CHAPTER 22

EMERGENCY MEDICATION KIT

22.2

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.

22.3

22.4

22.5

Sample NURSING CENTER

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

22.6

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

22.7

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

22.8

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.

22.9

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.

22.10

22.11

22.12

NURSING HOME

COMPANIES PROVIDING AUTOMATED CABINETS USED AS EMERGENCY KITS

MED-DISPENSE www.med-dispense.com

(877) 788-6855

OMNI CELL SOLUTIONS www.omnicell.com

(800) 850-6664

PYXIS www.cardinal.com/pyxis

(614) 757-5000

22.13

NURSING HOME

EXAMPLES OF AUTOMATED CABINETS

OMNI-CELL PRODUCTS

PYXIS MED DISPENSE

22.14

HOSPITAL

EMERGENCY DRUGS

1. Emergency Drugs Used in the Hospital

Crash carts

Resuscitation or medication trays

Various emergency kits or boxes

Eclampsia kit

Malignant hyperthermia cart

2. Standardize

Format – carts, trays or kits

Specific drugs used

Crash cart drugs directed by ACLS guidelines (last updated 2000)

May differ for adults and pediatrics

Location of drugs and supplies in the cart

Staff can quickly find what is needed

Education of staff on a continual basis

3. Emergency medications must be secure (TX 3.5.5)

Assure medications are available when needed

Prevent tampering

Options

Plastic break away lock or plastic wrap

No lock with regular inventory to assure contents are present

kept in a locked room

under constant surveillance

4. Plastic locks

Advantages of plastic locks

Expiration date placed on lock

When sealed lets staff know contents are complete and within their expiration date

Staff checks seal each shift and document

Once seal is broken – signifies contents removed or expired

Seal intact and within expiration date – do NOT need to check contents

Plastic locks MUST be controlled by the pharmacy

5. Documentation to show QA check

Filled by/checked by

Lot & expiration date

6. Common crash cart system in Hospital – exchange system with ready-to-go back-up carts

(May use different color seal when returning used cart)

22.15

SAMPLE CRASH CART USED IN THE HOSPITAL

SAMPLE POLICY: Emergency Medication and Crash Cart System

POLICY:

Emergency medications are consistently available, controlled, and secure in the pharmacy and patient care areas.

PROCEDURE:

A. Tamper Locks:

1. Pharmacy personnel shall NOT issue YELLOW tamper locks to any non-pharmacy personnel.

B. Crash Cart Exchange System:

1. Receiving and Dispensing Crash Carts:

a. The pharmacist or Pharmacy technician who receives the cart will verify that the medication sections are sealed

with a white zip-tie seal. If not, the pharmacy supervisor will be notified immediately.

b. Sterile Processing is responsible for cleaning and stocking the crash cart with supplies and respiratory equipment

before bringing it to the pharmacy. The pharmacy technician or pharmacist who receives the cart shall check the

medication drawers and trays for obvious contamination. If the cart or drug trays are

22.16

contaminated with blood or body fluids, pharmacy personnel shall not accept the cart. The cart must be

accompanied with the patient's name and account number. If these are absent, Sterile Processing must be

contacted, unless the cart is being returned because of expired medications. The new form shall be filed in the

Crash Cart notebook behind the corresponding crash cart divider number and the old form shall be removed.

Attach the slip with the patient's name and account number to the old form. The crash cart shall be sealed with a

YELLOW numbered plastic breakaway lock. The shortest expiration date for the entire cart will be indicated on

a tag on the lock. Refilling and sealing of the crash cart will be completed within 1 hour after delivery to

pharmacy.

c. The pharmacist or technician will transport the restocked and locked crash cart to Sterile Processing as soon as

possible.

2. Restocking the Crash Cart:

a. Before restocking the crash carts, the old form that had been filed in the crash cart notebook shall be used to

document and charge the medications that were used during the code. The technician shall inventory the

medication drawers and document on the old form the medications that were used or are missing. The old form

will then be forwarded to the technician responsible for charging. When charging is complete the technician

shall date, initial and write or stamp "Charged" on the form. The technician shall then file the old form in the

file cabinet according to the date.

b. In-patient crash cart medication drawers shall be restocked according to the form "Pharmaceutical Med/Surg,

Crash Cart Check List" (Appendices). Carts shall be restocked with medications that are to expire no sooner

than 6 months from date of restocking. If the medication drawers are soiled with dust or dirt, the technician

shall clean the drawers with a damp cloth and dry prior to restocking. When the drawers are restocked, the

earliest expiration date for each item will be recorded in the column marked "EXP. DATE" on the

"Pharmaceutical Check List" form. The earliest expiration date of all medications in the cart is then denoted

on the top of the form. All medication drawers shall be double-checked prior to dispensing. The pharmacist

or technician who has restocked the cart and the pharmacist who double checks the cart shall sign and date the

form in the spaces provided at the top of the form. The form is filed under the number of the cart.

C. Emergency Department (ED) Adult & Pediatric Resuscitation Trays:

1. Adult ED resuscitation trays consist of a single beige tray and pediatric ED Resuscitation trays consist of a single

blue tray. A supply of pre-stocked trays shall be kept in the pharmacy. Technicians shall exchange used

Resuscitation trays with restocked Resuscitation trays as needed on a daily basis. The used or opened tray must be

accompanied by the patient's name, account number and "ED Adult/Pediatric Resuscitation Checklist" form.

2. Drug trays that are contaminated with blood or body fluids shall not be handled or transported by pharmacy

personnel. In this case ED Nursing personnel shall be asked to discard contaminated drug and drug containers and

transport the contaminated drug tray to Sterile Processing for cleaning and sterilization. The rest of the medications

that are not contaminated shall be bagged with the checklist form for the tray, the patient's name and account

number, and retained by pharmacy for billing.

3. Before restocking the ED resuscitation trays, the old checklist form shall be used to document and charge the

medications that were used in the code. The technician shall inventory the medication tray, document on the old

form the medications that were used or are missing and deliver the completed checklist form to the charging area. If

ED personnel were not able to attach a patient's name to the resuscitation tray at the time the pharmacy technician

exchanged trays, then the charging technician shall charge the ED Department for any used or missing medications.

When charging is complete the charge technician shall date, initial and write or stamp "Charged" on the form. The

technician shall then file the old form in the file cabinet according to the date.

5. The liaison pharmacist is responsible for checking on a monthly basis the expiration dating of the resus trays and

replacing trays that are soon to expire.

the old form in the file cabinet according to the date.

ED RESUSCITATION TRAY PROCEDURES CHECK LIST (See Policy # Rx 01-006 for additional information)

22.17

A. EXCHANGE PROCEDURES 1. Used ED resus trays shall be exchanged by the technician making the 10:00 AM refill delivery.

2. The technician shall carry pre-stocked adult and pediatric resuscitation trays (located in the rolling shelves on shelf "L") with

him/her to exchange for used trays.

Select trays that have the shortest expiration dating but are at least 6 months from the date of restocking.

3. In the ED, check the medication trays for contamination of blood or body fluids. If the tray is contaminated, ask ED personnel

to discard contaminated drug and drug containers and transport the contaminated drug tray to Sterile Processing for cleaning and

sterilization. The remaining medications should be bagged together with the checklist form from the tray for billing.

4. Bring the tray back to pharmacy for restocking.

5. Before restocking the ED resus trays the technician shall:

a. Check the medication tray using the old checklist form.

b. Document on the old form the medications that were used or are missing.

c. Deliver the completed checklist form to the charge technician for charging to the patient.

1. If ED personnel were unable to attach a patient's name to the resus tray at the time of exchange, then the

charge technician shall charge the ED for any used or missing medications.

d. When charging is complete, the technician will date, initial and write or stamp "charged" on the form before filing the

form.

e. File the form in the "Crash Cart Notebook" behind the tab of the corresponding month.

B. RESTOCKING ED RESUSCITATION TRAYS

1. Before restocking resuscitation trays, check whether the trays are dusty or soiled. Clean with a damp cloth, if necessary.

2. Obtain a new ED checklist form from the file cabinet drawer in Central Pharmacy.

3. Restock the tray according to the checklist.

4. Replace any medications that will expire in less than six months with fresh medications.

5. Record the earliest expiration date for each item on the check list form in the column marked "EXP. DATE".

6. Ask a pharmacist to double check contents for accuracy.

7. The pharmacist or technician who has restocked the tray and the person who double checks the trays shall sign and date the

"Checklist form" in the spaces provided at the top of the form.

8. Place the form on top of the restocked tray and enclose the tray in a large plastic envelope found on the rolling shelves (shelf I-

13) and large sealed tamper-evident plastic bag.

9. Write the earliest expiration date on a sticker on the tray.

10. Place the sealed tray back on the rolling shelves.

A. Crash Cart Receiving/Restocking Procedures

1. Sterile Processing delivers crash cart to Central Pharmacy.

2. Before accepting the cart the pharmacist/technician shall:

22.18

A. Verify that the medication section is sealed with a white zip-tie seal. If not, the pharmacy supervisor will be

notified immediately.

B. Check the cart and medication trays for contamination of blood or body fluids.

C. Check the Crash Cart form accompanying the cart to assure that the cart has been restocked with all supplies

and equipment except medications. If the cart is contaminated or not restocked, do not accept the cart.

D. Check the patient's name for whom the cart was used. Ask Sterile Processing to furnish the name, if

missing. (Exception - cart was expired and not used on a patient).

4. Inventory the medication drawers and replace any medications that are not present. Medications must have a

minimum expiration date of 6 months.

5. Create a new “Pharmaceutical ICU/Ward Crash Cart Check List” form and indicate the expiration date for each

medication in the cart.

6. Have the cart double checked by a pharmacist.

7. Completely fill out the form as follows: the earliest expiration date, the name of the person dispensing the cart, the

name of the person checking the cart, and the date of dispensing. Place the completed form in the Ward/ICU Crash

Cart Notebook. It will be used later for inventorying and charging.

8. When restocking is complete, check that all drawers are completely closed, then, lock and seal the cart with a blue

plastic break-away lock (Clinical Center) or yellow numbered plastic breakaway lock (Pavilion). Attach a sticker to

the lock with the earliest expiration date of the cart written upon it.

10. Return the cart to Sterile Processing as soon as possible.

Crash Cart Charging Procedures

1. Obtain the old crash cart "Pharmaceutical ICU/Ward Crash Cart Check List" form from Crash Cart Notebook in the

cabinet in Central Pharmacy. Write or attach the patient's name, date and account number on the old form.

2. Inventory medication drawers denoting on the old check list form the items that are missing or have been used.

3. Forward the old check list form to the charging technician for charging.

Appendix A PHARMACEUTICAL MED/SURG CRASH CART CHECK LIST

EARLIEST EXPIRATION DATE:

STOCKED BY:

CART NO.:

RPH/ DATE DATE USED:

DATE STOCKED: CHECKED BY:

LOCATION:

GENERIC NAME

STRENGTH CHG. CODE EXP. DATE PAR QTY USED

DRAWER 1

Adenosine 6mg vial 6355 3

Amiodarone 150mg/3ml amp 2553 3

Bretylium 50mg/ml (10 ml PFS)

5342 4

Calcium Chloride 10% 1gm/10ml PFS 6435 2

Diphenhydramine 50mg/ml vial 5766 2

22.19

Epinephrine 1:1000 1mg/ml 30ml vial

5791 2

Epinephrine 1mg/ml 1ml amp 5778 2

Magnesium Sulfate 1g/2ml vial 5862 4

Naloxone 2mg/2ml amp 6955 2

Norephinephrine 4mg/4ml amp 5637 2

Phenytoin 250mg/5ml vial 5692 4

Procainamide 1g/10ml vial 5929 1

Sodium Bicarbonate 5mEq/10ml PFS (INFANT)

5420 2

Sodium Bicarbonate 10mEq/10ml PFS (PEDIATRIC)

5912 4

Sodium Chloride 0.9% 30ml vial (bacteriostatic)

6712 2

Vasopressin 20u/ml amp 5971 2

DRAWER 2

Atropine 1mg/10ml PFS 6791 4

Dextrose 50% 25gm/50ml PFS 5631 2

Dopamine 400mg/250ml bag 2082 2

Epinephrine 1:10,000 (0.1mg/ml) PFS

6727 8

Lidocaine 100mg/5ml PFS 5671 5

Lidocaine in D5W 2gm/500ml bag 5332 1

Sodium Bicarbonate 50mEq/50ml PFS (ADULT)

5695 4

Medication Labels -------------- --------- ----------- 3 ----

Emergency Drug Drip Card -------------- --------- ------------ 1 ----

White Zip-Tie Seal ------------- --------- ----------- 2

22.20

PHARMACEUTICAL ICU CRASH CART CHECK LIST

EARLIEST EXPIRATION DATE:

STOCKED BY: CART No:

RPH/ DATE DATE USED:

DATE STOCKED: CHECKED BY:

LOCATION:

GENERIC NAME

STRENGTH CHG CODE

EXP. DATE PA

R

QTY USED

TOP SHELF (#1)

Atropine 1mg/10ml PFS 6791 4

Epinephrine 1:10,000 (0.1mg/ml) PFS 6727 16

Lidocaine 100mg/5ml PFS 5671 5

Sodium Bicarbonate 50mEq/50ml PFS (ADULT)

5695 5

MEDICATION DRAWER (#2)

Adenosine 6mg vial 6355 3

Amiodarone 150mg/3ml amp 2553 3

Bretylium 500mg/10ml syringe 6422 4

Calcium Chloride 1g/10ml PFS 6435 4

Dextrose 50% 25gm/50ml PFS 5631 2

Diphenhydramine 50mg/lml vial 5766 2

Dobutamine 250mg/20ml inj 5412 4

Dopamine 400mg/250ml bag 2082 2

Epinephrine 1:1000 1mg/ml 30ml vial 5791 2

Epinephrine 1mg/ml 1ml amp 5778 2

Lidocaine 2g/500ml bag 5332 1

Magnesium Sulfate 1g/2ml 5862 4

Methylprednisolone 500mg vial 6559 4

Naloxone 2mg/2ml amp 6955 2

Norepinephrine 4mg/4ml amp 5637 4

Phenytoin 250mg/5ml amp 5692 4

Procainamide 1g/10ml vial 5929 2

Sodium Chloride 0.9% 30ml, Bacteriostatic 6031 2

Vasopressin 20u/ml amp 5971

2

Medication Labels ----------- ------ --- 4 ----

White Zip-Tie Seal ------------ ------ ---- 2

ADULT ER RESUSCITATION TRAY CHECKLIST

Patient Name: Stocked By: Earliest Expiration Date:

Date Stocked: Dispensed By:

Unit #: Checked By: Date Dispensed:

MEDICATION

EXP. DATE

PAR LEVEL

CHARGE CODE

QTY. USED

Adenosine 6mg/2ml vial 5 6355

Albuterol 3ml solution for neb 7 6094

Amiodarone 150mg/3ml amp 3 2553

Atropine Sulfate 1mg/10ml (PFS) 2 6791

Calcium chloride 10% 1g/ 10ml (PFS) 1 6435

Dextrose 50% 25gm/50ml (PFS) 2 5631

Dopamine 400mg/D5W 250ml 1 2082

Epinephrine 1:10,000 1mg/10 ml (PFS) 5 6727

Epinephrine 1:1,000 1mg/ml ,30ml vial 2 5791

Esmolol 100mg/10ml amp 2 5369

Lidocaine 100mg/5ml (PFS) 3 5671

Lidocaine 2g/D5W 500ml 1 5332

Magnesium Sulfate 1g/2ml inj 4 5862

Methylprednisolone 125mg inj 2 5613

Naloxone 2mg/2ml inj 5 6955

Norepinephrine 4mg/4ml) inj 2 5637

Procainamide 1000mg/10 ml vial 1 5929

Sodium bicarb. 8.4% (Adult) 50mEq/50ml (PFS) 2 5695

Vasopressin 20 units/ml vial 2 5971

22.21

PEDIATRIC ER RESUSCITATION TRAY CHECKLIST

Patient Name: Stocked By: Earliest Expiration Date:

Date Stocked: Dispensed By:

Unit #: Checked By: Date Dispensed:

MEDICATION

EXP. DATE

PAR LEVEL

CHARGE CODE

QTY. USED

Adenosine 6mg/2ml vial 3 6355

Albuterol 3ml solution for neb 7 6094

Atropine Sulfate 1mg/10ml (PFS) 2 6791

Bretylium Tosylate 500mg/10ml (PFS) 2 5342

Calcium chloride 10% 1gm/10ml (PFS) 1 6435

Dextrose 25% (10ml PFS) 2 5370

Dextrose 50% 25g/50ml (PFS) 2 5631

Diphenhydramine 50mg/ml inj 1 5766

Dopamine 400mg/D5W 250ml 1 2082

Epinephrine 1:10,000 (1mg/10ml PFS) 5 6727

Epinephrine 1:1000 (1mg/ml 30ml vial) 1 5791

Lidocaine 100mg/5ml (PFS) 3 5671

Lidocaine 2g/D5W 500ml) 1 5332

Mannitol 20% 250ml 1 5650

Methylprednisolone 125mg inj 1 5613

Naloxone 2mg/2ml amp 5 6955

Procainamide HCl 1000mg/10ml vial 1 5929

Racemic epinephrine (Vaponephrine) 15ml 1 6821

Sodium Bicarbonate 4.2% (Infant) 5meq/10ml (PFS) 2 5420

Sodium Bicarbonate 8.4% (Ped) 10mEq/10ml (PFS) 2 5912

Sodium Bicarb. 8.4% (Adult) 50mEq/50ml (PFS) 2 5695

22.22