CHAPTER 22 EMERGENCY MEDICATION KIT

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CHAPTER 22EMERGENCY MEDICATION KIT22.1

HOSPITALEMERGENCY DRUGS1.Emergency Drugs Used in the Hospital Crash carts Resuscitation or medication trays Various emergency kits or boxes Eclampsia kit Malignant hyperthermia cart2.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 basis3. 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 presentkept in a locked roomunder constant surveillance4.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 pharmacy5.Documentation to show QA check Filled by/checked by Lot & expiration date6.Common crash cart system in Hospital – exchange system with ready-to-go back-up carts(May use different color seal when returning used cart)22.2

SAMPLE CRASH CART USED IN THE HOSPITALSAMPLE POLICY: Emergency Medication and Crash Cart SystemPOLICY: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 sealedwith 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 equipmentbefore bringing it to the pharmacy. The pharmacy technician or pharmacist who receives the cart shall check the22.3

medication drawers and trays for obvious contamination. If the cart or drug trays are contaminated with bloodor body fluids, pharmacy personnel shall not accept the cart. The cart must be accompanied with the patient'sname and account number. If these are absent, Sterile Processing must be contacted, unless the cart is beingreturned because of expired medications. The new form shall be filed in the Crash Cart notebook behind thecorresponding crash cart divider number and the old form shall be removed. Attach the slip with the patient'sname and account number to the old form. The crash cart shall be sealed with a YELLOW numbered plasticbreakaway lock. The shortest expiration date for the entire cart will be indicated on a tag on the lock. Refillingand 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 aspossible.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 todocument and charge the medications that were used during the code. The technician shall inventory themedication drawers and document on the old form the medications that were used or are missing. The old formwill then be forwarded to the technician responsible for charging. When charging is complete the technicianshall date, initial and write or stamp "Charged" on the form. The technician shall then file the old form in thefile 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 soonerthan 6 months from date of restocking. If the medication drawers are soiled with dust or dirt, the technicianshall clean the drawers with a damp cloth and dry prior to restocking. When the drawers are restocked, theearliest 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 denotedon the top of the form. All medication drawers shall be double-checked prior to dispensing. The pharmacistor technician who has restocked the cart and the pharmacist who double checks the cart shall sign and date theform 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 singleblue tray. A supply of pre-stocked trays shall be kept in the pharmacy. Technicians shall exchange usedResuscitation trays with restocked Resuscitation trays as needed on a daily basis. The used or opened tray must beaccompanied 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 pharmacypersonnel. In this case ED Nursing personnel shall be asked to discard contaminated drug and drug containers andtransport the contaminated drug tray to Sterile Processing for cleaning and sterilization. The rest of the medicationsthat are not contaminated shall be bagged with the checklist form for the tray, the patient's name and accountnumber, and retained by pharmacy for billing.3. Before restocking the ED resuscitation trays, the old checklist form shall be used to document and charge themedications that were used in the code. The technician shall inventory the medication tray, document on the oldform the medications that were used or are missing and deliver the completed checklist form to the charging area. IfED personnel were not able to attach a patient's name to the resuscitation tray at the time the pharmacy technicianexchanged 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. Thetechnician 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 andreplacing trays that are soon to expire.the old form in the file cabinet according to the date.22.4

ED RESUSCITATION TRAY PROCEDURES CHECK LIST(See Policy # Rx 01-006 for additional information)A. EXCHANGE PROCEDURES1.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") withhim/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 personnelto discard contaminated drug and drug containers and transport the contaminated drug tray to Sterile Processing for cleaning andsterilization. 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 thecharge 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 theform.e.File the form in the "Crash Cart Notebook" behind the tab of the corresponding month.B. RESTOCKING ED RESUSCITATION TRAYS1.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 I13) 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.22.5

A. Crash Cart Receiving/Restocking Procedures1.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 benotified 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 suppliesand 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, ifmissing. (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 aminimum expiration date of 6 months.5.Create a new “Pharmaceutical ICU/Ward Crash Cart Check List” form and indicate the expiration date for eachmedication 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, thename of the person checking the cart, and the date of dispensing. Place the completed form in the Ward/ICU CrashCart 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 blueplastic break-away lock (Clinical Center) or yellow numbered plastic breakaway lock (Pavilion). Attach a sticker tothe 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 Procedures1.Obtain the old crash cart "Pharmaceutical ICU/Ward Crash Cart Check List" form from Crash Cart Notebook in thecabinet 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.Appendix APHARMACEUTICAL MED/SURG CRASH CART CHECK LISTEARLIEST EXPIRATIONDATE:STOCKED BY:CARTNO.:RPH/ DATEDATE STOCKED:CHECKED BY:GENERIC NAMESTRENGTHCHG. CODE6mg vial6355DATE USED:LOCATION:EXP. DATEPARDRAWER 1Adenosine22.63QTY USED

Amiodarone150mg/3ml amp25533Bretylium50mg/ml (10 mlPFS)53424Calcium Chloride10% 1gm/10ml PFS64352Diphenhydramine50mg/ml vial57662Epinephrine1:1000 1mg/ml 30mlvial57912Epinephrine1mg/ml 1ml amp57782Magnesium Sulfate1g/2ml vial58624Naloxone2mg/2ml amp69552Norephinephrine4mg/4ml amp56372Phenytoin250mg/5ml vial56924Procainamide1g/10ml vial59291Sodium Bicarbonate5mEq/10ml PFS(INFANT)54202Sodium Bicarbonate10mEq/10ml PFS(PEDIATRIC)59124Sodium Chloride 0.9%30ml vial(bacteriostatic)67122Vasopressin20u/ml amp59712Atropine1mg/10ml PFS67914Dextrose 50%25gm/50ml PFS56312Dopamine400mg/250ml bag20822Epinephrine1:10,000 (0.1mg/ml)PFS67278Lidocaine100mg/5ml PFS56715Lidocaine in D5W2gm/500ml bag53321Sodium Bicarbonate50mEq/50ml PFS(ADULT)56954DRAWER 2Medication ency Drug Drip Card-----------------------------------1----White Zip-Tie Seal---------------------------------222.7

PHARMACEUTICAL ICU CRASH CART CHECK LISTEARLIEST EXPIRATIONDATE:STOCKED BY:DATE STOCKED:CHECKED BY:GENERIC NAMESTRENGTHCARTNo:RPH/ DATEDATE USED:LOCATION:CHG CODEEXP. DATEQTY USEDPARTOP SHELF (#1)Atropine1mg/10ml PFS67914Epinephrine1:10,000 (0.1mg/ml) PFS672716Lidocaine100mg/5ml PFS56715Sodium Bicarbonate50mEq/50ml PFS(ADULT)56955Adenosine6mg vial63553Amiodarone150mg/3ml amp25533Bretylium500mg/10ml syringe64224Calcium Chloride1g/10ml PFS64354Dextrose 50%25gm/50ml PFS56312Diphenhydramine50mg/lml vial57662Dobutamine250mg/20ml inj54124Dopamine400mg/250ml bag20822Epinephrine1:1000 1mg/ml 30ml vial57912Epinephrine1mg/ml 1ml amp57782Lidocaine2g/500ml bag53321Magnesium Sulfate1g/2ml58624Methylprednisolone500mg vial65594Naloxone2mg/2ml amp69552Norepinephrine4mg/4ml amp56374Phenytoin250mg/5ml amp56924Procainamide1g/10ml vial59292Sodium Chloride0.9% 30ml, Bacteriostatic2Vasopressin20u/ml amp60315971MEDICATION DRAWER (#2)Medication LabelsWhite Zip-Tie -2----

ADULT ER RESUSCITATION TRAY CHECKLISTPatient Name:Unit #:Stocked By:Earliest Expiration Date:Date Stocked:Dispensed By:Checked By:Date Dispensed:EXP.DATEPARLEVELCHARGECODEAdenosine 6mg/2ml vial56355Albuterol 3ml solution for neb76094Amiodarone 150mg/3ml amp32553Atropine Sulfate 1mg/10ml (PFS)26791Calcium chloride 10% 1g/ 10ml (PFS)16435Dextrose 50% 25gm/50ml (PFS)25631Dopamine 400mg/D5W 250ml12082Epinephrine 1:10,000 1mg/10 ml (PFS)56727Epinephrine 1:1,000 1mg/ml ,30ml vial25791Esmolol 100mg/10ml amp25369Lidocaine 100mg/5ml (PFS)35671Lidocaine 2g/D5W 500ml15332Magnesium Sulfate 1g/2ml inj45862Methylprednisolone 125mg inj25613Naloxone 2mg/2ml inj56955Norepinephrine 4mg/4ml) inj25637Procainamide 1000mg/10 ml vial15929Sodium bicarb. 8.4% (Adult) 50mEq/50ml (PFS)25695Vasopressin 20 units/ml vial25971MEDICATION22.9QTY.USED

PEDIATRIC ER RESUSCITATION TRAY CHECKLISTPatient Name:Unit #:Stocked By:Earliest Expiration Date:Date Stocked:Dispensed By:Checked By:Date Dispensed:EXP.DATEPARLEVELCHARGECODEAdenosine 6mg/2ml vial36355Albuterol 3ml solution for neb76094Atropine Sulfate 1mg/10ml (PFS)26791Bretylium Tosylate 500mg/10ml (PFS)25342Calcium chloride 10% 1gm/10ml (PFS)16435Dextrose 25% (10ml PFS)25370Dextrose 50% 25g/50ml (PFS)25631Diphenhydramine 50mg/ml inj15766Dopamine 400mg/D5W 250ml12082Epinephrine 1:10,000 (1mg/10ml PFS)56727Epinephrine 1:1000 (1mg/ml 30ml vial)15791Lidocaine 100mg/5ml (PFS)35671Lidocaine 2g/D5W 500ml)15332Mannitol 20% 250ml15650Methylprednisolone 125mg inj15613Naloxone 2mg/2ml amp56955Procainamide HCl 1000mg/10ml vial15929Racemic epinephrine (Vaponephrine) 15ml16821Sodium Bicarbonate 4.2% (Infant) 5meq/10ml (PFS)25420Sodium Bicarbonate 8.4% (Ped) 10mEq/10ml (PFS)25912Sodium Bicarb. 8.4% (Adult) 50mEq/50ml (PFS)25695MEDICATION22.10QTY.USED

NURSING HOMEEmergency Drug Supply in the Nursing HomeI. 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 inconsultation with the Medical Director, Director of Nursing and Pharmacist, and it shall be in accordance withfacility policies and procedures. The kit shall be readily available and shall be kept sealed. All items in the kitshall be properly labeled. The facility shall maintain an accurate log of receipt and disposition of each item inthe Emergency Medication Kit. An inventory of the contents of the Emergency Medication Kit shall beattached 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 MedicationThe regulation at 42 CFR 483.60 (F425) requires that the facility provide or obtain routine and emergencymedications and biologicals in order to meet the needs of each resident. Facility procedures and applicable statelaws may allow the facility to maintain a limited supply of medications in the facility for use during emergencyor after-hours situations. Whether prescribed on a routine, emergency, or as needed basis, medications shouldbe administered in a timely manner. Delayed acquisition of a medication may impede timely administration andadversely affect a resident’s condition. Factors that may help determine timeliness and guide acquisitionprocedures include: Availability of medications to enable continuity of care for an anticipated admission or transfer of aresident from acute care or other institutional settings; Condition of the resident including the severity or instability of his/her condition, a significant change incondition, discomfort, risk factors, current signs and symptoms, and the potential impact of any delay inacquiring 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 CommitteeThe drugs will be selected by:A.Medical DirectorB.Director of NursingC.Consultant Pharmacist and or vendor Pharmacy22.11

NURSING HOMEIV.Current standards of practice go beyond the requirements of 59A-4.112A. The EDK should be stored in a secure area in appropriate temperature rangeB. 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 pharmacyD. The Pharmacy must record the date the EDK was checked, the lock number and the initials of thepharmacist sealing the kitE. The kit should contain a 2nd color break-away lock to reseal the kit after an emergency is overF. Whenever possible products should be in single unit of use formG. All items shall be properly labeledH. 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 used2. Date administered3. Resident’s name4. Physician’s name5. Signature of person removing drugJ. Only one dose of the product may be removed during the emergency. Subsequent doses must betreated 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 workingday.VII.A list of the contents should be posted at each nursing station. This will assist nursing in identify drugsavailable in house during a telephone conversation with the prescriber.22.12

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Sample NURSING CENTEREMERGENCY KIT LIST (Page 1 of 2)PRIMARY EDK - ADRUG & STRENGTHAdrenalin 1mg/mlAmoxicillin 250mgAmpicillin 250mgAntivert 12.5mgAtarax 10mgAtropine 1mg/mlAtrovent unit dose 0.02%Augmentin 500mgAugmentin 875mgBactrim DSBenadryl 25mgBenadryl 50mg/mlBiaxin 250mgCatapres 0.1mgCeftin 250mgCipro 250mgCleocin 150mgCogentin 0.5mgCogentin 2mg/2mlCoumadin 1mgCoumadin 5mgDecadron 4mgDecadron 4mg/mlDepakote Sprinkles 125mgDepo-Medrol 40mg/mlDextrose 50%DiaBeta 2.5mgDigoxin 0.25mg/mlDiflucan 100mgDilantin 100mgDilantin 100mg/2mlFlagyl 250mgGaramycin 80mg/2mlGlucagonGlucophage 500mgHeparin 5,000 units/mlImodium 2mgInsta-GlucoseKayexylateKeflex 250mgLanoxin 0.125mgLasix 20mgLasix 10mg/mlGENERIC NAMEEpinephrine HCL 1mg/mlAmoxicillin 250mgAmpicillin 250mgMeclizine 12.5mgHydroxyzine HCL 10mgAtropine 1mg/mlIpratropium BromideAmoxicillin/Clavulanate 500mgAmoxicillin/Clavulanate 875mgSeptra or SMX-TMP DSDiphenhydramineDiphenhydramine 50mg/mlClarithromycin 250mgClonidine HCLCefuroximeCiprofloxacin 250mgClindamycin 150mgBenztropine 0.5mgBenztropine 2mg/2mlWarfarin SodiumWarfarin SodiumDexamethasone 4mgDexamethasone 4mg/mlDivalproex Sodium 125mgMethylPrednisolone 40mg/mlDextrose 50% SyringeGlyburide 2.5mgDigoxin 0.25mg/mlFluconazolePhenytoinPhenytoin 100mg/2mlMetronidazole 250mgGentamycin 80mg/2mlGlucagonMetformin 500mgHeparin 5,000 units/mlLoperamide HCL 2mgGlucose OralSod Polystyrene SulfonateCephalexin 250mgDigoxin 0.125mgFurosemide 20mgFurosemide Slow Release tsInjectableCapsulesOral GelOral SuspCapsulesTabletsTabletsInjectableQUANTITY2 x 1ml881042 x 1ml533552 x 1ml553101041 x 2ml5552 x 1ml52 x 1ml1 x 50ml52 x 1ml552 x 2ml103 x 2ml252 x 1ml524 x 60ml10455 x 2mlEXPIRATION

Sample NURSING CENTEREMERGENCY KIT LIST (Page 2 of 2)DRUG & STRENGTHLevaquin 250mgLevsin Sublingual 0.125mgLopressor 25mgLovenox 40mg/0.4mlLovenox 60mg/0.6mlNarcan 0.4mg/mlNebcin 80mg/2mlNeurontin 100mgNitroglycerin Patch 0.2mg/hrNitroglycerin Patch 0.4mg/hrNitrostat 0.4mg (1/150gr)Penicillin VK 250mgPhenergan 25mg/mlPrednisone 1mgPrednisone 5mgPrevacid Capsules 15mgPrinivil 2.5mgProcardia 10mgProventil Inhaler 90mcgReglan 5mgRemeron SoluTab 15mgRisperdal 0.5mgRocephin 1GMSoluMedrol 125mgTetracycline 250mgTheodur 200mgUltram 50mgVentolin unit dose 0.083%Vibramycin 50mgVistaril 50mg/mlVitamin K 10mg/mlWater for InjectionXylocaine 1%Zaroxolyn 2.5mgZithromax 250mgGENERIC NAMELevofloxacinHyoscamine Sulfate S.L. 0.125mgMetoprolol 25mgEnoxaparin Sodium 40mg/0.4mlEnoxaparin Sodium 40mg/0.6mlNaloxone 0.4mg/mlTobramycin 80mg/2mlGabapentin 100mgNitroglycerin Patch 0.2mg/hrNitroglycerin Patch 0.4mg/hrNitroglycerin Sublingual 0.4mgPenicillin VK 250mgPromethazine HCL 25mg/mlPrednisone 1mgPrednisone 5mgLansoprazole Capsules 15mgLisinopril 2.5mgNifedipine 10mgAlbuterol Inhaler 90mcgMetoclopramide HCLMirtazapine Solutab 15mgRisperidone 0.5mgCeftriaxone Sodium 1gmMethylPrednisolone 125mgTetracycline 250mgTheophylline 200mgTramadol 50mgAlbuterol Sulfate Soln 0.083%Doxycycline Hyclate 50mgHydroxyzineAquamephytonWater for InjectionLidocaine HCL 1%MetolazoneAzithromycin Dihydrate 250mg22.16FORMTabletsTablets -SublingualTabletsInjectable SyringeInjectable ts - leInjectableCapsulesSustained Release TabletsTabletsNebulizer leTabletsTabletsQUANTITY10352 x 0.4ml2 x 0.6ml2 x 1ml3 x 2ml10221 x 25102 x 1ml51010551 x 17gm553421055552 x 1ml2 x 1ml1 x 50ml2 x 5ml310EXPIRATION

Sample NURSING CENTERCONTROLLED SUBSTANCESEMERGENCY KIT - ADRUG NAMEAmbien Tablets 5mgAtivan Tablets 0.5mgDarvocet N 100 TabletsDemerol 50mg/ml vialsDilaudid Tablets 2mgDuragesic Patch 25mcgLomotil Tablets 2.5mgMorphine 10mg/ml vialOxycontin ER Tablets 10mgOxyFast Oral Concentrate InveAmps20mg/mlOxy IR Tablets 5mgPercocet Tablets 5mg/325mgRestoril Capsules 7.5mgRoxanol InveAmps 20mg/1mlTylenol #3 Tablets 30mg/300mgValium Multi-dose vial 5mg/mlVicodin Tablets 5mg/500mgXanax Tablets 0.25mgGENERIC NAMEZolpidem Tablet 5mgLorazepam Tablets 0.5mgPropoxyphene Nap W APAP 100mg/650mgMeperidine Inj 50mg/mlHydromorphone Tablets 2mgFentanyl Patch 25mcgDiphenoxylate w Atropine Tablets 2.5mgMorphine 10mg/ml vialOxycodone E.R. Tablets 10mgQUANTITY55102545210Oxycodone Oral 20mg/mlOxycodone Tablets 5mgOxycodone w APAP Tablets 5mg/325mgTemazepam Capsules 7.5mgMorphine Soln 20mg/1mlAcetaminophen w Codeine Tablets30mg/300mgDiazepam Injectable 5mg/mlHydrocodone w APAP Tablets 5/500mgAlprazolam Tablets 0.25mg31010551011010Sample NURSING CENTERREFRIGERATOREMERGENCY KITDRUG NAMENovolin R Insulin U-100Novolin N Insulin U-100Novolin 70/30 InsulinHumalog 75/25 InsulinNovolog U100 InsulinLantus Insulin 100u/mlAtivan 2mg/ml ampsCompazine Supp 25mgPhenergan Supp 25mgGENERIC NAMEHuman Insulin RegularHuman Insulin NPHHuman Insulin NPH/Regular mixInsulin analog (Lispro)Insulin analog (Aspart)Insulin GlargineLorazepam InjectableProchlorperazine Supp 25mgPromethazine Supp 25mg22.17QUANTITY111111432EXP DATEEXP DATE

NURSING HOMESAMPLE POLICY & METHODSEmergency Pharmacy ServiceMETHODS:1.Telephone numbers for emergency pharmacy services are posted at the nursingstation of each patient services wing.2.If an emergency drug order is received, the charge nurse is to determine if thedrug is in the emergency drug supply box. This is done by referring to the list ofcontents which is posted (1) by the telephone at the nursing station, or (2) on theemergency supply box itself.3.If an emergency drug order is received which is not in the facility’s approvedemergency drug supply, OR in an emergency where the staff needs to consultwith a pharmacist, the facility’s staff may reach a pharmacist during thepharmacy’s scheduled business hours by calling 372-2575.4.After the pharmacy’s regularly scheduled business hours, a pharmacist may bereached by dialing (See Appendix).5.If a stat drug order is received during the pharmacy’s normal business hours, thenurse is to immediately order the medication from the pharmacy by dialing 3722575. 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, pharmacistreceiving the order will determine if the pharmacy can make the delivery with inthe time required. If not, the pharmacist will call another local pharmacy to makethe delivery. However, the facility staff should always call the facility’s regularpharmacy. The facility has agreed not to call another local pharmacy directly foremergency medication orders.7.No one is to stockpile or hoard drugs, nor are medications to be borrowed fromone patient to meet the needs of another patient.22.18

NURSING HOMESAMPLE POLICY & METHODSEmergency Box ProceduresTo supplement normal pharmacy services a red emergency drug box is maintained in thewest wing nurses station the contents are reviewed regularly, at least yearly by the PharmacyServices Committee, and revised, if necessary. The consultant pharmacist inspects the boxregularly, at least monthly, and orders replacements from the vendor pharmacist if any item ismissing or out of date. The Director of Nursing is to be notified by the consultant pharmacist ofany irregularity with the emergency box.Once this emergency box is opened it cannot be closed without a key. Please do not tryto force this box closed. The Director of Nursing is to be notified whenever the box is opened soit may be closed again.All medications used from this box must have an order from the physician written on thechart. The vendor pharmacist must be notified by the nurse or if the pharmacy is closed, theoncoming nursing personnel must be requested to notify the pharmacy when they open that theemergency 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 wasopened. The following information shall be recorded:2. Date entered,3. Drug removed,4. Name of the patient,5. Name of the ordering physician6. Signature of the nurse.7. 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 Nursingoffice for a new Log Form. The completed Log Form will be retained for a year.22.19

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NURSING HOMECOMPANIES PROVIDING AUTOMATED CABINETS USED ASEMERGENCY KITSMED-DISPENSEwww.med-dispense.com(877) 788-6855OMNI CELL SOLUTIONSwww.omnicell.com(800) 850-6664PYXISwww.cardinal.com/pyxis(614) 757-500022.22

NURSING HOMEEXAMPLES OF AUTOMATED CABINETSOMNI-CELL PRODUCTSPYXISMED DISPENSE22.23

22.2 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

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Part One: Heir of Ash Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 Chapter 24 Chapter 25 Chapter 26 Chapter 27 Chapter 28 Chapter 29 Chapter 30 .

TO KILL A MOCKINGBIRD. Contents Dedication Epigraph Part One Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Part Two Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18. Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 Chapter 24 Chapter 25 Chapter 26

DEDICATION PART ONE Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 PART TWO Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 .

B.Known causes of medication errors include: confusing labeling and nomenclature, human and environmental factors and medication shortages C.Medication safety measures include barcoding, smart pumps, medication reconciliation and pharmacists D.Medication errors are the most common sentinel event reported. E.None of the above LEARNINGOBJECTIVES

a. Read medication administration plan b. Read label 4. Observe student prepare and take medication as per medication plan 5. Document as required or stated in plan a. By unlicensed school staff member b. By student RECORDING MEDICATION ADMINISTRATION 1. Use Medication Administration Daily Log (paper or computer) 2. Record in ink only if using .

Carb.3. Repair Kit Carburetor Assembly Walbro WA226 #530069754 Zama C1U--W7 #530069971 1 2 Gasket/3. Dia. Kit 3 KIT D KIT D KIT D KIT D KIT KIT KIT KIT Kit -- Carburetor Assembly No. 530071630 -- C1U--W7D Note: No Repair kits are available for this carburetor, please order the complete assembly part number 530--071630 (C1U--W7D)

Tulang rawan yang paling banyak dijumpai pada orang dewasa. Lokasi : - Ujung ventral iga - Larynx,trachea, bronchus - Permukaan sendi tulang - Pada janin & anak yg sedang tumbuh pada lempeng epifisis Matriks tulang rawan hilain mengandung kolagen tipe II, meskipun terdapat juga sejumlah kecil kolagen tipe IX, X, XI dan tipe lainnya. Proteoglikan mengandung kondroitin 4-sulfat, kondroitin 6 .