Ambulatory Surgery Center Pharmacy consult

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Medication Storage

• Medication storage areas are clean, neat, and well organized.

  Yes

  No

  N/A

• External use medications are stored separately from internal use medications.

  Yes

  No

  N/A

• No food products or lab specimens are stored near drugs.

  Yes

  No

  N/A

• Narcotics are in a secure storage area.

  Yes

  No

  N/A

• Narcotic cabinet is double locked.

  Yes

  No

  N/A

• Crash cart is locked.

  Yes

  No

  N/A

• Crash cart locks are stored in a locked cabinet.

  Yes

  No

  N/A

• Refrigerated Medications are stored in a refrigerator at 36 - 46 degrees F.

  Yes

  No

  N/A

• Medication refrigerator is used for medications only.

  Yes

  No

  N/A

• Medications are secured appropriately during and outside of hours of operation.

  Yes

  No

  N/A

• There are no outdated medications.

  Yes

  No

  N/A

• Anesthesia carts are locked when not in use.

  Yes

  No

  N/A

• Medication waste is disposed of according to policy.

  Yes

  No

  N/A

• No pre-drawn doses of medication or pre-drawn syringes are present.

  Yes

  No

  N/A

Medication labeling

• All medications are labeled properly, preferably in the original manufacturer's package.

  Yes

  No

  N/A

• Opened multidose vials are labeled with the date the vial will expire (28 days after first use).

  Yes

  No

  N/A

Prescriptions

• Tamper proof prescription pads are used.

  Yes

  No

  N/A

• Prescription pads are stored in locked cabinets away from patient access.

  Yes

  No

  N/A

• Pre-signed and/or post dated prescription pads are not used.

  Yes

  No

  N/A

Documentation

• Refrigerator temperature log is complete and up to date.

  Yes

  No

  N/A

• Daily narcotic counts and balances agree.

  Yes

  No

  N/A

• Narcotic counts are done at the beginning and end of the shift.

  Yes

  No

  N/A

• Narcotic counts have 2 licensed nurse signatures, including waste of controlled medications.

  Yes

  No

  N/A

• Medication review is done in Admitting.

  Yes

  No

  N/A

• Medication reconciliation is done in DWA.

  Yes

  No

  N/A

• A file of recalled medications is maintained.

  Yes

  No

  N/A

• Adverse drug reactions are recorded on an Incident form and reviewed by the pharmacy consultant.

  Yes

  No

  N/A

• An Incident Report is completed in the event of a medication error, and reviewed by the pharmacy consultant.

  Yes

  No

  N/A

Miscellaneous

• Current drug references are available to staff e.g. Nurse Drug Reference, online drug reference.

  Yes

  No

  N/A

• DEA permits are available and current.

  Yes

  No

  N/A

Actions

• Discussion/recommendations:

• Manager is emailed the monthly report, include name

  Yes

  No

  N/A

• Audit done by:

  Sign

• Pharmacist review

  Sign