeeding)
Keeping knowledge up-to-date with the latest editions and evidence
Using these tools is a sign of professionalism, not uncertainty.
13. Key Clinical Reflections and Practical Takeaways
Across all of these areas, several themes stand out:
Systems and people must work togetherProtocols, digital systems (DMICP, JDTS, JAMES), and forms are only as good as the people using them. Training, supervision and a questioning mindset are essential.
Documentation is a clinical interventionAccurate records of stock, prescriptions, dispensing and CAS responses protect patients, support continuity of care and enable learning from events.
Competence needs continual maintenanceFrom MIPs to controlled drugs to PODs, competence is not a one-off tick box. Regular refreshers, audits and supervision drive standards up.
Patient-centred care remains at the coreWhether counselling on a new medicine, checking a prescription or managing a patient’s own drugs, clear communication and respect for the patient’s perspective make care safer and more effective.
Logistics are clinicalStock control, demand management and complaints about supply are not merely administrative; they directly influence the quality and safety of front-line care.
14. Conclusion & Next Steps with Kraken Medical
Safe medicines management is not about memorising policies – it is about embedding good habits, resilient systems and a culture where patient safety is non-negotiable. From MIPs and controlled drugs to JDTS and the BNF, every step in the medicines pathway offers an opportunity either to protect patients or to introduce risk.
Comments