Each hospital’s medicines policy will set out the roles and responsibilities for the safe and secure storage of medicines on wards.
Storage arrangements
Each hospital’s
medicines policy will set out the roles and responsibilities for the safe and
secure storage of medicines on wards. For the most part, the appointed
registered nurse in charge of the ward or clinical area (usually the ward
manager or theatre manager) or other professionally qualified person (possibly
an operating department practitioner or radiographer) must ensure that systems
for the safe use and security of medicines are followed and that stocks are
safeguarded. He or she may delegate some of the duties, such as access, to
another nurse or to a member of the pharmacy staff, but the responsibility
always remains with him or her. In almost all instances, medi-cines will be
stored in locked cupboards or another secure receptacle, such as patients’
medicines cabinets, described above. The pharmaceutical service may assume
responsibility for replenishment of these stocks, advise on the type and
location of cupboards, regularly inspect and audit them and assure the quality
of the product at the time of use. However, pharmacy staff are rarely in a
position to do more than this as they do not administer or use the items
stored. What is clear is that this arrangement does present some risks if the
wrong patient’s medicines, stock items or medicines that are no longer needed
are left in the patient’s locker and not managed appropriately.
The keys to
medicines stock cupboards, drug trolleys and patients’ medicines cabinets
should be labelled, kept separate and carried on the person of a nurse (or
other qualified person in charge). Controlled drug (CD) cupboard keys should be
kept on a separate ring that can be readily identified and carried by the
assigned nurse in charge, that is, the senior registered nurse on duty for the
ward or clinical area, identified as nurse in charge for that shift. This all
has the effect of minimising unnecessary access to medicines. For
self-administra-tion schemes patients may hold the key for their own medicines
locker; the appointed nurse in charge as described above should keep a master
key.
Separate lockable
cupboards should be available for internal and external medicines (constructed
to the British Standard specification) and CDs. In small units, if space does
not permit a separate cupboard for external medicines, they must be kept on a
separate shelf, below those for internal use. A separate lockable medicine
refrigerator must be available in all areas where medicines may require it,
with a maximum minimum thermometer to enable regular checks that temperatures
are maintained in the range 2–8 C. A num-ber of hospitals are now using
automated systems to monitor the fridges used to store medicines: these fridges
are linked to alarm systems in the event of fridge failure.
Medicines in current
use on wards are either kept in a lockable trolley or in individual patient
medicine cabinets or drawers, usually at the bedside; none of these must be
used for permanent storage. The trolley must be immobilised when not in use,
locked either in a cupboard or to a wall; it is not normally used for CDs.
Patient medicine cabinets or drawers must be lockable and not readily portable.
In some hospitals, patients’ medicines lockers are attached or an integrated
part of their bedside locker, tend to be on wheels and are therefore portable
to some extent. However, in practice this is seen as acceptable in many British
hospitals.
There are no
published data to quantify the volume or cost of medicines that are
misappropriated by hospital staff. Although the concept of diversion is rarely
discussed, there are a number of anecdotal examples that suggest it is more
common that most people would assume. Unpublished studies have suggested that
as much as 20% of the medicines supplied to a ward will be unaccounted for.
Procedures and
documentation need to minimise opportunities for misap-propriation and some
departments ask nursing staff to sign for deliveries to ensure there is an
audit trail from the point of ordering to the point of delivery to wards.
A minimum
requirement to give an audit trail in a manual system is that the requisition
has the signature of the ordering nurse, that pharmacy can verify, the issuer’s
and checker’s signature is entered and a receipt is obtained. Serial numbering
and book-fast copies (kept for a minimum of 2 years) minimise the opportunity
for destruction of records to go undetected. Where requisition books are used
there should be only one in each ward or department, kept locked away, with new
ones treated as controlled station-ery, stocked only in pharmacy.
In some cases,
organisations may decide that some medicines should be left in more readily
accessible locations. Although this may not be ideal, a risk assessment may
identify that this is an appropriate course of action.
Examples might include:
·
medicines in emergency kits or on emergency drug trolleys,
in clearly labelled boxes with a tamper-evident seal, kept readily accessible
·
intravenous fluids, antiseptic and irrigation solutions
·
medicines considered appropriate for some patients to
administer under the supervision of a registered nurse, unless there is a
hazard to other patients.
The last situation
is distinct from participation in a formally recognised self-administration
scheme, which allows greater independence of action for patients and no limit
on the range of medicines covered. There must be a valid prescription for the
medicine. The prescriber may specify that the patient should have ready access
to the preparation but generally this is not specifically required in medicines
policies. The registered nurse may decide (and this should be documented) on
whether to have the medicine on the patient’s bedside locker. The patient must
be capable of administering the medicine correctly and willing and able to tell
the nurse when a dose has been taken so that this can be recorded on the
prescription sheet. Clearly, where a patient is using a medicine on a
when-required or regular basis, a lack of awareness that the patient is doing
so, that is, a lack of documen-tation on the drug administration record or
prescription sheet, may mask a clinical issue that the team caring for the
patient may wish to address. Examples include an increased use of glyceryl
trinitrate spray, reliever inhalers or increased use of insulin devices. The
medicine is likely to be in one of the following categories:
· inhalers
· glyceryl trinitrate
sublingual tablets or spray
· oral contraceptives
and hormone replacement therapy products – ointments or creams
· insulin
preparations.
Related Topics
TH 2019 - 2023 pharmacy180.com; Developed by Therithal info.