Make sure medication is controlled, secure
Contrary to popular opinion, the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, doesn't require facilities to have locks on medication.
"We're going to say that drugs need to be controlled and secure," says Ann Kobs, sentinel event specialist for the Department of Standards. "How you do that is up to you."
From January to July 1997, 15.5% of facilities surveyed by the Joint Commission received a score of 3, 4, or 5 on patient care standard TX.3.5, medication appropriately controlled.
When a case is finished and another patient is being brought into the OR, the anesthesiologist doesn't need to take all of the medications out of their cart and lock them up. Kobs asks, how many episodes of diversion have you had? "Then that is your defense: You've not had episodes of diversion," she says.
Many same-day surgery managers are concerned that night cleaning staff might steal medications, Kobs acknowledges. However, if those staff members sign a statement saying they will not steal from the facility, that action is sufficient, she says.
Ensure that your prescription pads are controlled and secure from unauthorized access, advises Barbara Ann Harmer, director of surgical services at East Pasco Medical Center in Zephyr hills, FL, and a surveyor for the Accreditation Association for Ambulatory Health Care in Skokie, IL. Also, don't use presigned or post -dated prescription pads, Harmer says.
Use a tackle box for wastage
One of the biggest problem areas for surgical programs is drug wastage, Kobs says. Wastage needs to be witnessed, and you need to have a system that offers tight controls over narcotics, she says.
One appropriate method for disposing of drugs is to put used syringes in tackle box, Kobs suggests. The box needs to be locked and taken to the pharmacy area at the end of the day, she advises. Periodically, the pharmacist needs to test the wastage to determine if the tackle box actually contains what it says it does, Kobs suggests.
"That's worked very well," she says. "That's controlled. That's secured."
Consider hiring a pharmacist consultant, even if your state doesn't require it, to review policies for locks and wastage, Harmer suggests.
"An independent third party who looks you over and makes sure you not only have appropriate medications, but that your inventory levels are appropriate and that you have substitutions where possible, is not only in the patients' best interests, but also makes sense from a fiscal perspective," Harmer says.
The consultant should attend your ongoing performance improvement meetings, she suggests. Also, the pharmacist can be available for telephone consultations regarding medication questions.
If you acquire drugs from the pharmacist, he or she may do the consulting for free, Harmer says. At the most, expect to pay $150 a year, she says.
Do you have to count crash carts?
Another potential problem area is crash carts, Kobs says. From January to July 1997, 11% of facilities surveyed by the Joint Commis sion received a score of 3, 4, or 5 for patient care standard TX.3.5.5, emergency medication controlled.
It's a myth that the Joint Commission requires staff to count the items in the crash cart, Kobs says. "'The emergency medication's being controlled' means you have them available," she says.
However, nurses need to be familiar with the items in the cart in the event that a patient crisis happens when no physicians are nearby, Kobs says.
To avoid constantly having to go through the crash chart to check for expired medications, write the date of the medication that will expire first on the outside of the cart, Harmer suggests. "It saves locks and it saves time by not repeatedly going in when there's no need to."
Develop a timing sequence so a specific individual visually inspects the crash cart once a week to ensure the lock hasn't been broken and the first medication to expire isn't close to the expiration date, she advises.
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