Ottumwa Regional Health Center



|Policy Number: |Department: |

|Policy Name: Drug boxes, Medications |Effective Date: |

|Replaces Policy Dated: |Reviewed By: |

|Approved By: |Cross Reference(s): |

The Pharmacy requirements for 641-132.8(4)c.d.e.(147A) of the Iowa Code are met and a signed agreement is on file with the __________________service application. ______________________will be treated within the hospital structure as a patient care unit, with the hospital pharmacy maintaining ownership of all medications in the drug box. The Pharmacy will also be responsible for dispensing, records, inspection, and security of medications while in the Pharmacy. The Pharmacy follows rules and regulations as established by the Iowa Board of Pharmacy Examiners.

All medications, with the exception of IV solutions, Nitroglycerin SL, Albuterol for inhalation, and Nitrous Oxide will be kept in a separate and distinct “box”. This box will be sealed with a tamper-evident lock. The box, as a separate unit, will be locked inside the ambulance to prevent unauthorized entry. As such, a double lock system will be maintained. The drugs contained within the box will be those items approved by the Director of EMS, Director of Pharmacy and Medical Control Physician. The ___________________protocols will be sent to the IA Bureau of EMS for their file. ___________________staff will sign out a numbered “drug key” at the beginning and end of their shift to access the vehicle drug box lock up. Keys will be stored in dispatch when not with a medic. Only EMT-P or EMT-PS or RN may administer medications from the drug box, as per scope of practice.

All authorized physician orders will be reduced to writing on _____________________Dispatch/Doctor’s Orders Form. This documentation should occur as soon as it is feasible. This will include verbal patient report, 911 dispatch information and times, medication orders(verbal/written) and any other physician orders derived from the approved protocols. After administration of medications, a copy of the signed order form shall be supplied to the Pharmacy for verification. This will serve as the beginning process to replace the medication stock. The __________________Nursing policy will be followed regarding medication documentation. The disposal, wastage, or destruction of any controlled substance shall be documented in writing and signed by two EMT-P/PS/RN’s.

After medication administration, the attending ____________________staff member is responsible for checking the contents of the box, removing all trash , reseal with the tamper-evident yellow lock, pending it’s return to Pharmacy. The box will be returned to pharmacy ASAP after the call. At no time will the drug box be left unattended or not secured by double locks.

After restock, the drug box will be checked by a Pharmacist, and placed in the ED Pyxis system for storage. Pharmacy will run daily Pyxis reports for drug box use, every morning and afternoon to determine the restock quantity. ORMICS may obtain a drug box from Pharmacy when the supply stored in Pyxis is depleted. (After hours, contact the nursing supervisor or float RN on duty.)

A variance report will be completed if a patient experiences an adverse drug reaction or allergy, or any unusual circumstances while in the care of the medic. Any time a drug box is found with a broken or missing seal or a device, drug or machine exhibits an apparent flaw while administering medications, a variance will be completed. The medical control physician will be notified immediately. Follow up will include notifying the EMS PCC for CQI action plan.

Nitrous Oxide will be kept in the ambulances. The valve control will be kept in a locked box, separate from the nitrous tanks. Nitroglycerin SL, and Albuterol for inhalation is kept in a separate pocket of the jump kit and locked between use. Restock will be obtained from the Pyxis system. The Nitroglycerin SL will have a sticker affixed after opening, stating the medication expires 30 days from the opening date, per Pharmacy policy.

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