CHAPTER 22
EMERGENCY MEDICATION KIT
NURSING HOME
Emergency Drug Supply in the Nursing Home
I. Legal Requirements for an EDK (59A-4.112 Pharmacy Services)
The facility shall maintain an Emergency Medication Kit, the contents of which shall be determined in consultation with the Medical Director, Director of Nursing and Pharmacist, and it shall be in accordance with facility policies and procedures. The kit shall be readily available and shall be kept sealed. All items in the kit shall be properly labeled. The facility shall maintain an accurate log of receipt and disposition of each item in the Emergency Medication Kit. An inventory of the contents of the Emergency Medication Kit shall be attached to the outside of the kit. If the seal is broken, the kit must be resealed the next business day after use.
II. A Nursing Home MUST have an emergency medication kit(s)
III. The content list is approved by the Quality Assessment & Assurance Committee
The drugs will be selected by:
A. Medical Director
B. Director of Nursing
C. Consultant Pharmacist and or vendor Pharmacy
IV. Current standards of practice go beyond the requirements of 59A-4.112
A. The EDK should be stored in a secure area in appropriate temperature range
B. The EDK must be made to prevent undetectable entry (i.e. check hinges)
C. The box should be sealed with a numbered break-away lock issued by the pharmacy
D. The Pharmacy must record the date the EDK was checked, the lock number and the initials of the pharmacist sealing the kit
E. The kit should contain a 2nd color break-away lock to reseal the kit after an emergency is over
F. Whenever possible products should be in single unit of use form
G. All items shall be properly labeled
H. The EDK must contain a list of the contents (both brand & generic name), dosage,
quantity of each item and expiration date.
I. There must be a permanent log of receipt and disposition that will identify:
1. Name and amount of drug used
2. Date administered
3. Resident’s name
4. Physician’s name
5. Signature of person removing drug
J. Only one dose of the product may be removed during the emergency. Subsequent doses must be
treated as a new emergency.
V. The Consultant Pharmacist should check the contents list at least quarterly (monthly preferred)
VI. When the box has been used, the contents must be checked and items replaced no later than next working day.
VII. A list of the contents should be posted at each nursing station. This will assist nursing in identify drugs available in house during a telephone conversation with the prescriber.
EMERGENCY KIT LIST (Page 1 of 2)
PRIMARY EDK - A
DRUG & STRENGTH / GENERIC NAME / FORM / QUANTITY / EXPIRATION
Adrenalin 1mg/ml / Epinephrine HCL 1mg/ml / Injectable / 2 x 1ml
Amoxicillin 250mg / Amoxicillin 250mg / Capsules / 8
Ampicillin 250mg / Ampicillin 250mg / Capsules / 8
Antivert 12.5mg / Meclizine 12.5mg / Tablets / 10
Atarax 10mg / Hydroxyzine HCL 10mg / Tablets / 4
Atropine 1mg/ml / Atropine 1mg/ml / Injectable / 2 x 1ml
Atrovent unit dose 0.02% / Ipratropium Bromide / Nebulizer / 5
Augmentin 500mg / Amoxicillin/Clavulanate 500mg / Tablets / 3
Augmentin 875mg / Amoxicillin/Clavulanate 875mg / Tablets / 3
Bactrim DS / Septra or SMX-TMP DS / Tablets / 5
Benadryl 25mg / Diphenhydramine / Capsules / 5
Benadryl 50mg/ml / Diphenhydramine 50mg/ml / Injectable / 2 x 1ml
Biaxin 250mg / Clarithromycin 250mg / Tablets / 5
Catapres 0.1mg / Clonidine HCL / Tablets / 5
Ceftin 250mg / Cefuroxime / Tablets / 3
Cipro 250mg / Ciprofloxacin 250mg / Tablets / 10
Cleocin 150mg / Clindamycin 150mg / Capsules / 10
Cogentin 0.5mg / Benztropine 0.5mg / Tablets / 4
Cogentin 2mg/2ml / Benztropine 2mg/2ml / Injectable / 1 x 2ml
Coumadin 1mg / Warfarin Sodium / Tablets / 5
Coumadin 5mg / Warfarin Sodium / Tablets / 5
Decadron 4mg / Dexamethasone 4mg / Tablets / 5
Decadron 4mg/ml / Dexamethasone 4mg/ml / Injectable / 2 x 1ml
Depakote Sprinkles 125mg / Divalproex Sodium 125mg / Capsules / 5
Depo-Medrol 40mg/ml / MethylPrednisolone 40mg/ml / Injectable / 2 x 1ml
Dextrose 50% / Dextrose 50% Syringe / Injectable / 1 x 50ml
DiaBeta 2.5mg / Glyburide 2.5mg / Tablets / 5
Digoxin 0.25mg/ml / Digoxin 0.25mg/ml / Injectable / 2 x 1ml
Diflucan 100mg / Fluconazole / Tablets / 5
Dilantin 100mg / Phenytoin / Slow Release Capsules / 5
Dilantin 100mg/2ml / Phenytoin 100mg/2ml / Injectable / 2 x 2ml
Flagyl 250mg / Metronidazole 250mg / Tablets / 10
Garamycin 80mg/2ml / Gentamycin 80mg/2ml / Injectable / 3 x 2ml
Glucagon / Glucagon / Injectable / 2
Glucophage 500mg / Metformin 500mg / Tablets / 5
Heparin 5,000 units/ml / Heparin 5,000 units/ml / Injectable / 2 x 1ml
Imodium 2mg / Loperamide HCL 2mg / Capsules / 5
Insta-Glucose / Glucose Oral / Oral Gel / 2
Kayexylate / Sod Polystyrene Sulfonate / Oral Susp / 4 x 60ml
Keflex 250mg / Cephalexin 250mg / Capsules / 10
Lanoxin 0.125mg / Digoxin 0.125mg / Tablets / 4
Lasix 20mg / Furosemide 20mg / Tablets / 5
Lasix 10mg/ml / Furosemide 10mg/ml / Injectable / 5 x 2ml
Levaquin 250mg / Levofloxacin / Tablets / 10
Levsin Sublingual 0.125mg / Hyoscamine Sulfate S.L. 0.125mg / Tablets -Sublingual / 3
Lopressor 25mg / Metoprolol 25mg / Tablets / 5
Lovenox 40mg/0.4ml / Enoxaparin Sodium 40mg/0.4ml / Injectable Syringe / 2 x 0.4ml
Lovenox 60mg/0.6ml / Enoxaparin Sodium 40mg/0.6ml / Injectable Syringe / 2 x 0.6ml
Sample NURSING CENTER
EMERGENCY KIT LIST (Page 2 of 2)
DRUG & STRENGTH / GENERIC NAME / FORM / QUANTITY / EXPIRATION
Macrodantin 50mg / Nitrofurantoin Macrocrystals 50mg / Capsules / 5
Mephyton 5mg / Vitamin K 5mg / Tablets / 2
Micro-K 10meq / Potassium Chloride / Capsules / 5
Mucomyst 10% / Acetylcysteine 10% / Nebulizer Soln / 2 x 4ml
Narcan 0.4mg/ml / Naloxone 0.4mg/ml / Injectable / 2 x 1ml
Nebcin 80mg/2ml / Tobramycin 80mg/2ml / Injectable / 3 x 2ml
Neurontin 100mg / Gabapentin 100mg / Capsules / 10
Nitroglycerin Patch 0.2mg/hr / Nitroglycerin Patch 0.2mg/hr / Patch / 2
Nitroglycerin Patch 0.4mg/hr / Nitroglycerin Patch 0.4mg/hr / Patch / 2
Nitrostat 0.4mg (1/150gr) / Nitroglycerin Sublingual 0.4mg / Tablets - Sublingual / 1 x 25
Penicillin VK 250mg / Penicillin VK 250mg / Tablets / 10
Phenergan 25mg/ml / Promethazine HCL 25mg/ml / Injectable / 2 x 1ml
Prednisone 1mg / Prednisone 1mg / Tablets / 5
Prednisone 5mg / Prednisone 5mg / Tablets / 10
Prevacid Capsules 15mg / Lansoprazole Capsules 15mg / Capsules / 10
Prinivil 2.5mg / Lisinopril 2.5mg / Tablets / 5
Procardia 10mg / Nifedipine 10mg / Capsules / 5
Proventil Inhaler 90mcg / Albuterol Inhaler 90mcg / Inhaler / 1 x 17gm
Reglan 5mg / Metoclopramide HCL / Tablets / 5
Remeron SoluTab 15mg / Mirtazapine Solutab 15mg / Tablets / 5
Risperdal 0.5mg / Risperidone 0.5mg / Tablets / 3
Rocephin 1GM / Ceftriaxone Sodium 1gm / Injectable / 4
SoluMedrol 125mg / MethylPrednisolone 125mg / Injectable / 2
Tetracycline 250mg / Tetracycline 250mg / Capsules / 10
Theodur 200mg / Theophylline 200mg / Sustained Release Tablets / 5
Ultram 50mg / Tramadol 50mg / Tablets / 5
Ventolin unit dose 0.083% / Albuterol Sulfate Soln 0.083% / Nebulizer Soln / 5
Vibramycin 50mg / Doxycycline Hyclate 50mg / Capsules / 5
Vistaril 50mg/ml / Hydroxyzine / Injectable / 2 x 1ml
Vitamin K 10mg/ml / Aquamephyton / Injectable / 2 x 1ml
Water for Injection / Water for Injection / Injectable / 1 x 50ml
Xylocaine 1% / Lidocaine HCL 1% / Injectable / 2 x 5ml
Zaroxolyn 2.5mg / Metolazone / Tablets / 3
Zithromax 250mg / Azithromycin Dihydrate 250mg / Tablets / 10
Sample NURSING CENTER
CONTROLLED SUBSTANCES
EMERGENCY KIT - A
DRUG NAME / GENERIC NAME / QUANTITY / EXP DATE
Ambien Tablets 5mg / Zolpidem Tablet 5mg / 5
Ativan Tablets 0.5mg / Lorazepam Tablets 0.5mg / 5
Darvocet N 100 Tablets / Propoxyphene Nap W APAP 100mg/650mg / 10
Demerol 50mg/ml vials / Meperidine Inj 50mg/ml / 2
Dilaudid Tablets 2mg / Hydromorphone Tablets 2mg / 5
Duragesic Patch 25mcg / Fentanyl Patch 25mcg / 4
Lomotil Tablets 2.5mg / Diphenoxylate w Atropine Tablets 2.5mg / 5
Morphine 10mg/ml vial / Morphine 10mg/ml vial / 2
Oxycontin ER Tablets 10mg / Oxycodone E.R. Tablets 10mg / 10
OxyFast Oral Concentrate InveAmps 20mg/ml / Oxycodone Oral 20mg/ml / 3
Oxy IR Tablets 5mg / Oxycodone Tablets 5mg / 10
Percocet Tablets 5mg/325mg / Oxycodone w APAP Tablets 5mg/325mg / 10
Restoril Capsules 7.5mg / Temazepam Capsules 7.5mg / 5
Roxanol InveAmps 20mg/1ml / Morphine Soln 20mg/1ml / 5
Tylenol #3 Tablets 30mg/300mg / Acetaminophen w Codeine Tablets 30mg/300mg / 10
Valium Multi-dose vial 5mg/ml / Diazepam Injectable 5mg/ml / 1
Vicodin Tablets 5mg/500mg / Hydrocodone w APAP Tablets 5/500mg / 10
Xanax Tablets 0.25mg / Alprazolam Tablets 0.25mg / 10
Sample NURSING CENTER
REFRIGERATOR
EMERGENCY KIT
DRUG NAME / GENERIC NAME / QUANTITY / EXP DATE
Novolin R Insulin U-100 / Human Insulin Regular / 1
Novolin N Insulin U-100 / Human Insulin NPH / 1
Novolin 70/30 Insulin / Human Insulin NPH/Regular mix / 1
Humalog 75/25 Insulin / Insulin analog (Lispro) / 1
Novolog U100 Insulin / Insulin analog (Aspart) / 1
Lantus Insulin 100u/ml / Insulin Glargine / 1
Ativan 2mg/ml amps / Lorazepam Injectable / 4
Compazine Supp 25mg / Prochlorperazine Supp 25mg / 3
Phenergan Supp 25mg / Promethazine Supp 25mg / 2
NURSING HOME
SAMPLE POLICY & METHODS
Emergency Pharmacy Service
METHODS:
1. Telephone numbers for emergency pharmacy services are posted at the nursing station of each patient services wing.
2. If an emergency drug order is received, the charge nurse is to determine if the drug is in the emergency drug supply box. This is done by referring to the list of contents which is posted (1) by the telephone at the nursing station, or (2) on the emergency supply box itself.
3. If an emergency drug order is received which is not in the facility’s approved emergency drug supply, OR in an emergency where the staff needs to consult with a pharmacist, the facility’s staff may reach a pharmacist during the pharmacy’s scheduled business hours by calling 372-2575.
4. After the pharmacy’s regularly scheduled business hours, a pharmacist may be reached by dialing (See Appendix).
5. If a stat drug order is received during the pharmacy’s normal business hours, the nurse is to immediately order the medication from the pharmacy by dialing 372-2575. After hours, a pharmacist may be reached by dialing (See Appendix). When ordering the Medication, the nurse is to inform the pharmacist of the stat nature of the order.
6. When an emergency or stat order is received by the pharmacy, pharmacist receiving the order will determine if the pharmacy can make the delivery with in the time required. If not, the pharmacist will call another local pharmacy to make the delivery. However, the facility staff should always call the facility’s regular pharmacy. The facility has agreed not to call another local pharmacy directly for emergency medication orders.
7. No one is to stockpile or hoard drugs, nor are medications to be borrowed from one patient to meet the needs of another patient.
NURSING HOME
SAMPLE POLICY & METHODS
Emergency Box Procedures
To supplement normal pharmacy services a red emergency drug box is maintained in the west wing nurses station the contents are reviewed regularly, at least yearly by the Pharmacy Services Committee, and revised, if necessary. The consultant pharmacist inspects the box regularly, at least monthly, and orders replacements from the vendor pharmacist if any item is missing or out of date. The Director of Nursing is to be notified by the consultant pharmacist of any irregularity with the emergency box.
Once this emergency box is opened it cannot be closed without a key. Please do not try to force this box closed. The Director of Nursing is to be notified whenever the box is opened so it may be closed again.
All medications used from this box must have an order from the physician written on the chart. The vendor pharmacist must be notified by the nurse or if the pharmacy is closed, the oncoming nursing personnel must be requested to notify the pharmacy when they open that the emergency box was opened and what medication was used on what patient.
A Log Form will be kept in the box on which the nurse will record why the box was opened. The following information shall be recorded:
1. Date entered,
2. Drug removed,
3. Name of the patient,
4. Name of the ordering physician
5. Signature of the nurse.
6. If the box is opened as a part of an in-service, this should also be recorded.
When this Log Form is completely full it is to be returned to the Director of Nursing office for a new Log Form. The completed Log Form will be retained for a year.