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What surveyors asked ED nurses about drug storage
Accurate temperatures, outdated drugs are focus
Surveyors walking through an ED see medication by a patient's bedside table with no staff in the vicinity. Or a medication is lying in plain sight on a counter by the nurse's station, and visitors have full access to it.
These are two red flags that will alert Joint Commission surveyors that your ED is not ensuring that medications are securely stored, says Pat Adamski, director of The Joint Commission's Standards Interpretation Group. During surveys, ED nurses will be asked how it is determined who is going to have access to medications and how they are stored to ensure that the nurse gets what is needed, says Adamski.
"If it is determined that the housekeeper needs to have access to the medication room to clean, you can certainly do that. But since unlicensed people have access, all of the narcotics must be under lock and key," she says.
Medication security can be a bigger challenge for some EDs than other hospital units, since EDs frequently have large, open areas without separation between treatment areas and patients or visitors, says Adamski. "As newer EDs are built, more thought is given to security of medications," she says. "Back 30 years ago, people didn't really think about the fact that people would actually steal drugs or that a confused patient could pick up a medication that could harm them."
During a recent survey at Providence St. Vincent Hospital in Portland, OR, Joint Commission surveyors asked ED nurses about special medication kits created for easy access to certain drugs during an emergency, such as acute myocardial infarction and rapid-sequence intubation boxes. Eileen Wheaton, RN, ED nurse, says, "We comply by having the boxes checked for outdates, and we document this monthly."
Because these medications are kept outside of the automated dispenser unit, the surveyors were concerned that they might not be checked for outdates on a regular basis, says Wheaton. They were satisfied that a specific nurse is assigned all kits for checks on a monthly basis, she says.
At Anaheim (CA) Memorial Medical Center, surveyors checked for the proper temperature of vaccines in the ED's refrigerators, says Angeli R. Leggitt, MSN, RN, director of emergency services. "There are very specific procedures to ensure appropriate ranges, including that temperatures are to be checked twice daily and logged," she says. Temperature monitoring is a critical component of cold chain management, according to Morbidity and Mortality Weekly Report, she says.1
One person should be assigned primary responsibility for maintaining temperature logs, with a second person assigned as backup to review the log each week, advises Leggitt. "The surveyor specifically asked how many times per day our refrigerator temperatures were checked," she says. Nurses explained that one person is assigned to be responsible each shift for checking the temperature logs of all refrigerators and warmers, and this check is documented on a shift assignment sheet.
In addition, temperature logs should be maintained for three years unless state or local statutes mandate a longer time period, says Leggitt. "An automated monitoring system that alerts staff when a temperature deviation occurs is optimal," she says. "However, even if an automated monitoring system is used, temperatures should still be manually checked and recorded twice a day."
For more information about The Joint Commission's requirements for medication storage, contact: