Information

  • Document No.

  • Audit Title

  • White Oak EMS

  • Conducted on

  • Personnel

  • DRUG BOX #

TOP SHELF

  • Sodium Bicarbonate =1

  • Expiration Date

  • Narcan = 2

  • Expiration Date

  • Expiration Date

  • Dextrose =1

  • Expiration Date

  • Epi 1:10,000 = 1

  • Expiration Date

  • Atropine = 1

  • Expiration Date

  • Lidocaine = 1

  • Expiration Date

  • 1cc Syringe = 2

  • Expiration Date

  • Expiration Date

  • 3 cc Syringe = 2

  • Expiration Date

  • Expiration Date

  • 5 cc Syringe = 2

  • Expiration Date

  • Expiration Date

  • 10 cc Syringe = 2

  • Expiration Date

  • Expiration Date

SECOND SHELF

IV CATH's (2 Each)

  • 24 g

  • Expiration Date

  • Expiration Date

  • 22 g

  • Expiration Date

  • Expiration Date

  • 20 g

  • Expiration Date

  • Expiration Date

  • 18 g

  • Expiration Date

  • Expiration Date

  • 16 g

  • Expiration Date

  • Expiration Date

  • 14 g

  • Expiration Date

  • Expiration Date

  • NSS Syringe 3 cc = 2

  • Expiration Date

  • Expiration Date

  • Syringe Needles (2 each) 18 25 22<br>

  • Expiration Date = 18

  • Expiration Date =18

  • Expiration Date =25

  • Expiration Date = 25

  • Expiration Date = 22

  • Expiration Date = 22

  • Tourniquet = 2

  • Penlight = 1

  • MAD Device

  • Expiration Date

  • Razor = 1

  • Blood Tube, Purple =2

  • Expiration Date

  • Expiration Date

  • Blood Tube, Red = 2

  • Expiration Date

  • Expiration Date

  • Tape 1" & 1/2" (1 each)

  • Hep locks = 2

  • Expiration Date

  • Expiration Date

  • Blood tube - vac container = 2

  • Expiration Date

  • Expiration Date

  • Blood draw needles (needle less ) =2

THIRD SHELF

  • Amiodarone = 3

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Calcium = 2

  • Expiration Date

  • Expiration Date

  • Epi 1:1,000 = 5

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Glucagon = 1

  • Expiration Date

  • Zofran = 2

  • Expiration Date

  • Expiration Date

  • Benadryl = 2

  • Expiration Date

  • Expiration Date

  • Albuterol (box) = 3

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Albuterol (O2 green bag) = 5

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Ipratropium = 4

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Narcan = 2

  • Expiration Date

  • Expiration Date

  • Adenosine = 5

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Solumedrol = 2

  • Expiration Date

  • Expiration Date

  • Lasix = 5 (total 200mg)

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • NTG Pills = 1 bottle

  • Expiration Date

  • Mag Sulfate = 4

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Alcohol prep pads = 5

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Band aids = 5

  • Carpuject = 1

  • Tubex = 1

  • Filter needles = 2

  • Expiration Date

  • Expiration Date

  • Diltiazem 100mg / 0.9% ADD-Vantage NSS = 2

  • Expiration Date

  • Expiration Date

  • 60 drop = 1

  • Expiration Date

  • Enalaprilat = 2

  • Expiration Date

  • Expiration Date

  • Tetracaine Opthalmic = 1

  • Expiration Date

  • Nitro paste single use = 12

  • Expiration Date

  • Nitro paste papers = 12

  • Expiration Date

  • Verapamil = 2

  • Expiration Date

  • Expiration Date

BOTTOM OF BOX

  • Dopamine Drip (premix) 60 drop = 1

  • Expiration Date

  • Dobutamine / 60 drop = 1

  • Expiration Date

  • NSS 500cc = 1

  • Expiration Date

  • Lidocaine = 3

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Lidocaine Premix / 60 drop = 1

  • Expiration Date

  • Epi 1:10,000 = 3

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Atropine = 1

  • Expiration Date

  • IV Sets 10gtts = 2

  • Expiration Date

  • Expiration Date

  • Kling roll = 1

  • Expiration Date

  • IN Start Kits = 2

  • Expiration Date

  • Expiration Date

  • Nebulizer = 1

  • Expiration Date

  • IV extension sets = 2

  • Expiration Date

  • Expiration Date

  • Opsites = 5

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Dressings 4x4 = 5

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Dressings 2x2 = 5

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

  • Expiration Date

NARCOTICS

  • Valium

  • Lot #

  • Expiration Date

  • Control #

  • Valium

  • Lot #

  • Expiration Date

  • Control #

  • Versed

  • Lot #

  • Expiration Date

  • Control #

  • Versed

  • Lot #

  • Expiration Date

  • Control #

  • Morphine

  • Lot #

  • Expiration Date

  • Control #

  • Morphine

  • Lot #

  • Expiration Date

  • Control #

  • Fentanyl

  • Lot #

  • Expiration Date

  • Control #

  • Fentanyl

  • Lot #

  • Expiration Date

  • Control #

  • Drug box old seal #

  • Drug box new seal #

  • Narcotics old seal #

  • Narcotics new seal #

COMMENTS

EXPIRING DRUGS NEXT 2 MONTHS

  • Drug

  • Expiration Date

  • Drug

  • Expiration Date

  • Drug

  • Expiration Date

  • Drug

  • Expiration Date

  • Drug

  • Expiration Date

  • Drug

  • Expiration Date

  • Drug

  • Expiration Date

  • Drug

  • Expiration Date

  • Drug

  • Expiration Date

MEDIA (If needed)

  • Add media

CREW SIGNATURES

  • Add signature

  • Add signature

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