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Saferating OceanView Demonstration Area

Pharmacy Department Medication Area Inspection Record

A form used to assure compliance with regulations as to safe and effective storage of medication in a patient care area.

 NOTE: Fields marked with "*" are required.
 

Location

Form will be emailed to Unit Manager

Nursing Unit*:

General Storage and Infection Control Criteria

Is area neat, clean, organized and secure?*:
Are injectable medications being used appropriately (single vs. mult use vials)?:
Are antiseptics and cleaning solutions properly labeled?*:
Are internal medications separated from products for external use?*:
Are all open vials properly initialed, dated and not used beyond the time specified in the policy and procedures?*:

USP Specific Storage Criteria

Are drugs properly stored (e.g., refrigerated or protected from light)?*:
Are light sensitive medications protected from light?*:
Are medications labeled with exp.date, control number, and appropriate warnings?*:
Are medications protected from contamination ( seperated from food or drink)?:
Are medications stored in most ready to administer dosage form available?*:

Medication Safety Criteria

Are there any concentrated electrolyte solutions available( KCl,KPhos,NaCl,Mag.Ca.):
Are neuromuscular blockers available?*:
If neuromuscular blockers are available are they labeled and stored to prevent miss use?:
Do look alike/sound alike medications have the appropriate warnings?:
Do Atrovent/Combivent inhalers have cautionary stickers?:
Are there adult strength medications in pediatric areas?:
Are there medications with preservatives in a pediatric location?:
Are medications segregated to minimize storage associated adverse events?:

Pharmaceutical Reference Material Criteria

Is there a current formulary available?*:
Is an antidote chart posted?*:
Is the Poison Control phone number posted on all phones?*:
Are conversion charts posted?*:

Outdated Medication Criteria

Are there any outdated medications present?*:
Please enter names of out dated medications:
Please enter names of out dated medications:

Sample Medication Criteria

If samples are authorized by policy are samples logged in according to policy?:
Are samples logged out at dispensing according to policy?:

Controlled Substance Criteria

Are controlled substances secured?*:
Are controlled substances counts accurate and documentation correct?*:
Did you perform a random count?*:
What medication did you count?:
What was the count ?:
Was random count correct?*:
Are wasted medications countersigned*:
Are all items counted every shift( NA if automation is used)?:

Refrigerator Criteria

Is refrigerator secured?*:
Is a temperature log maintained? (Temp within 36 and 46 F)*:
Is refrigerator clean and free of excess frost*:
Is there any food or drink in medication refrigerator?*:
Is refrigerator labeled NOT FOR THE STORAGE OF FLAMMABLE LIQUIDS?*:

Crash(Code) Cart Criteria

Are crash carts locked and in date with next expiring date posted?*:
Are crash cart lock number same as documented?*:
Is a contents list attached?*:
Are quality check sheets completed every shift by nursing?*:

Investigational Drug Criteria

Are investigational drugs stored according to protocol?:
Is the investigational drug protocol readily available to nursing staff?:

Form will be emailed to pharmacist in charge

Please Identify Staff Completing Form*:
       
     
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