Medication/Fluid Storage & Security

Section 2 - EMERGENCY OPERATIONS

PURPOSE:

To establish for the Maitland Fire Rescue Department medication, fluids, and controlled substances inventory, storage, and security procedures. (In accordance with 64E-2.037 F.A.C. and GS4 Item # 127))

PROCEDURE:

RESPONSIBILITY

It is the responsibility of each ALS provider to secure against unauthorized entry, the areas where medications, fluids, and controlled substances are stored. Therefore the Maitland Fire Rescue Department will follow the procedures listed:

• All IV fluids and medications shall be stored in an area that is secured by a locking mechanism. Medications not assigned to an ALS vehicle shall be kept in vending machine at either station or in the treatment room closet at Station 45..
• All medications shall be stored in a climate controlled location (i.e. air conditioned and heated). Please note if medications are subjected or exposed to extreme temperatures the person checking the medication shall notify their supervisor and the on duty Battalion Chief as well as the Deputy Chief for medical evaluation of the medication.
• Controlled substances will be kept in a separate container and will be kept in the locked security box inside each ALS box located on each ALS unit.
• Refrigerated controlled substances will be kept in a separate tagged container and will be kept in the refrigerator on each rescue unit.
• Only state licensed Paramedics employed by the Maitland Fire Rescue Department shall have access (keys) to controlled substances.
• A Medication Inventory Log will be kept on all spare fluids and medications (vehicles, drug boxes, and storage cabinets). The log will include: Date of inventory, quantities of any addition or deletion from stock, location of stock, and the legible name of the person completing the inventory.
• Quarterly there shall be a controlled substance inspection completed by the EMS Battalion Chief. The EMS Battalion Chief must confirm amounts received, administered, disposed of, and transferred based on reports, receipts, expiration dates, and documentation. Any discrepancies must be addressed ASAP and resolved or proper notification made to Deputy Chief and Medical Director.
• All fluids and medications will be examined on the first weekday shift of each month (Including vehicles, drug boxes, and storage cabinets) and documented in the Medication Inventory Log.
  

Any medications or fluids found to be within one month of expiration should be removed from service and properly forwarded to the person in charge of medications for their disposal or return credit. The person in charge of medications shall store all expired medications in a locked cabinet separate from the current medications until such time as they are disposed of or returned for credit. All medications and fluids that are forwarded shall be documented accordingly in the Medication Inventory Log.

Anytime a drug/fluid is used and replaced during routine operations, it shall be examined to ensure expiration date is not within one month and that the fluid/medication is not damaged or deteriorated.

Controlled Substances

• There shall be a stocked supply of controlled substances for the entire department located at Station 45 (Safe and refrigerator). The stocked supply shall be secured by two different forms of locking devices and there shall only be certain personnel (Fire Chief, Deputy Chief, Division Chief, Battalion Chiefs, Fire Marshal) with approved access. Anytime the stocked supply is opened whether for supplies received, disbursement, or any other reason the drug log must be completed and verified by two authorized personnel. Both members must complete and sign the log indicating the specific reason for the entry.
• Only state licensed Maitland Fire Rescue Department employed Paramedics shall have access to controlled substances.
• An inventory for all controlled substances shall be conducted at the beginning of each shift by the individual responsible for drug security during that shift and for each instance of use during a call.
• Any time a controlled substance is removed from the stock, documentation must be recorded as to why (i.e. administered, broken, expired etc.). If the medication was administered the Paramedic must document the amount given, lot #, expiration date, and the amount wasted. The documentation must be signed by the administering Paramedic and a witness verifying the disposal of the unused portion. If the medication is transferred, documentation must show the Unit (i.e. E45, R45), Amount, Milligrams, Milliliters, expiration date, lot number and reason.
• Once the call and documentation is complete the inventory shall be restocked to reflect the proper amount to be maintained on the unit.
• When stripping a unit(s) to go out of service and out of the city that has narcotics and/or medications assigned to it, the drug box with narcotics, spare medications, and refrigerated medications with narcotics will be brought to Station 45 and given to the on-duty Battalion Chief. The on-duty Battalion Chief will place and lock these items in the first floor treatment room closet and/or refrigerator. When it is time to restock the unit(s), the on-duty Battalion Chief will retrieve the medications from the treatment room and give them to the crew(s).* Records shall be maintained for Morphine, Fentanyl, Ativan, Valium, Ketamine and Versed.
  

*Any controlled substance additions to the inventory will have records maintained in the appropriate log book. See example below.

Daily Controlled Substance Check Out

• Fill out the control log as directed. Unit #, employee name, date, time, and drug name(s).
• Visualize each medication and the amount present.
• Fill in the log with the information. Amount of mg and ml, expiration date, and lot #. Indicate on each line the name of the drug when filling in the information.
• Compare to the previous day to assure concurrency.
• If there are any discrepancies, identify the problem. If the problem cannot be resolved by yourself and the prior shift's Paramedic, you must notify the on duty Lieutenant, Battalion Chief, Deputy Chief and Medical Director.
  

Note: this should be completed as close to the shift change as possible (early morning).

Documented Administration

• Fill in the amount administered, lot #, expiration date, and run number.
• The administering Paramedic must print and sign their name.
• The unused portion disposal must be witnessed; the witness must print and sign their name.
• The comments line should indicate the amount given to the patient and the amount disposed of.

Documented Transfer

• When restocking controlled substances in the drug box, the station drug log must be filled out.
• In the station drug log, the TRANSFERRED TO section needs to be filled in. Unit, amount, milligrams, milliliters, expiration date, lot #, and reason. The comments line shall be filled in as needed.
• When placing the narcotics in the drug box, the drug box log must be filled out.
• In the drug box log, the RECEIVED FROM section must be filled in. Unit, amount, milligrams, milliliters, lot #, and reason. The comments line shall be filled in as needed.
• Any discrepancy found during the inventory (errors, missing pages, incomplete inventory, missing meds, incorrect meds, or broken meds) shall be reported immediately to the on-duty Lieutenant, Battalion Chief, Deputy Chief and the Medical Director.
• Inventory records shall be maintained for a period of three years minimum, at Station 45.

Disposal Procedures

• Any unused or damaged medication that is removed from service shall be disposed of into a department approved medication waste container. All attempts should be made to dispose of unused medications at the receiving emergency department through the proper bio-hazard waste disposal protocol. Any expired medications shall be forwarded to the person in charge of the medications for their return and credit. Empty ampules, vials, sharps, and syringes shall be disposed of according to bio-waste protocols.
• Controlled substances are not to be disposed of in the black box at Station 45
• Disposal of any controlled substance (including unused portions) shall be documented in the appropriate log. Disposal shall take place with a witness.
• The printed name and signature of the person witnessing the disposal of each unused portion of controlled substance shall be included in the log.
• Medication errors and reactions shall be reported to the physician who ordered the medication, receiving physician, Deputy Chief and the Medical Director.