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How one PA pharmacy uses manual dispensing to control narcotics

Pharmacy Regulation Resource, August 11, 2004

Lehigh Valley (PA) Hospital saw a 30% reduction in narcotic discrepancies after opening a pharmacy last year in the OR suite, says pharmacy director Robert Begliomini, RPh, PharmD. The hospital also won honorable mention in the 2004 Institute for Safe Medication Practices Medication Safety Contest for conducting a Failure Modes and Effects Analysis on narcotic dispensing.

Controlling narcotics is a JCAHO requirement and vital to efforts to improve patient safety. The OR pharmacy allows pharmacists to check for expired medications in OR rooms while on rounds.

Lehigh Valley Hospital used to store its narcotics in the OR in automated dispensing cabinets, Begliomini says. Not only did nurses have to wait in line while others were getting narcotics from the machine, but the pharmacy could not generate accurate discrepancy and waste reports.

To solve that problem, the hospital put a pharmacy in the OR suite, Begliomini says. Anesthesiologists and certified registered nurse anesthetists (CRNA) go to the pharmacy each morning and sign out a box containing the medications they will need for the day.

Pharmacy technicians document every medication in the box, and CRNAs must fill out forms detailing how much of each narcotic they used during a procedure. Pharmacists then make sure that the CRNA report adds up correctly.

Pharmacists also check the forms in the box against the patient's record. For example, if the patient's record says Mr. Smith received 3 milliliters of the narcotic pain reliever fentanyl, the form in the box must verify it, Begliomini says.

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