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JCAHO REQ: Locked meds in ED

Michael Ferker xg2k2 at yahoo.com
Tue Apr 18 18:57:40 BST 2006


Hi Peter,

This is actually a situation I'm atleast a bit familiar with. Our hospitals (ENH) utilize the Pyxis system, which is virtually similar to Omnicell. We utilize Pyxis "vending machine" on each individual departmental floor, including the ER, ICU, Surgery, Radiology, PACU, etc., and 2 such units for the larger primary care floors. Each system is restocked daily with some of the more commonly used medications, and kept locked up. What seems to work best for us is the meticulous maintenance of crash carts with as many of the more commonly used RS meds as possible. The crash carts are a fairly high priority refill item, with the pharmacist always ensuring every med inside is approved. The crash cart can be quickly opened for deployment of the meds without forcing a nurse to run to the machine, log in, highlight the appropriate med, count remaining meds, etc. We also have pharmacists who "patrol" the various floors and departments in the hospital, so they are available rather nearby for
 whenever a doc or nurse has a question. It's cheaper than permanently stationing someone at the ED, because the patrolling pharmacist can also have some concurrent responsibilities like assisting in unit-dosing and approving meds for patients who need to be placed on something ASAP. I really don't know if there are any ways to satisfy JCAHO without increasing spending, but perhaps reworking pharmacy shift schedules may atleast help soften the blow.

-Mike F



"Howard, Dot" <DotHoward at mhd.com> wrote: 
Need help with this one. Having been cited by JCAHO for not having
either all meds locked up in Omnicell or having a pharmacist review each
med before it is given, we are now faced with dilemma trying to meet
JCAHO rules. As we just had a trauma patient who needed a rapid
intubation, we had a delay due to the nurse having to go out of the room
to the Omnicell and pull meds, this also complicated by the fact that
the patient arriving by ambulance is "not in the computer" so a trauma
patient number has to be generated ( taking more time) before the order
can even be entered. Result : delays in care to a patient due to lack of
ready access to Rapid Sequence Meds.

Options that have been considered... 1) small Omnicell in each room but
cost prohibited ( $20,000 per room)or 2) having a fanny pack for nurse
with drugs- pharmacy says that is prohibited by JCAHO, 3) have
pharmacist stationed 24/7 in ED ( cost prohibited) .



Surely others are having this issue as well, where JCAHO 's desire for
safety may be in conflict with an emergency patient's needs.

Your recommendations would be appreciated. Than ks





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