Policies & Procedures Title: MEDICATION – ADMINISTRATION I.D.

Policies & Procedures
Title:
MEDICATION – ADMINISTRATION
I.D. Number: 1170
Authorization:
[x] SHR Nursing Practice Committee
Source: Nursing
Date Revised: May 2014
Date Effective: May 1999
Scope: SHR Urban & Rural Acute, Rural LTC
Any PRINTED version of this document is only accurate up to the date of printing 7-Jul-14. Saskatoon Health Region (SHR)
cannot guarantee the currency or accuracy of any printed policy. Always refer to the Policies and Procedures site for the
most current versions of documents in effect. SHR accepts no responsibility for use of this material by any person or
organization not associated with SHR. No part of this document may be reproduced in any form for publication without
permission of SHR.
Definition
Health Care Professional – for the purpose of this policy, Health Care Professional will be used to refer
to Registered Nurse (RN), Graduate Nurse (GN), Registered Psychiatric Nurse (RPN), Nurse
Practitioner (RN(NP)), Licensed Practical Nurse (LPN), Graduate Practical Nurse (GPN),
Physician, Registered Respiratory Technician (RRT), Pharmacist, Paramedic and nursing
/paramedic students.
1. PURPOSE
1.1
To ensure patient safety when preparing & administering all medications including
immunizations.
1.2
To comply with medical-legal standards.
2. POLICY
2.1
All medications shall be ordered as per the policy “Ordering of Medications” #7311-60-004
located in the SHR Regional Policy Manual.
2.2
Medication orders shall be clarified if it is believed patient safety will be affected by
carrying out the order.
2.3
2.4
Urban Acute Care & Humboldt District Hospital:
Pharmacy will be notified of all patient allergies and should be informed of the patient’s
height and weight as soon as possible after admission.
A Compendium of Pharmaceuticals and Specialties (CPS) and Intravenous Medication
Reference Manual shall be available on each nursing unit.
Note:
E-CPS is available from the Medical Library website of the SHR InfoNet. An
electronic IV Medication Reference Manual is available on the Pharmaceutical
Services webpage of the SHR Infonet. Lexicomp Online provides drug and clinical
information (including IV COMPATIBILITY). It can be accessed through the Medical
Library or Pharmaceutical Services webpage of the SHR InfoNet.
2.5
Fridges used to store medications will not be used to store food items.
2.6
All medications previously dispensed by Pharmacy Services will be returned to pharmacy
when the medication is discontinued and when the patient is discharged.
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2.7
IV medications infusing at shift change either continuously or intermittently must be verified
by the oncoming shift nurse.
2.8
Preparation
2.8.1
The Health Care Professional administering the medication must prepare it. This
excludes premixed and unit dose medications.
2.8.2
Medications will be prepared using aseptic technique.
2.8.3
All medications prepared by the Health Care Professional will be labeled with:
• patient name
• name of medication
• dose
• name of preparer
• date and time prepared
Unlabeled medications must be discarded.
Note:
2.9
A medication prepared on the nursing unit is to be administered within one
hour of preparation. If administration has not begun within one hour of
preparation, the medication must be discarded.
2.8.4
All intravenous containers and syringes will remain in their original overwrap until
ready to be prepared and/or administered.
2.8.5
More than one medication or multiple doses of medications will not be drawn in a
single syringe or minibag/IV solution for injection/infusion.
2.8.6
Filter needles will be used when drawing medications from glass ampules to prevent
glass contamination in the syringe. The filter needle will be changed before IM
injection or injection into the IV solution.
Administration
2.9.1
Medications shall be administered by Health Care Professionals as per specific
educational institution guidelines.
2.9.2
Health Care Professionals administering medications shall understand the
indication, therapeutic effect, side effects, and clinical responsibilities (eg. checking
heart rate prior to digoxin administration) for each medication.
2.9.3
Hand hygiene will be performed before and after medication administration.
2.9.4
To prevent distractions from other persons or activities, Health Care Professionals will
refrain from other aspects of individualized patient care while administering
medications to ensure appropriate safety checks are followed.
2.9.5
All oral medications will remain in their original packaging until they reach the
patient. This includes medications that require crushing or dissolving.
2.9.6
All oral suspensions will be prepared in, delivered and administered to patients in a
labeled oral syringe. Oral medications will not be prepared in syringes usually used
for injections.
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2.9.7
I.D. # 1170
Patients shall be observed when taking oral medications. Refer to policy #7311-60004 Ordering of Medications located in the SHR Regional Policy Manual for a list of
medications that may be left at the bedside on adult units.
Note:
On pediatrics or in long term care, if the parent/guardian is administering
the medication, the health care professional will still prepare the medication
and will observe the medication being given.
2.9.8
All intravenous medications infusing continuously (over 24 hours every day) will be
infused as the primary infusion on the infusion pump with the exception of
chemotherapy drugs.
2.9.9
The Health Care Professional will take the medication cart/tray/medication and the
medication administration record to the patient during medication administration
using routine practices taking care to avoid contamination of the cart or tray. See
Appendix A for information on medication cart use and Appendix B for information
regarding Pyxis® 4000 MedStation.
Note:
This includes all isolation rooms. The use of personal protective equipment
will vary with each situation.
2.9.10 Administration times:
2.9.10.1 Regularly scheduled medications shall be administered within 60 minutes
before or after the indicated time, except in unusual circumstances (e.g.
Code Blue situations, the patient is off of the nursing unit, or the medication
is not available).
2.9.10.2 “Stat” medications shall be administered as soon as the medication is
available.
2.9.10.3 Medications are to be administered at standard administration times
whenever possible as defined by Pharmaceutical Services. Judgement is
required when the first dose is administered at other than a “standard” time.
For example, a medication can be administered before the midpoint of the
dosing interval or if it is after the midpoint of the dosing interval, the
medication should be given at the next scheduled administration time.
2.9.11 Interpreting Range Orders and Administering p.r.n. medications:
2.9.11.1 The initial medication dose is based on clinical assessment, pain scales and
the indications for the p.r.n. medication and other medications that have
been administered.
2.9.11.2 Ongoing doses are based on the clinical assessment, pain scales and
effectiveness of prior doses of the p.r.n. medication.
2.9.11.3 Once a dose within the range is chosen & administered, no more
medication under this order may be administered until the next time
interval.
Note:If it is assessed that the patient requires more of this medication, an
order from the prescriber is required.
2.9.11.4 Documentation of the p.r.n. medication will occur on the appropriate
record immediately after administration and include clinical assessment,
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pain scale (if used) and indications for use. Therapeutic effectiveness and
any adverse effects will also be documented following administration at the
appropriate time.
2.9.12 All high-alert medications will be administered as per the policy High Alert
Medications #7311-60-020 located in the SHR Regional Policy Manual.
3. PROCEDURE
3.1
Clarify orders if needed as per SHR Regional policy “Ordering of Medications” #7311-60-004
3.2
Verify patient is not allergic to medication being administered.
3.3
Prepare the medication (if applicable).
3.4
Take the medication cart/tray and medication administration record to the bedside. Use
proper hand hygiene & infection prevention principles during this procedure to prevent
cart/tray contamination.
3.5
Directly compare two patient identifiers with the medication administraton record each
time you administer medications. See SHR Regional policy “Verification of
Patient/Resident/Client Identification Before the Initiation of Treatment, Procedure or
Therapy” #7311-60-017.
Whenever possible, also verbally confirm proper identification by asking the patient their
name and date of birth. The verbal confirmation should match the information written on
the identification band, photograph (in LTC) and/or medication administration record. If
the patient is unable to provide verbal confirmation family members, if present, may
identify the patient.
3.6
Administer the medication by the ordered route. Follow the procedures outlined in the
resource textbook Nursing Interventions and Clinical Skills by Elkin, Perry and Potter with the
following additions and/or exceptions:
3.6.1
Transdermal patches
3.6.1.1 Remove any previously applied transdermal patch of the same medication
before applying a new patch. Fold the patch with medication surface
inside and dispose in the sharps container or appropriate secure waste
receptacle.
Note:
Hairy areas may be clipped, but not shaved. Note that the
preferred site of application of each drug is unique. For example:
∗ Nitroglycerin - upper limbs (adults)
- chest and abdomen (young pediatrics)
∗ Scopolamine - behind ear
∗ Estrogen - buttocks, lower abdomen, side, lower back
∗ Fentanyl - upper arms, chest, back
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Policies & Procedures: Medication – Administration
3.6.1.2
•
•
•
3.6.2
I.D. # 1170
Document on the MAR or equivalent record:
the location of placement of the patch
change in dosage
the removal of the patch
Intramuscular Injections (IMs)
Note:
IM injections are not route of choice in Pediatric patients except for such
medications as immunizations, chemotherapy, antibiotics or select
emergency medications such as epinephrine for anaphylaxis. Use an
alternative route whenever possible.
3.6.2.1 Needle gauges
Use a larger gauge for administering thick suspensions such as Penicillin G.
Neonate: 25 - 27 gauge, 1.3 - 1.6 cm long
Note:
Use only up to a 3 ml syringe. The amount of the IM injection should
not be greater than 3 ml (adult), 2 ml (children older than 2 years), 1
ml (children younger than 2 years), or 0.5 ml (neonate) for each
muscle site.
3.6.2.2 For pediatric patients, apply a topical anesthetic agent as ordered or use
oral sucrose solution for infants. See policy #1102 Sucrose Solution for Infant
and Pediatric Procedural Pain Management in SHR Nursing Policy &
Procedure Manual.
3.6.2.3 Landmark the appropriate site:
Pediatrics:
­ Vastus Lateralis is the preferred site for infants under 7 months of age
­ Ventrogluteal is the preferred site for children over 7 months of age
3.6.2.4 If the medication is known to stain the tissues, change needle before
administration. Do Not Prime the needle.
3.6.2.5 DO NOT massage the injection site.
Note:
3.6.3
It is recommended that IM injections administered to adults are
given using the Z-track technique. Z-track technique is not
recommended for pediatric patients.
Intravenous Injections/Infusions. Refer to Intravenous &/or Peripheral Saline Lock
Insertion & Maintenance #1118 & IV Push Administration #1089 policies in the SHR
Nursing Policy & Procedure Manual.
Note:
•
•
•
•
Do not use Pre-filled sodium chloride flush syringes for preparing and
administering medications.
Administer IV medications as directed in the IV Medication Reference
Manual.
Change IV bags containing medications prepared on the nursing unit every
24 hours.
Remove labels or obscure patient information from IV bags/syringes before
discarding as waste.
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Policies & Procedures: Medication – Administration
3.6.4
I.D. # 1170
Eye Drops/Ointments/Gels
3.6.4.1 If giving more than one type of drop, administer the thickest last, and allow
five minutes between eye drops and 10 minutes between eye ointments or
administer as ordered by appropriate prescriber.
3.6.4.2 Administer ointments after eye drops.
3.6.4.3 If administering gel, instill into eye(s) as ordered and tape eye(s) shut.
3.6.5
Nose Drops/Sprays
3.6.5.1 If not contraindicated, have patients blow their nose before medication
administration to clear nasal passages.
3.6.5.2 Position patient sitting up straight, head facing forward when administering
nasal sprays and with head tilted back when administering nose drops. See
package insert for alternate recommendations. For young pediatric
patients, a supine position may be required.
3.6.5.3 Instill drops or spray into nasal passages as ordered.
3.6.5.4 After administering nose drops, instruct patient to mouth breathe and tilt
head back for five minutes following medication if able.
3.6.5.5 After administering nasal spray, have the patient sniff gently through the
affected nares.
3.6.6
Nebulizer Aerosolized Medications: Refer to Aerosolized Medication for Inhalation
#1023 in the SHR Nursing Policy & Procedure Manual or #A-91 in the SHR Rural
Nursing Policy & Procedure Manual.
3.6.7
Oral Medication
3.6.7.1 If patient is unable to swallow or when administering via a PEG, G button or
an orogastric, nasogastric or jejunal tube, contact the pharmacist for
advice on alternative dose formulations and the prescriber for a new
medical order.
3.7
Documentation
Rural Acute Care: refer to SHR Rural Nursing Policy & Procedure Manual
Urban Acute Care:
3.7.1 Document the exact time the medication was administered on the MAR or
equivalent record immediately after the medication is given. In addition, chart the
following as applicable:
3.7.1.1 For “stat” medication, record the exact time given and initial next to the
prescriber’s order, and record the time given and reason for the medication
administration on the Progress Record/Nurses Notes.
3.7.1.2 For “prn” medications, record the reason for the medication administration
on the Progress Record/Nurses Notes.
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3.7.1.3 Document side effects and/or therapeutic effects of the medication on the
Progress Record/Nurses Notes.
3.7.1.4 If applicable, record the administration site on the MAR or equivalent
record.
Note: Refer to MAR policy #1091 in SHR Nursing Policy & Procedure Manual or
#M–16 in SHR Rural Nursing Policy & Procedure Manual if applicable.
3.8
3.7.2
If a scheduled dose is not given, or is given outside 60 minutes of the scheduled
time, document the reason on the MAR or equivalent record and in the Progress
Record/Nurses Notes. Report as directed below.
3.7.3
Document all double checks and verifications for high alert medications as per High
Alert Medications policy #7311-60-020 in the SHR Regional Policy & Procedure
Manual.
Reporting
3.8.1
Notify the prescriber and Pharmacy of any unusual or adverse medication
reactions.
3.8.2
Immediately report any medication errors to the prescriber and patient/family and
complete a Medication Incident Report.
Note:
3.9
A Medication error is defined as a medication, diagnostic agent or procedure
requiring the use of such agents which are not the prescribed medication or are
inappropriately delayed, administered, or omitted:
• to the wrong patient
• in an incorrect dosage
• at the incorrect time
• by a route or method not specified by the prescriber or approved by
hospital policy
• incorrect medication prescribed
Patient Transfers and Discharges
3.9.1
When transferring patients within a hospital or to other hospitals within Saskatoon,
send their current MAR or equivalent record, and medications (except refrigerated
IV antibiotics) with the chart to the receiving unit. Continue to use the same MAR for
the remainder of that day.
Note:
3.9.2
When discharging the patient to another facility, copy the present day
medication administration record after all medications are administered and
send with the patient with other applicable paperwork.
On discharge, send medications with which the patient has had direct contact
(e.g. metered dose inhalers, ointments, eye drops or nose drops) home with the
patient if required, or return them to pharmacy.
Note:
If sending these medications home with the patient, ensure the patient
understands how and when the medication is to be taken.
Urban Acute Care & Humboldt District Hospital: If patient-oriented or revised
instructions are needed, contact Pharmacy for relabeling.
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3.10 Missing Doses
3.10.1 If you are missing a medication dose, search all the logical locations including other
units if patient was a recent transfer.
Urban Acute Care:
3.10.2 Investigate why the dose is missing:
• was the order faxed to Pharmacy
• has the dose been delivered by Pharmacy
Note:
If this is a new order, pharmacy will send a new dose if the administration time is
less than half-way to the next scheduled administration time. Otherwise, wait to
give the dose at the next scheduled time.
3.10.3 After Pharmacy Hours
Urban Acute Care:
3.10.3.1 Process orders before Pharmacy staff leaves for the day if possible. When
orders are processed after this time, pharmacy will deliver the ordered
medications the next morning.
3.10.3.2 To obtain a replacement, access the Night Cupboard for available doses. If
necessary, phone the Pharmacy Missing Dose Line at your site with the
following information:
• patient’s name
• 6 digit medical record number
• generic name of the missing medication as written in MAR or equivalent
record, and dose
• your name and nursing unit
• brief comment if necessary
Note: If the dose is required stat, page a pharmacist through switchboard. If this
is an original order, fax the order to Pharmacy.
Note:If the medication is not in the night cupboard, phone the pharmacist on
call through switchboard.
Rural Sites:
If it is imperative the medication is administered after Pharmacy hours and
the dose is not available from another unit or in the night cupboard,
contact the rural pharmacy manager for further direction.
4.
REFERENCES
Alberta Health Services, 2008. Corporate Administrative Directive 2.3.4.1 Pro Re Nata (PRN)
Medication. October.
College & Association of Registered Nurses of Alberta, 2007. Medication Administration: Guidelines
for Registered Nurses. November.
College of Nurses of Ontario, November 1996 (revised 2008, updated 2009). Practice Standard:
Medication.
Eisenberg, Seth, 2010. Practice Safe Nursing with Oral Hazardous Drugs, ONS Connect, January
2010., page 8.
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Elkin, M.K., Perry, A.G., & Potter, P.A. 2004. Nursing Interventions & Clinical Skills. 3rd Ed. Mosby, St.
Louis, Mo. pg.409-490
http://allergies.about.com/od/noseandsinusallergies/a/nasalsprays.htm
Infection Prevention & Control Manual #20-10 Standard Precautions, #20-25 Point of Care Risk
Assessment
Institute for Safe Medication Practices (ISMP), March 10, 2011, Volume 16, Issue 5. Oops, Sorry,
Wrong Patient: A patient verification process is needed everywhere, not just at the bedside.
Saskatchewan Registered Nurses Association, April 2000 (revised February 2007). Medication
Administration: Guidelines for Registered Nurses
SHR Nursing Policy & Procedure Manual #1023 Aerosolized Medication for Inhalation
SHR Nursing Policy & Procedure Manual #1118 Intravenous &/or Peripheral Saline Lock Insertion
& Maintenance
SHR Nursing Policy & Procedure Manual #1089 Intravenous – Push Medication Administration
SHR Nursing Policy & Procedure Manual #1091 Medication Administration Record (MAR)
SHR Nursing Policy & Procedure Manual #1102 Sucrose Solution for Infant and Pediatric
Procedural Pain Management
SHR Region-Wide Policies & Procedures Manual #7311-60-020 High Alert Medications
SHR Region-Wide Policies & Procedures Manual #7311-60-004 Ordering of Medications
SHR Region-Wide Policies & Procedures Manual #7311-60-017 Verification of
Patient/Resident/Client Identification Before the Initiation of Treatment, Procedure or Therapy
SHR Rural Nursing Policy & Procedure Manual #A-91 Aerosolized Medication for Inhalation
SHR Rural Nursing Policy & Procedure Manual #M-16 Medication Administration Record (MAR)
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Appendix A
Lionville Medication Carts
Metro Tech Series: T7 & T8 Cart Instructions
®
Use the pushbutton (left side) to adjust the height from 31” (sitting) to 41” (standing).
I. Keys, Locks & Locking System
A. Best® Key Locks
1. System Keys - The following keys are provided: two Sub-Master Keys, two Master and two Core keys
per system. In addition, two keys each (except when carts are keyed alike) are provided for each cart’s
main and optional narcotic locks. All cart locks have key-removable and replaceable cores.
a) The Master keys (imprinted “M”) operate all Best locks in your Lionville equipment. The “M”
keys should only be used in an emergency.
c) The Core keys (imprinted “C”) are used to remove and replace lock cores.
d) The cart keys (“S” and “N”) are explained in detail below.
2. Cart Main Locks - Each cart is keyed with a different main lock combination unless otherwise specified
or if the cart has a LockAlert VI keypad (see next paragraph). The main lock is located on the left side
of the cart. The key to this lock is imprinted with an “S” followed by a number, e.g. “S1”. This key will
open cart main locks with a matching imprint. In carts equipped with LockAlert VI keypad locking, the
main lock functions as an override lock. All cart override locks for a facility are keyed with the same “S”
combination unless otherwise specified.
3. Narcotic Locks (Optional) - All double-locked drawers for a facility will be keyed with a different key
combination unless otherwise specified. The narcotic drawer lock and key are imprinted with an “N”
followed by a number e.g. “N1”. This key will open the drawer lock with a matching imprint. A red dot
on the key visually distinguishes narcotic keys from main lock keys. Narcotic drawers have a snapclose feature which means that drawers relock without a key.
B. LockAlert VI (Keypad w/ Display) Overview:
1. LockAlert VI Keypad and Display – The keypad with display located on the cart’s control panel is used
for day-to-day operation of the cart’s main lock. As many as 1998 four digit ID numbers (operator and
manager combined) are available for each cart. The factory set numbers should be changed to a
unique combination before each cart is put into service. Each cart also has 2 three digit ID numbers –
one for set-up routines, the other for service functions. An optional one to four digit PIN can be added
to all ID numbers. Optional names can also be added to operator, CS, and manager ID numbers.
2. Keyless Narcotic/Storage Drawers (LockAlert VI) may also have one to twelve “keyless” access
narcotic/storage drawers. 2000 drawer numbers (called CS codes) are available per cart. A CS code
includes a 4-digit number assigned by a manager and an optional 1 to 4 digit personal PIN.
3. Automatic Relocking – LockAlert VI carts have an internal PC board with an adjustable timer and
motion sensor. The timer is factory set at 5 minutes but can be reset (10 seconds to 999 minutes) by a
System Manager. The cart’s main locking mechanism will automatically engage if the set time elapses
and no motion is sensed. Before relocking, an audible tone will sound 5 times. While the tone sounds,
tapping the right side of the cart near the middle or moving the cart will reset the timer.
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C. Unlocking and Relocking the Cart
Positive Locking Feature (patented) – If cassette section patient drawers are ajar ½” or less when the main
latching mechanism engages, the mechanism will automatically “grab” and pull the drawers closed. Drawers
that are open more than ½” must be closed manually.
1. Manual Locking & Unlocking - Using the metal “S” key with the same imprint as the cart lock (located
on the left side of the cart), turn the key in the lock on the left side of the cart 180° clockwise until you
hear the latch plate spring up. This releases the main cart lock and unlocks the drawers (except
narcotic drawers). To Relock the Cart – Place the “S” key in the lock and turn the key 180° counter
clockwise until you hear the latch plate drop down.
2. LockAlert VI Keypad Locking & Unlocking – Press appropriate keys to enter a valid ID then press the
OK key. The lock latch plate will spring up and all drawers (except double-locked narcotic drawers) will
unlock. Note that allowing more than 4-5 seconds between keystrokes will invalidate the entry. Start
over if this occurs. Three consecutive invalid entry attempts will trigger a tamper alarm.
3. To Relock the Cart - press the Sign Out key. Or, the cart will automatically relock after the LockAlert
time-out period elapses. Note: The time-out will be preceded by five alert tones. While the tones are
sounding, tap the right side of the cart to re-set the timer.
4. Manual Narcotic Lock - The narcotic drawer is double-locked. It cannot be unlocked (via a metal key
or LockAlert VI keypad) until the main locking mechanism is disengaged as described previously.
Unlock the drawer with the “N” key that has the same imprint as the drawer lock. Close the drawer to
relock it.
5. LockAlert VI Keyless Access Drawers - press the CS key and then enter a valid CS code to unlock all
keyless drawers or unlock the drawer(s) manually with the appropriate metal “N” key(s). For keyless
access drawers, close the drawer after removing or counting meds. It will remain unlocked until the CS
key is pressed or the CS drawer time-out period elapses.
Note: If the main cart time-out occurs and a narcotic drawer is ajar, a continuous alarm will sound until
the drawer is manually closed.
D. Battery Recharging:
1. Recharging Carts - When the warning red light on the top of the cart illuminates and/or a
“Low Battery” message displays, it indicates a low battery condition. Plug the cart’s electrical
cord into a standard AC outlet. Allow the battery to recharge for 10 to 12 hours. Avoid low
battery conditions by recharging carts routinely (once a week). Power Solution Carts - If the
cart is equipped with a LPS (rechargeable power supply for a computer), the cart’s
LockAlert system will recharge when the computer batteries recharge. The battery indicator
panel (shown at right) on the center top of the cart indicates the state of the LPS batteries.
Green lights indicate a Full to Medium charge condition. The amber Low light indicates that it
is time to recharge. The red Recharge light warns that shut down will occur. Press the
Refresh button for 5 to 10 more minutes of operation. The red Charging light illuminates
when the cart’s power plug is plugged into an AC outlet.
II. Cart Features & Accessories
A. Caster Brakes:
The iCart/pc is equipped with brakes on both front wheels. Disengage the brakes when pushing the cart.
Engage the brakes if the cart is parked for a long period of time or if hallway floors are sloped.
B. Removing & Exchanging Cassettes:
To minimize confusion when exchanging med cart cassettes, color-code the faceplates using colored labels.
For example: Cassettes that are to be replaced have red room number labels on the faceplates; the cassettes
to be exchanged have blue. Color-coding is helpful when cassette exchange is interrupted for some reason –
the person doing the exchange knows where to begin again.
1. To remove cassettes, the cart’s main lock must be disengaged. Open the center patient drawer in the
second row of patient drawers of the uppermost cassette. Lift up and pull forward.
2. Lift out the next cassette, etc.
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1. Replace cassettes in the reverse order, starting with the bottom-most. Be certain that cassette notches
are properly seated and cassettes are properly aligned.
2. After replacing all cassettes, relock the cart by turning the key (or, on keypad carts, by pressing the
Sign Out key).
C. Patient Confidentiality:
If required by HIPPA or similar regulatory agencies, optional clip-on nametag holders are available from
Lionville. The clip-on holder is used inside the patient drawer. It clips onto the front-most set of divider
channels and holds a patient nametag at a right angle to the bottom of the drawer. The patient name is visible
to the nurse as soon as the drawer is opened. The clear plate on each drawer front is used to identify the room
and drawer number. Contact Customer Service (ext. 256) for more information.
D. Cleaning Cart Tops:
1. Remove the optional clear top mat and swab the top with cleaning solution that is suitable for ABS
plastic or melamine counter surfaces. Suitable solutions should contain a low % of Isopropyl alcohol*.
Solutions with other alcohol com pounds including Amyl, Butyl, and Ethyl alcohol are rated as good to
excellent for cleaning ABS surfaces as are ammonia based cleaning compounds. Solutions containing
bleach (Sodium Hypochlorite) are suitable in concentrations of 20% or less and should not discolor
ABS surfaces although bleach based solutions may discolor fabrics (e.g. clothing) so care should be
exercised in their use.
* 70% Isopropyl alcohol solutions can be used to wipe the work space but this solution should not
be allowed to “pool” on the cart top. ABS plastic may become brittle when immersed repeatedly in
Isopropyl alcohol for extended time periods.
2. Wait until the top is thoroughly dry before replacing the top mat. The top mat can be cleaned with the
same solution used for the top.
3. To protect against permanent stains, periodically apply one or two coats of Armor-All to cart tops. This
should be repeated every three to four months.
E. General Cart Care:
1. Patient Drawers – Styrene patient drawers can be rinsed with warm soapy water. They can also be
cleaned in institutional dishwashers however we strongly recommend that one drawer be tested before
washing all drawers. Wash drawers on the dishwasher’s top level using a 180° cycle for one minute
then rinse at 220° for one minute (don’t exceed one minute at this temperature!). Dry at 180° for
another minute. If your test wash is not successful, try lower temperatures. If you damage any
drawers, contact customer service for replacements.
2. Cart Body – Never wash carts in pressure washers especially carts with electronics (keypads,
automatic relocking, halogen night lights). This will void your warranty. Clean the cart body with alcohol
or ammonia-based cleaners or over-the counter cleaning solutions (e.g. Windex, Lysol Spray,
Fantastic, etc.). Never use solvent-based cleaners on the carts because they can damage plastic
components.
3. Cart Locks – If lock cylinder keys are tight or difficult to remove, lubricate the cylinders with powdered
graphite or silicon spray.
4. Check Latchplate – To prevent cart locking problems, every two to three months, remove the bottommost storage drawer or cassette in each cart section to check for and remove meds and debris that
has fallen out of over-filled drawers. Remind nurses not to over-fill drawers.
If you have any questions about your cart(s), do not hesitate to contact a Customer Service Representative
(800-523-7114, ext. 256) weekdays between 8:00 AM and 4:30 PM (EST).
InterMetro Industries Corporation, North Washington Street, Wilkes-Barre, PA 18705
www.metro.com
Revised 1/25/06
Page 12 of 15
Policies & Procedures: Medication – Administration
I.D. # 1170
Medication Cart FAQ's
The following list is a guide to help you resolve issues related to the new medication carts
Click on links below for further instructions
Please note that Facilities & Engineering Services
does not resolve issues related to forgotten ID's or
PIN numbers, see your Nursing Manager to resolve.
The Problem
Operator PIN added to cart by mistake
Steps towards a Solution
•
•
•
Cart drawers will not open with keypad or
keys
•
•
•
Monday to Friday 7:30AM – 4:30PM call Facilities &
Engineering Services at 2535 or place a on-line
request. After hours call switchboard for shift
mechanic/Energy Center.
•
Obtain narcotics from another cart until the drawer is
repaired.
Note: Perform a narcotic count once the drawer is
functional.
Monday to Friday 7:30AM – 4:30PM call Facilities &
Engineering Services at 2535 or place a on-line
request. After hours call switchboard for shift
mechanic/Energy Center.
•
Narcotic (CS) drawer will not close/lock
•
•
•
•
Wardstock/patient drawers will not open
using keypad
Call on-site Pharmacy 7:30AM - 4:00PM, 7 days a week,
after hours have on-call Pharmacist paged to replace
patient specific medications.
Obtain narcotics/wardstock from another cart until the
cart is repaired.
Monday to Friday 7:30AM – 4:30PM call Facilities &
Engineering Services at 2535 or place a on-line
request. After hours call switchboard for shift
mechanic/Energy Center.
•
Burnt out light on the cart
Narcotic (CS) drawer will not open
Contact Charge Nurse for access to a alternate CART ID
or access to the cart key
Obtain narcotics from another cart until the problem has
been resolved.
Notify your Nursing Manager to correct.
•
•
Secure Narcotics
Call on-site Pharmacy 7:30AM – 4:00PM, 7 days a week
to have the narcotics picked up.
Obtain narcotics from another cart until the drawer is
repaired
Monday – Friday 7:30AM – 4:30PM call Facilities &
Engineering Services at 2535 or place a on-line
request. After hours call switchboard for shift
mechanic/Energy Center.
Contact Charge Nurse for access to the cart key
Monday – Friday 7:30AM – 4:30PM call Facilities &
Engineering Services at 2535 or place a on-line
request. After hours call switchboard for shift
mechanic/Energy Center.
Page 13 of 15
Policies & Procedures: Medication – Administration
I.D. # 1170
Wardstock/patient drawers will not
close/lock
•
•
Put cart in a secure area/location
Monday – Friday 7:30AM – 4:30PM call Facilities &
Engineering Services at 2535 or place a on-line
request. After hours call switchboard for shift
mechanic/Energy Center.
Display is non-functional
•
Push cart “Reset Button” (CART NEEDS TO BE
UNPLUGED FIRST), if problem not resolved then reset
cart fuse by removing it and then putting it back in. If
problem still not resolved then contact Charge Nurse for
access to the cart key
Obtain narcotics from another cart
Monday – Friday 7:30AM – 4:30PM call Facilities &
Engineering Services at 2535 or place a on-line
request. After hours call switchboard for shift
mechanic/Energy Center.
•
•
Display indicates “Call
Maintenance/Services"
•
PIN number put on cart by mistake
•
•
•
Contact Charge Nurse for access to the cart key
Obtain narcotics from another cart
Notify your Nursing Manager to correct.
Cannot remember my CS ID number
•
•
Have another nurse access the narcotics drawer
Notify your Nursing Manager to correct.
Cannot remember my CS PIN number
•
•
Have another nurse access the narcotics drawer
Notify your Nursing Manager to correct.
Battery will not hold a charge
•
•
•
Contact Charge Nurse for access to the cart key
Obtain narcotics from another cart
Monday – Friday 7:30AM – 4:30PM call Facilities &
Engineering Services at 2535 or place a on-line
request. After hours call switchboard for shift
mechanic/Energy Center.
Wheels will not turn
•
Monday – Friday 7:30AM – 4:30PM call Facilities &
Engineering Services at 2535 or place a on-line
request. After hours call switchboard for shift
mechanic/Energy Center.
Brakes do not work
•
Monday – Friday 7:30AM – 4:30PM call Facilities &
Engineering Services at 2535 or place a on-line
request. After hours call switchboard for shift
mechanic/Energy Center.
Cart constantly alarming
•
Push the “Reset Button” (CART NEEDS TO BE
UNPLUGED FIRST) on the cart. If still alarming then
reset the fuse by removing it and then putting it back in.
If cart is still alarming remove the fuse and do not
replace it.
Contact Charge Nurse for access to the cart key
Obtain narcotics from another cart
Monday – Friday 7:30AM – 4:30PM call Facilities &
Engineering Services at 2535 or place a on-line
request. After hours call switchboard for shift
mechanic/Energy Center.
•
•
•
•
•
Reset cart fuse, if problem not resolved contact Charge
Nurse for access to the cart key
Obtain narcotics from another cart
Monday – Friday 7:30AM – 4:30PM call Facilities &
Engineering Services at 2535 or place a on-line
request. After hours call switchboard for shift
mechanic/Energy Center.
Page 14 of 15
Policies & Procedures: Medication – Administration
I.D. # 1170
Appendix B
Pyxis® 4000 MedStation
Nurse superusers and endusers are expected to be familiar with MedStation procedures and
demonstrate competence in the following tasks

Log-in to the MedStation

Change your password

Register BioID

Change BioID

Select “My Patients” list

Remove one medication for one patient

Remove a medication for a patient not on your list

Skip a medication during the remove process

Return a narcotic medication (controlled substance, benzodiazepine)

Waste a narcotic medication (controlled substance, benzodiazepine)

Create, discover & resolve a narcotic count discrepancy

Return of unused medications

Remove a range dose medication

Accessing a medication using override

Add a temporary patient

Adding a temporary user

Recover a failed minidrawer or matrix

Recover a failed carousel

Recover a failed cubie

Access LexiComp feature

Exit from the MedStation

Changing a roll of paper

Cleaning the MedStation & BIO ID scanner

Alert icons

Troubleshooting

Using the Reports feature
Also refer to Pyxis® 4000 MedStation Training/User Manual or the Pyxis® 4000 MedStation Quick
Reference Guide
Page 15 of 15
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