22.1
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
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
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)
22.2
SAMPLE CRASH CART USED IN THE HOSPITAL
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.
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
22.3
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.
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.
22.4
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.
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.
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.
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".
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.
22.5
A. Crash Cart Receiving/Restocking Procedures
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.
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.
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.
GENERIC NAME STRENGTH CHG. CODE EXP. DATE PAR QTY USED
DRAWER 1
Adenosine 6mg vial 6355 3
22.6
Amiodarone 150mg/3ml amp 2553 3
Bretylium 50mg/ml (10 ml 5342 4
PFS)
Calcium Chloride 10% 1gm/10ml PFS 6435 2
Diphenhydramine 50mg/ml vial 5766 2
Epinephrine 1:1000 1mg/ml 30ml 5791 2
vial
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 5420 2
(INFANT)
Sodium Bicarbonate 10mEq/10ml PFS 5912 4
(PEDIATRIC)
Sodium Chloride 0.9% 30ml vial 6712 2
(bacteriostatic)
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) 6727 8
PFS
Lidocaine 100mg/5ml PFS 5671 5
Lidocaine in D5W 2gm/500ml bag 5332 1
Sodium Bicarbonate 50mEq/50ml PFS 5695 4
(ADULT)
Medication Labels -------------- --------- ----------- 3 ----
Emergency Drug Drip Card -------------- --------- ------------ 1 ----
White Zip-Tie Seal ------------- --------- ----------- 2
22.7
PHARMACEUTICAL ICU CRASH CART CHECK LIST
EARLIEST EXPIRATION STOCKED BY: CART RPH/ DATE DATE USED:
DATE: No:
22.8
ADULT ER RESUSCITATION TRAY CHECKLIST
22.9
PEDIATRIC ER RESUSCITATION TRAY CHECKLIST
22.10
NURSING HOME
• 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;
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
22.11
NURSING HOME
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.
22.12
22.13
22.14
Sample NURSING CENTER
EMERGENCY KIT LIST (Page 1 of 2)
PRIMARY EDK - A
22.17
NURSING HOME
SAMPLE POLICY & METHODS
METHODS:
1. Telephone numbers for emergency pharmacy services are posted at the nursing
station of each patient services wing.
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.
22.18
NURSING HOME
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:
2. Date entered,
3. Drug removed,
4. Name of the patient,
5. Name of the ordering physician
6. 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 Nursing
office for a new Log Form. The completed Log Form will be retained for a year.
22.19
22.20
22.21
NURSING HOME
MED-DISPENSE
www.med-dispense.com
(877) 788-6855
PYXIS
www.cardinal.com/pyxis
(614) 757-5000
22.22
NURSING HOME
OMNI-CELL PRODUCTS
22.23