Archive April 2019 XX, No. 4

Your Prescription for Medication Safety

Our pharmacy consultant dispenses indispensable advice.

Sheldon Sones

Sheldon Sones, RPh, FASCP


Pamela Bevelhymer, RN, BSN, CNOR
MULTI-STRENGTH While you want to avoid stocking more than one strength of medication whenever possible, it's unavoidable for some drugs like Lidocaine.

Instead of discarding unused fentanyl in real time, your anesthesia provider aggregates all discards and brings them out for witnessing by another licensed professional at the end of each day. Sounds like an efficient way to handle discards, right? Wrong.

Here’s the issue: Potential drug diverters may see this process as an opportunity to substitute the fentanyl for a substance like saline. At the end of the day, the witness will only see clear liquid and have no way of discerning the actual contents within.

Thanks in large part to the opioid crisis, your controlled substance practices are under the microscope. Documentation is your best friend here. You need to create an easy-to-follow trail of controlled drug withdrawal from the PACU to the ORs each day, with documentation of the when — and by whom (at least 2 licensed individuals).

To prevent diversion, you’ll want to ensure a licensed individual witnesses discards of partial portions of any controlled substance. Both the discarder and witness should sign off at the time of discard. You should also validate a count of the controlled drug cabinet at the beginning and end of each day.

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