CHAPTER 39
CHAPTER 22
EMERGENCY MEDICATION KIT
HOSPITAL
EMERGENCY DRUGS
1. Emergency Drugs Used in the Hospital
• Crash carts
• Resuscitation or medication trays
• Various emergency kits or boxes
• Eclampsia kit
• Malignant hyperthermia cart
2. Standardize
• Format – carts, trays or kits
➢ Specific drugs used
➢ Crash cart drugs directed by ACLS guidelines (last updated 2000)
➢ May differ for adults and pediatrics
• Location of drugs and supplies in the cart
➢ Staff can quickly find what is needed
➢ Education of staff on a continual basis
3. Emergency medications must be secure (TX 3.5.5)
• Assure medications are available when needed
• Prevent tampering
• Options
➢ Plastic break away lock or plastic wrap
➢ No lock with regular inventory to assure contents are present
kept in a locked room
under constant surveillance
4. Plastic locks
• Advantages of plastic locks
➢ Expiration date placed on lock
➢ When sealed lets staff know contents are complete and within their expiration date
➢ Staff checks seal each shift and document
➢ Once seal is broken – signifies contents removed or expired
➢ Seal intact and within expiration date – do NOT need to check contents
• Plastic locks MUST be controlled by the pharmacy
5. Documentation to show QA check
• Filled by/checked by
• Lot & expiration date
6. Common crash cart system in Hospital – exchange system with ready-to-go back-up carts (May use different color seal when returning used cart)
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SAMPLE CRASH CART USED IN THE HOSPITAL
SAMPLE POLICY: Emergency Medication and Crash Cart System
POLICY:
Emergency medications are consistently available, controlled, and secure in the pharmacy and patient care areas.
PROCEDURE:
A. Tamper Locks:
1. Pharmacy personnel shall NOT issue YELLOW tamper locks to any non-pharmacy personnel.
B. Crash Cart Exchange System:
1. Receiving and Dispensing Crash Carts:
a. The pharmacist or Pharmacy technician who receives the cart will verify that the medication sections are sealed with a white zip-tie seal. If not, the pharmacy supervisor will be notified immediately.
b. Sterile Processing is responsible for cleaning and stocking the crash cart with supplies and respiratory equipment before bringing it to the pharmacy. The pharmacy technician or pharmacist who receives the cart shall check the medication drawers and trays for obvious contamination. If the cart or drug trays are contaminated with blood or body fluids, pharmacy personnel shall not accept the cart. The cart must be accompanied with the patient's name and account number. If these are absent, Sterile Processing must be contacted, unless the cart is being returned because of expired medications. The new form shall be filed in the Crash Cart notebook behind the corresponding crash cart divider number and the old form shall be removed. Attach the slip with the patient's name and account number to the old form. The crash cart shall be sealed with a YELLOW numbered plastic breakaway lock. The shortest expiration date for the entire cart will be indicated on a tag on the lock. Refilling and sealing of the crash cart will be completed within 1 hour after delivery to pharmacy.
c. The pharmacist or technician will transport the restocked and locked crash cart to Sterile Processing as soon as possible.
2. Restocking the Crash Cart:
a. Before restocking the crash carts, the old form that had been filed in the crash cart notebook shall be used to document and charge the medications that were used during the code. The technician shall inventory the medication drawers and document on the old form the medications that were used or are missing. The old form will then be forwarded to the technician responsible for charging. When charging is complete the technician shall date, initial and write or stamp "Charged" on the form. The technician shall then file the old form in the file cabinet according to the date.
b. In-patient crash cart medication drawers shall be restocked according to the form "Pharmaceutical Med/Surg, Crash Cart Check List" (Appendices). Carts shall be restocked with medications that are to expire no sooner than 6 months from date of restocking. If the medication drawers are soiled with dust or dirt, the technician shall clean the drawers with a damp cloth and dry prior to restocking. When the drawers are restocked, the earliest expiration date for each item will be recorded in the column marked "EXP. DATE" on the "Pharmaceutical Check List" form. The earliest expiration date of all medications in the cart is then denoted on the top of the form. All medication drawers shall be double-checked prior to dispensing. The pharmacist or technician who has restocked the cart and the pharmacist who double checks the cart shall sign and date the form in the spaces provided at the top of the form. The form is filed under the number of the cart.
C. Emergency Department (ED) Adult & Pediatric Resuscitation Trays:
1. Adult ED resuscitation trays consist of a single beige tray and pediatric ED Resuscitation trays consist of a single blue tray. A supply of pre-stocked trays shall be kept in the pharmacy. Technicians shall exchange used Resuscitation trays with restocked Resuscitation trays as needed on a daily basis. The used or opened tray must be accompanied by the patient's name, account number and "ED Adult/Pediatric Resuscitation Checklist" form.
2. Drug trays that are contaminated with blood or body fluids shall not be handled or transported by pharmacy personnel. In this case ED Nursing personnel shall be asked to discard contaminated drug and drug containers and transport the contaminated drug tray to Sterile Processing for cleaning and sterilization. The rest of the medications that are not contaminated shall be bagged with the checklist form for the tray, the patient's name and account number, and retained by pharmacy for billing.
3. Before restocking the ED resuscitation trays, the old checklist form shall be used to document and charge the medications that were used in the code. The technician shall inventory the medication tray, document on the old form the medications that were used or are missing and deliver the completed checklist form to the charging area. If ED personnel were not able to attach a patient's name to the resuscitation tray at the time the pharmacy technician exchanged trays, then the charging technician shall charge the ED Department for any used or missing medications. When charging is complete the charge technician shall date, initial and write or stamp "Charged" on the form. The technician shall then file the old form in the file cabinet according to the date.
5. The liaison pharmacist is responsible for checking on a monthly basis the expiration dating of the resus trays and replacing trays that are soon to expire.
the old form in the file cabinet according to the date.
ED RESUSCITATION TRAY PROCEDURES CHECK LIST
(See Policy # Rx 01-006 for additional information)
A. EXCHANGE PROCEDURES
1. Used ED resus trays shall be exchanged by the technician making the 10:00 AM refill delivery.
2. The technician shall carry pre-stocked adult and pediatric resuscitation trays (located in the rolling shelves on shelf "L") with him/her to exchange for used trays.
Select trays that have the shortest expiration dating but are at least 6 months from the date of restocking.
3. In the ED, check the medication trays for contamination of blood or body fluids. If the tray is contaminated, ask ED personnel to discard contaminated drug and drug containers and transport the contaminated drug tray to Sterile Processing for cleaning and sterilization. The remaining medications should be bagged together with the checklist form from the tray for billing.
4. Bring the tray back to pharmacy for restocking.
5. Before restocking the ED resus trays the technician shall:
a. Check the medication tray using the old checklist form.
b. Document on the old form the medications that were used or are missing.
c. Deliver the completed checklist form to the charge technician for charging to the patient.
1. If ED personnel were unable to attach a patient's name to the resus tray at the time of exchange, then the charge technician shall charge the ED for any used or missing medications.
d. When charging is complete, the technician will date, initial and write or stamp "charged" on the form before filing the form.
e. File the form in the "Crash Cart Notebook" behind the tab of the corresponding month.
B. RESTOCKING ED RESUSCITATION TRAYS
1. Before restocking resuscitation trays, check whether the trays are dusty or soiled. Clean with a damp cloth, if necessary.
2. Obtain a new ED checklist form from the file cabinet drawer in Central Pharmacy.
3. Restock the tray according to the checklist.
4. Replace any medications that will expire in less than six months with fresh medications.
5. Record the earliest expiration date for each item on the check list form in the column marked "EXP. DATE".
6. Ask a pharmacist to double check contents for accuracy.
7. The pharmacist or technician who has restocked the tray and the person who double checks the trays shall sign and date the "Checklist form" in the spaces provided at the top of the form.
8. Place the form on top of the restocked tray and enclose the tray in a large plastic envelope found on the rolling shelves (shelf I-13) and large sealed tamper-evident plastic bag.
9. Write the earliest expiration date on a sticker on the tray.
10. Place the sealed tray back on the rolling shelves.
A. Crash Cart Receiving/Restocking Procedures
1. Sterile Processing delivers crash cart to Central Pharmacy.
2. Before accepting the cart the pharmacist/technician shall:
A. Verify that the medication section is sealed with a white zip-tie seal. If not, the pharmacy supervisor will be notified immediately.
B. Check the cart and medication trays for contamination of blood or body fluids.
C. Check the Crash Cart form accompanying the cart to assure that the cart has been restocked with all supplies and equipment except medications. If the cart is contaminated or not restocked, do not accept the cart.
D. Check the patient's name for whom the cart was used. Ask Sterile Processing to furnish the name, if missing. (Exception - cart was expired and not used on a patient).
4. Inventory the medication drawers and replace any medications that are not present. Medications must have a minimum expiration date of 6 months.
5. Create a new “Pharmaceutical ICU/Ward Crash Cart Check List” form and indicate the expiration date for each medication in the cart.
6. Have the cart double checked by a pharmacist.
7. Completely fill out the form as follows: the earliest expiration date, the name of the person dispensing the cart, the name of the person checking the cart, and the date of dispensing. Place the completed form in the Ward/ICU Crash Cart Notebook. It will be used later for inventorying and charging.
8. When restocking is complete, check that all drawers are completely closed, then, lock and seal the cart with a blue plastic break-away lock (Clinical Center) or yellow numbered plastic breakaway lock (Pavilion). Attach a sticker to the lock with the earliest expiration date of the cart written upon it.
10. Return the cart to Sterile Processing as soon as possible.
Crash Cart Charging Procedures
1. Obtain the old crash cart "Pharmaceutical ICU/Ward Crash Cart Check List" form from Crash Cart Notebook in the cabinet in Central Pharmacy. Write or attach the patient's name, date and account number on the old form.
2. Inventory medication drawers denoting on the old check list form the items that are missing or have been used.
3. Forward the old check list form to the charging technician for charging.
A Appendix A PHARMACEUTICAL MED/SURG CRASH CART CHECK LIST
|EARLIEST EXPIRATION DATE: |STOCKED BY: |CART |RPH/ DATE |DATE USED: |
| | |NO.: | | |
|DATE STOCKED: |CHECKED BY: | | |LOCATION: |
|GENERIC NAME |STRENGTH |CHG. CODE |EXP. DATE |PAR |QTY USED |
|DRAWER 1 |
|Adenosine |6mg vial |6355 | |3 | |
|Amiodarone |150mg/3ml amp |2553 | |3 | |
|Bretylium |50mg/ml (10 ml PFS) |5342 | |4 | |
|Calcium Chloride |10% 1gm/10ml PFS |6435 | |2 | |
|Diphenhydramine |50mg/ml vial |5766 | |2 | |
|Epinephrine |1:1000 1mg/ml 30ml vial |5791 | |2 | |
|Epinephrine |1mg/ml 1ml amp |5778 | |2 | |
|Magnesium Sulfate |1g/2ml vial |5862 | |4 | |
|Naloxone |2mg/2ml amp |6955 | |2 | |
|Norephinephrine |4mg/4ml amp |5637 | |2 | |
|Phenytoin |250mg/5ml vial |5692 | |4 | |
|Procainamide |1g/10ml vial |5929 | |1 | |
|Sodium Bicarbonate |5mEq/10ml PFS (INFANT) |5420 | |2 | |
|Sodium Bicarbonate |10mEq/10ml PFS (PEDIATRIC) |5912 | |4 | |
|Sodium Chloride 0.9% |30ml vial (bacteriostatic) |6712 | |2 | |
|Vasopressin |20u/ml amp |5971 | |2 | |
|DRAWER 2 |
|Atropine |1mg/10ml PFS |6791 | |4 | |
|Dextrose 50% |25gm/50ml PFS |5631 | |2 | |
|Dopamine |400mg/250ml bag |2082 | |2 | |
|Epinephrine |1:10,000 (0.1mg/ml) PFS |6727 | |8 | |
|Lidocaine |100mg/5ml PFS |5671 | |5 | |
|Lidocaine in D5W |2gm/500ml bag |5332 | |1 | |
|Sodium Bicarbonate |50mEq/50ml PFS (ADULT) |5695 | |4 | |
|Medication Labels |-------------- |--------- |----------- |3 | ---- |
|Emergency Drug Drip Card |-------------- |--------- |------------ |1 | ---- |
|White Zip-Tie Seal |------------- |--------- |----------- |2 | |
PHARMACEUTICAL ICU CRASH CART CHECK LIST
|EARLIEST EXPIRATION |STOCKED BY: |CART |RPH/ DATE |DATE USED: |
|DATE: | |No: | | |
|DATE STOCKED: |CHECKED BY: | | |LOCATION: |
|GENERIC NAME |STRENGTH |CHG CODE |EXP. DATE |PAR |QTY USED |
|TOP SHELF (#1) |
|Atropine |1mg/10ml PFS |6791 | |4 | |
|Epinephrine |1:10,000 (0.1mg/ml) PFS |6727 | |16 | |
|Lidocaine |100mg/5ml PFS |5671 | |5 | |
|Sodium Bicarbonate |50mEq/50ml PFS |5695 | |5 | |
| |(ADULT) | | | | |
|MEDICATION DRAWER (#2) |
|Adenosine |6mg vial |6355 | |3 | |
|Amiodarone |150mg/3ml amp |2553 | |3 | |
|Bretylium |500mg/10ml syringe |6422 | |4 | |
|Calcium Chloride |1g/10ml PFS |6435 | |4 | |
|Dextrose 50% |25gm/50ml PFS |5631 | |2 | |
|Diphenhydramine |50mg/lml vial |5766 | |2 | |
|Dobutamine |250mg/20ml inj |5412 | |4 | |
|Dopamine |400mg/250ml bag |2082 | |2 | |
|Epinephrine |1:1000 1mg/ml 30ml vial |5791 | |2 | |
|Epinephrine |1mg/ml 1ml amp |5778 | |2 | |
|Lidocaine |2g/500ml bag |5332 | |1 | |
|Magnesium Sulfate |1g/2ml |5862 | |4 | |
|Methylprednisolone |500mg vial |6559 | |4 | |
|Naloxone |2mg/2ml amp |6955 | |2 | |
|Norepinephrine |4mg/4ml amp |5637 | |4 | |
|Phenytoin |250mg/5ml amp |5692 | |4 | |
|Procainamide |1g/10ml vial |5929 | |2 | |
|Sodium Chloride |0.9% 30ml, Bacteriostatic |6031 | |2 | |
|Vasopressin |20u/ml amp |5971 | | 2 | |
|Medication Labels | ----------- | ------ |--- |4 | ---- |
|White Zip-Tie Seal |------------ |------ |---- |2 | |
ADULT ER RESUSCITATION TRAY CHECKLIST
|Patient Name: |Stocked By: |Earliest Expiration Date: |
| |Date Stocked: |Dispensed By: |
|Unit #: |Checked By: |Date Dispensed: |
| | EXP. | PAR | CHARGE | QTY. |
|MEDICATION |DATE |LEVEL |CODE |USED |
|Adenosine 6mg/2ml vial | |5 |6355 | |
|Albuterol 3ml solution for neb | |7 |6094 | |
|Amiodarone 150mg/3ml amp | |3 |2553 | |
|Atropine Sulfate 1mg/10ml (PFS) | |2 |6791 | |
|Calcium chloride 10% 1g/ 10ml (PFS) | |1 |6435 | |
|Dextrose 50% 25gm/50ml (PFS) | |2 |5631 | |
|Dopamine 400mg/D5W 250ml | |1 |2082 | |
|Epinephrine 1:10,000 1mg/10 ml (PFS) | |5 |6727 | |
|Epinephrine 1:1,000 1mg/ml ,30ml vial | |2 |5791 | |
|Esmolol 100mg/10ml amp | |2 |5369 | |
|Lidocaine 100mg/5ml (PFS) | |3 |5671 | |
|Lidocaine 2g/D5W 500ml | |1 |5332 | |
|Magnesium Sulfate 1g/2ml inj | |4 |5862 | |
|Methylprednisolone 125mg inj | |2 |5613 | |
|Naloxone 2mg/2ml inj | |5 |6955 | |
|Norepinephrine 4mg/4ml) inj | |2 |5637 | |
|Procainamide 1000mg/10 ml vial | |1 |5929 | |
|Sodium bicarb. 8.4% (Adult) 50mEq/50ml (PFS) | |2 |5695 | |
|Vasopressin 20 units/ml vial | |2 |5971 | |
PEDIATRIC ER RESUSCITATION TRAY CHECKLIST
|Patient Name: |Stocked By: |Earliest Expiration Date: |
| |Date Stocked: |Dispensed By: |
|Unit #: |Checked By: |Date Dispensed: |
| | EXP. | PAR | CHARGE |QTY. |
|MEDICATION |DATE |LEVEL |CODE |USED |
|Adenosine 6mg/2ml vial | |3 |6355 | |
|Albuterol 3ml solution for neb | |7 |6094 | |
|Atropine Sulfate 1mg/10ml (PFS) | |2 | 6791 | |
|Bretylium Tosylate 500mg/10ml (PFS) | |2 |5342 | |
|Calcium chloride 10% 1gm/10ml (PFS) | |1 |6435 | |
|Dextrose 25% (10ml PFS) | |2 |5370 | |
|Dextrose 50% 25g/50ml (PFS) | |2 | 5631 | |
|Diphenhydramine 50mg/ml inj | |1 |5766 | |
|Dopamine 400mg/D5W 250ml | |1 |2082 | |
|Epinephrine 1:10,000 (1mg/10ml PFS) | |5 |6727 | |
|Epinephrine 1:1000 (1mg/ml 30ml vial) | |1 |5791 | |
|Lidocaine 100mg/5ml (PFS) | |3 |5671 | |
|Lidocaine 2g/D5W 500ml) | |1 |5332 | |
|Mannitol 20% 250ml | |1 |5650 | |
|Methylprednisolone 125mg inj | |1 |5613 | |
|Naloxone 2mg/2ml amp | |5 |6955 | |
|Procainamide HCl 1000mg/10ml vial | |1 |5929 | |
|Racemic epinephrine (Vaponephrine) 15ml | |1 |6821 | |
|Sodium Bicarbonate 4.2% (Infant) 5meq/10ml (PFS) | |2 |5420 | |
|Sodium Bicarbonate 8.4% (Ped) 10mEq/10ml (PFS) | |2 |5912 | |
|Sodium Bicarb. 8.4% (Adult) 50mEq/50ml (PFS) | |2 |5695 | |
NURSING HOME
Emergency Drug Supply in the Nursing Home
I. Legal Requirements for an EDK (59A-4.112 Pharmacy Services)
The facility shall maintain an Emergency Medication Kit, the contents of which shall be determined in consultation with the Medical Director, Director of Nursing and Pharmacist, and it shall be in accordance with facility policies and procedures. The kit shall be readily available and shall be kept sealed. All items in the kit shall be properly labeled. The facility shall maintain an accurate log of receipt and disposition of each item in the Emergency Medication Kit. An inventory of the contents of the Emergency Medication Kit shall be attached to the outside of the kit. If the seal is broken, the kit must be resealed the next business day after use.
Interpretive Guidelines Provision of Routine and/or Emergency Medication
The regulation at 42 CFR 483.60 (F425) requires that the facility provide or obtain routine and emergency medications and biologicals in order to meet the needs of each resident. Facility procedures and applicable state laws may allow the facility to maintain a limited supply of medications in the facility for use during emergency or after-hours situations. Whether prescribed on a routine, emergency, or as needed basis, medications should be administered in a timely manner. Delayed acquisition of a medication may impede timely administration and adversely affect a resident’s condition. Factors that may help determine timeliness and guide acquisition procedures include:
• Availability of medications to enable continuity of care for an anticipated admission or transfer of a resident from acute care or other institutional settings;
• Condition of the resident including the severity or instability of his/her condition, a significant change in condition, discomfort, risk factors, current signs and symptoms, and the potential impact of any delay in acquiring the medications;
• Category of medication, such as antibiotics or analgesics;
• Availability of medications in emergency supply, if applicable; and
• Ordered start time for a medication.
II. A Nursing Home MUST have an emergency medication kit(s)
III. The content list is approved by the Quality Assessment & Assurance Committee
The drugs will be selected by:
A. Medical Director
B. Director of Nursing
C. Consultant Pharmacist and or vendor Pharmacy
NURSING HOME
IV. Current standards of practice go beyond the requirements of 59A-4.112
A. The EDK should be stored in a secure area in appropriate temperature range
B. The EDK must be made to prevent undetectable entry (i.e. check hinges)
C. The box should be sealed with a numbered break-away lock issued by the pharmacy
D. The Pharmacy must record the date the EDK was checked, the lock number and the initials of the pharmacist sealing the kit
E. The kit should contain a 2nd color break-away lock to reseal the kit after an emergency is over
F. Whenever possible products should be in single unit of use form
G. All items shall be properly labeled
H. The EDK must contain a list of the contents (both brand & generic name), dosage,
quantity of each item and expiration date.
I. There must be a permanent log of receipt and disposition that will identify:
1. Name and amount of drug used
2. Date administered
3. Resident’s name
4. Physician’s name
5. Signature of person removing drug
J. Only one dose of the product may be removed during the emergency. Subsequent doses must be
treated as a new emergency.
V. The Consultant Pharmacist should check the contents list at least quarterly (monthly preferred)
VI. When the box has been used, the contents must be checked and items replaced no later than next working day.
VII. A list of the contents should be posted at each nursing station. This will assist nursing in identify drugs available in house during a telephone conversation with the prescriber.
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|Sample NURSING CENTER |
|EMERGENCY KIT LIST (Page 1 of 2) |
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|PRIMARY EDK - A | | | | |
| | | | | |
|DRUG & STRENGTH |GENERIC NAME |FORM |QUANTITY |EXPIRATION |
|Adrenalin 1mg/ml |Epinephrine HCL 1mg/ml |Injectable |2 x 1ml | |
|Amoxicillin 250mg |Amoxicillin 250mg |Capsules |8 | |
|Ampicillin 250mg |Ampicillin 250mg |Capsules |8 | |
|Antivert 12.5mg |Meclizine 12.5mg |Tablets |10 | |
|Atarax 10mg |Hydroxyzine HCL 10mg |Tablets |4 | |
|Atropine 1mg/ml |Atropine 1mg/ml |Injectable |2 x 1ml | |
|Atrovent unit dose 0.02% |Ipratropium Bromide |Nebulizer |5 | |
|Augmentin 500mg |Amoxicillin/Clavulanate 500mg |Tablets |3 | |
|Augmentin 875mg |Amoxicillin/Clavulanate 875mg |Tablets |3 | |
|Bactrim DS |Septra or SMX-TMP DS |Tablets |5 | |
|Benadryl 25mg |Diphenhydramine |Capsules |5 | |
|Benadryl 50mg/ml |Diphenhydramine 50mg/ml |Injectable |2 x 1ml | |
|Biaxin 250mg |Clarithromycin 250mg |Tablets |5 | |
|Catapres 0.1mg |Clonidine HCL |Tablets |5 | |
|Ceftin 250mg |Cefuroxime |Tablets |3 | |
|Cipro 250mg |Ciprofloxacin 250mg |Tablets |10 | |
|Cleocin 150mg |Clindamycin 150mg |Capsules |10 | |
|Cogentin 0.5mg |Benztropine 0.5mg |Tablets |4 | |
|Cogentin 2mg/2ml |Benztropine 2mg/2ml |Injectable |1 x 2ml | |
|Coumadin 1mg |Warfarin Sodium |Tablets |5 | |
|Coumadin 5mg |Warfarin Sodium |Tablets |5 | |
|Decadron 4mg |Dexamethasone 4mg |Tablets |5 | |
|Decadron 4mg/ml |Dexamethasone 4mg/ml |Injectable |2 x 1ml | |
|Depakote Sprinkles 125mg |Divalproex Sodium 125mg |Capsules |5 | |
|Depo-Medrol 40mg/ml |MethylPrednisolone 40mg/ml |Injectable |2 x 1ml | |
|Dextrose 50% |Dextrose 50% Syringe |Injectable |1 x 50ml | |
|DiaBeta 2.5mg |Glyburide 2.5mg |Tablets |5 | |
|Digoxin 0.25mg/ml |Digoxin 0.25mg/ml |Injectable |2 x 1ml | |
|Diflucan 100mg |Fluconazole |Tablets |5 | |
|Dilantin 100mg |Phenytoin |Slow Release Capsules |5 | |
|Dilantin 100mg/2ml |Phenytoin 100mg/2ml |Injectable |2 x 2ml | |
|Flagyl 250mg |Metronidazole 250mg |Tablets |10 | |
|Garamycin 80mg/2ml |Gentamycin 80mg/2ml |Injectable |3 x 2ml | |
|Glucagon |Glucagon |Injectable |2 | |
|Glucophage 500mg |Metformin 500mg |Tablets |5 | |
|Heparin 5,000 units/ml |Heparin 5,000 units/ml |Injectable |2 x 1ml | |
|Imodium 2mg |Loperamide HCL 2mg |Capsules |5 | |
|Insta-Glucose |Glucose Oral |Oral Gel |2 | |
|Kayexylate |Sod Polystyrene Sulfonate |Oral Susp |4 x 60ml | |
|Keflex 250mg |Cephalexin 250mg |Capsules |10 | |
|Lanoxin 0.125mg |Digoxin 0.125mg |Tablets |4 | |
|Lasix 20mg |Furosemide 20mg |Tablets |5 | |
|Lasix 10mg/ml |Furosemide 10mg/ml |Injectable |5 x 2ml | |
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|Sample NURSING CENTER |
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|EMERGENCY KIT LIST (Page 2 of 2) |
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|DRUG & STRENGTH |GENERIC NAME |FORM |QUANTITY |EXPIRATION |
|Levaquin 250mg |Levofloxacin |Tablets |10 | |
|Levsin Sublingual 0.125mg |Hyoscamine Sulfate S.L. 0.125mg |Tablets -Sublingual |3 | |
|Lopressor 25mg |Metoprolol 25mg |Tablets |5 | |
|Lovenox 40mg/0.4ml |Enoxaparin Sodium 40mg/0.4ml |Injectable Syringe |2 x 0.4ml | |
|Lovenox 60mg/0.6ml |Enoxaparin Sodium 40mg/0.6ml |Injectable Syringe |2 x 0.6ml | |
|Narcan 0.4mg/ml |Naloxone 0.4mg/ml |Injectable |2 x 1ml | |
|Nebcin 80mg/2ml |Tobramycin 80mg/2ml |Injectable |3 x 2ml | |
|Neurontin 100mg |Gabapentin 100mg |Capsules |10 | |
|Nitroglycerin Patch 0.2mg/hr |Nitroglycerin Patch 0.2mg/hr |Patch |2 | |
|Nitroglycerin Patch 0.4mg/hr |Nitroglycerin Patch 0.4mg/hr |Patch |2 | |
|Nitrostat 0.4mg (1/150gr) |Nitroglycerin Sublingual 0.4mg |Tablets - Sublingual |1 x 25 | |
|Penicillin VK 250mg |Penicillin VK 250mg |Tablets |10 | |
|Phenergan 25mg/ml |Promethazine HCL 25mg/ml |Injectable |2 x 1ml | |
|Prednisone 1mg |Prednisone 1mg |Tablets |5 | |
|Prednisone 5mg |Prednisone 5mg |Tablets |10 | |
|Prevacid Capsules 15mg |Lansoprazole Capsules 15mg |Capsules |10 | |
|Prinivil 2.5mg |Lisinopril 2.5mg |Tablets |5 | |
|Procardia 10mg |Nifedipine 10mg |Capsules |5 | |
|Proventil Inhaler 90mcg |Albuterol Inhaler 90mcg |Inhaler |1 x 17gm | |
|Reglan 5mg |Metoclopramide HCL |Tablets |5 | |
|Remeron SoluTab 15mg |Mirtazapine Solutab 15mg |Tablets |5 | |
|Risperdal 0.5mg |Risperidone 0.5mg |Tablets |3 | |
|Rocephin 1GM |Ceftriaxone Sodium 1gm |Injectable |4 | |
|SoluMedrol 125mg |MethylPrednisolone 125mg |Injectable |2 | |
|Tetracycline 250mg |Tetracycline 250mg |Capsules |10 | |
|Theodur 200mg |Theophylline 200mg |Sustained Release Tablets |5 | |
|Ultram 50mg |Tramadol 50mg |Tablets |5 | |
|Ventolin unit dose 0.083% |Albuterol Sulfate Soln 0.083% |Nebulizer Soln |5 | |
|Vibramycin 50mg |Doxycycline Hyclate 50mg |Capsules |5 | |
|Vistaril 50mg/ml |Hydroxyzine |Injectable |2 x 1ml | |
|Vitamin K 10mg/ml |Aquamephyton |Injectable |2 x 1ml | |
|Water for Injection |Water for Injection |Injectable |1 x 50ml | |
|Xylocaine 1% |Lidocaine HCL 1% |Injectable |2 x 5ml | |
|Zaroxolyn 2.5mg |Metolazone |Tablets |3 | |
|Zithromax 250mg |Azithromycin Dihydrate 250mg |Tablets |10 | |
|Sample NURSING CENTER |
|CONTROLLED SUBSTANCES |
|EMERGENCY KIT - A |
| | | | |
| | | | |
|DRUG NAME |GENERIC NAME |QUANTITY |EXP DATE |
|Ambien Tablets 5mg |Zolpidem Tablet 5mg |5 | |
|Ativan Tablets 0.5mg |Lorazepam Tablets 0.5mg |5 | |
|Darvocet N 100 Tablets |Propoxyphene Nap W APAP 100mg/650mg |10 | |
|Demerol 50mg/ml vials |Meperidine Inj 50mg/ml |2 | |
|Dilaudid Tablets 2mg |Hydromorphone Tablets 2mg |5 | |
|Duragesic Patch 25mcg |Fentanyl Patch 25mcg |4 | |
|Lomotil Tablets 2.5mg |Diphenoxylate w Atropine Tablets 2.5mg |5 | |
|Morphine 10mg/ml vial |Morphine 10mg/ml vial |2 | |
|Oxycontin ER Tablets 10mg |Oxycodone E.R. Tablets 10mg |10 | |
|OxyFast Oral Concentrate InveAmps 20mg/ml |Oxycodone Oral 20mg/ml |3 | |
|Oxy IR Tablets 5mg |Oxycodone Tablets 5mg |10 | |
|Percocet Tablets 5mg/325mg |Oxycodone w APAP Tablets 5mg/325mg |10 | |
|Restoril Capsules 7.5mg |Temazepam Capsules 7.5mg |5 | |
|Roxanol InveAmps 20mg/1ml |Morphine Soln 20mg/1ml |5 | |
|Tylenol #3 Tablets 30mg/300mg |Acetaminophen w Codeine Tablets 30mg/300mg |10 | |
|Valium Multi-dose vial 5mg/ml |Diazepam Injectable 5mg/ml |1 | |
|Vicodin Tablets 5mg/500mg |Hydrocodone w APAP Tablets 5/500mg |10 | |
|Xanax Tablets 0.25mg |Alprazolam Tablets 0.25mg |10 | |
|Sample NURSING CENTER |
|REFRIGERATOR |
|EMERGENCY KIT |
| | | | |
| | | | |
|DRUG NAME |GENERIC NAME |QUANTITY |EXP DATE |
|Novolin R Insulin U-100 |Human Insulin Regular |1 | |
|Novolin N Insulin U-100 |Human Insulin NPH |1 | |
|Novolin 70/30 Insulin |Human Insulin NPH/Regular mix |1 | |
|Humalog 75/25 Insulin |Insulin analog (Lispro) |1 | |
|Novolog U100 Insulin |Insulin analog (Aspart) |1 | |
|Lantus Insulin 100u/ml |Insulin Glargine |1 | |
|Ativan 2mg/ml amps |Lorazepam Injectable |4 | |
|Compazine Supp 25mg |Prochlorperazine Supp 25mg |3 | |
|Phenergan Supp 25mg |Promethazine Supp 25mg |2 | |
NURSING HOME
SAMPLE POLICY & METHODS
Emergency Pharmacy Service
METHODS:
1. Telephone numbers for emergency pharmacy services are posted at the nursing station of each patient services wing.
2. If an emergency drug order is received, the charge nurse is to determine if the drug is in the emergency drug supply box. This is done by referring to the list of contents which is posted (1) by the telephone at the nursing station, or (2) on the emergency supply box itself.
3. If an emergency drug order is received which is not in the facility’s approved emergency drug supply, OR in an emergency where the staff needs to consult with a pharmacist, the facility’s staff may reach a pharmacist during the pharmacy’s scheduled business hours by calling 372-2575.
4. After the pharmacy’s regularly scheduled business hours, a pharmacist may be reached by dialing (See Appendix).
5. If a stat drug order is received during the pharmacy’s normal business hours, the nurse is to immediately order the medication from the pharmacy by dialing 372-2575. After hours, a pharmacist may be reached by dialing (See Appendix). When ordering the Medication, the nurse is to inform the pharmacist of the “stat” nature of the order.
6. When an emergency or “stat” order is received by the pharmacy, pharmacist receiving the order will determine if the pharmacy can make the delivery with in the time required. If not, the pharmacist will call another local pharmacy to make the delivery. However, the facility staff should always call the facility’s regular pharmacy. The facility has agreed not to call another local pharmacy directly for emergency medication orders.
7. No one is to stockpile or hoard drugs, nor are medications to be borrowed from one patient to meet the needs of another patient.
NURSING HOME
SAMPLE POLICY & METHODS
Emergency Box Procedures
To supplement normal pharmacy services a red emergency drug box is maintained in the west wing nurses station the contents are reviewed regularly, at least yearly by the Pharmacy Services Committee, and revised, if necessary. The consultant pharmacist inspects the box regularly, at least monthly, and orders replacements from the vendor pharmacist if any item is missing or out of date. The Director of Nursing is to be notified by the consultant pharmacist of any irregularity with the emergency box.
Once this emergency box is opened it cannot be closed without a key. Please do not try to force this box closed. The Director of Nursing is to be notified whenever the box is opened so it may be closed again.
All medications used from this box must have an order from the physician written on the chart. The vendor pharmacist must be notified by the nurse or if the pharmacy is closed, the oncoming nursing personnel must be requested to notify the pharmacy when they open that the emergency box was opened and what medication was used on what patient.
A Log Form will be kept in the box on which the nurse will record why the box was opened. The following information shall be recorded:
1. Date entered,
2. Drug removed,
3. Name of the patient,
4. Name of the ordering physician
5. Signature of the nurse.
6. If the box is opened as a part of an in-service, this should also be recorded.
When this Log Form is completely full it is to be returned to the Director of Nursing office for a new Log Form. The completed Log Form will be retained for a year.
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NURSING HOME
COMPANIES PROVIDING AUTOMATED CABINETS USED AS EMERGENCY KITS
MED-DISPENSE
med-
(877) 788-6855
OMNI CELL SOLUTIONS
(800) 850-6664
PYXIS
pyxis
(614) 757-5000
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NURSING HOME
EXAMPLES OF AUTOMATED CABINETS
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OMNI-CELL PRODUCTS
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PYXIS MED DISPENSE
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