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Storage of Drugs in Anaesthetic Rooms 1 Guidance on best practice from the RCoA and AAGBI The Royal College of Anaesthetists (RCoA) and Association of Anaesthetists of Great Britain and Ireland (AAGBI) recognise that secure drug storage makes an important contribution to patient safety, and the safety of the public, but patient safety must always be the priority. The RCoA and AAGBI support a system of standard operating procedures (SOPs) that makes patient safety paramount, and recognises that even short delays in accessing drugs may result in an adverse patient outcome. All drugs and medicines § need to be stored safely. The Royal Pharmaceutical Society (RPS) recognises that there are special requirements for the storage of drugs in operating theatre departments, and recommends that there should be a system of Standard Operating Procedures (SOPs) covering each of the activities concerned with medicines use to ensure the safety and security of medicines stored and used in operating departments. 1 A particular situation not mentioned in the RPS document is that anaesthetic rooms, which function as a form of ‘annexe’ to the main operating theatre, are usually a place in which drugs and fluids are stored. During the conduct of an anaesthetic and surgery the anaesthetic room may temporarily and intermittently be unoccupied when the patient is in theatre. Care Quality Commission (CQC) inspectors have in recent months identified a need for guidance as to whether the storage of drugs and fluids in unlocked cupboards in temporarily unoccupied anaesthetic rooms is acceptable. The Health and Social Care Act 2008 2 demands that patients and healthcare staff be protected ‘against the risks associated with the unsafe use and management of medicines by means of the making of appropriate arrangements for the obtaining, recording, handling, using, safe keeping, dispensing, safe administration and disposal of medicines’. There is clear guidance on the storage of Controlled Drugs such as morphine, cocaine, and fentanyl in this setting, 3 but there is currently no specific advice on best practice for the storage of non-controlled drugs and fluids in anaesthetic rooms. The Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) convened a working party to address this issue. This document is the report of the working party. Guidance 1 Patient safety must be the paramount consideration. Immediate access to a variety of drugs can sometimes be essential, such that even short delays in drug availability can make a difference to patient outcome. 2 It is not possible to provide a definitive list of ‘emergency drugs’ that should be immediately available at all times, as these vary depending on patient condition and the surgical procedures being performed. There are few drugs commonly stored in anaesthetic room drug cupboards that will not be needed urgently on occasion. 3 Local SOPs should exist for the safe storage of drugs (both controlled and non-controlled medicines) and fluids in operating theatre departments. These should be adequately risk-assessed and agreed by pharmacists, anaesthetists, nurses, operating department practitioners and ratified by the organisations medicines management committee. The Accountable Officer for medicines within the organisation should endorse these. 4 4 Decisions about drug security in anaesthetic rooms must reflect a balance between patient safety, staff protection and security. We understand that this may mean that in defined circumstances, drug cupboards (excluding those containing Controlled Drugs) may remain unlocked when the anaesthetic room is temporarily unoccupied and the operating theatre is in use. 5 Even if anaesthetic room drug cupboards cannot, in the interests of patient safety, be locked during surgical procedures, practices can be followed that may minimise medicines security risks, e.g. drugs and fluids prepared in advance for procedures can be kept in closed cupboards. 6 An unoccupied anaesthetic room should ideally remain visible at all times to those in the operating theatre, usually through windows in the door. 7 Anaesthetic room drug cupboards must be locked when the operating theatre is unoccupied. § For the purposes of this paper the terms drugs, medicines and fluids are used interchangeably. In this guidance, the term ‘drug cupboard’ includes all forms of drug and fluid storage, including refrigerators.
Storage of Drugs in Anaesthetic Rooms 2 Guidance on best practice from the RCoA and AAGBI 8 It is common practice to prepare a selection of ‘emergency drugs’ that should be immediately available during the course of an anaesthetic. These will often accompany the patient from the anaesthetic room into the operating theatre but, if this is not possible, they should be stored in the anaesthetic room in a manner that maintains their immediate availability. They should be adequately labelled, and disposed of appropriately if not used. 9 Certain rarely-used emergency drugs may be stored in a central location, serving the entire theatre suite, e.g. dantrolene and intralipid. Local SOPs should be compliant with relevant legislation and should ensure that the locations of these drugs are conspicuously signposted. 10 We support the use of effective access control systems for all routes that allow entry into operating departments, limiting access to only those with legitimate reasons for access. References 1 The safe and secure handling of medicines: a team approach. RPSGB, London 2005 (http://bit.ly/1R893Hc). 2 The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (http://bit.ly/1Zr5Lny). 3 Controlled Drugs (Supervision of management and use) Regulations 2013: Information about the Regulations. DH, London 2013 (http://bit.ly/1R88CNa). 4 Patient Safety Alert (NHS/PSA/D/2014/005). Stage Three: Directive: Improving medication error incident reporting and learning, 20 March 2014. MHRA and NHSE, London (http://bit.ly/1Zr6h4T). The RCoA and AAGBI would like to thank the following organisations for providing beneficial comment on this document: The Royal Pharmaceutical Society (RPS) The Association for Perioperative Practice (AfPP) The College of Operating Department Practitioners (CODP) The Association of Physicians’ Assistants (APA) The Care Quality Commission (CQC) Members of the Working Party Dr Richard Marks, Vice-President, Royal College of Anaesthetists (Chairman) Dr William Harrop-Griffiths, Council Member, Royal College of Anaesthetists Mr Mike Zeiderman, National Professional Advisor for Surgical Specialities, CQC Dr David Selwyn, Chair of Clinical Director Network Dr Kathleen Ferguson, Council Member AAGBI, Representative of SALG Ms Katharina Floss, Critical Care Pharmacist, John Radcliffe Hospital June 2016 Latest review date June 2019 © The Royal College of Anaesthetists (RCoA) and Association of Anaesthetists of Great Britain and Ireland (AAGBI) 2016 Churchill House, 35 Red Lion Square, London WC1R 4SG 020 7092 1500 standards@rcoa.ac.uk www.rcoa.ac.uk
Page 1: New Bookmark Drugs Table of Content
Page 4 and 5: MEMBERSHIP OF THE WORKING PARTY Dr
Page 6 and 7: SECTION I - SUMMARY AND RECOMMENDAT
Page 8 and 9: SECTION III - INTRODUCTION Patients
Page 10 and 11: purchase these services. They must
Page 12 and 13: SECTION VI - PREPARATION FOR THE TR
Page 14 and 15: A patient who remains hypotensive d
Page 16 and 17: A patient who has been made physiol
Page 18 and 19: 4. Other equipment • suction •
Page 20 and 21: important to involve those who take
Page 22 and 23: REFERENCES 1. Association of Anaest
Page 24 and 25: APPENDIX II TRANSFER CHECKLIST FOR
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Page 34 and 35: • Clean theatre clothing should b
Page 36 and 37: • Protective face shields must be
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Page 40 and 41: • Please read NJR Manual and Trai
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Page 46 and 47: Example of Environmental Theatre Cl
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• The deceased patient should be
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11 Leakages from the oral cavity, v
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• Mormonism o It is essential tha
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FAITH CONTACT ADDRESS TELEPHONE NO
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• The active electrode must alway
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Generic Theatre Standard No 11 - De
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Generic Theatre Standard No 13 - Ma
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• The labelled container must be
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• Staff Responsibility • All st
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• It is the responsibility of the
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6. Induction of anaesthesia • See
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4. Time Out - Before start of surgi
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• The registered anaesthetic prac
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• The Senior Surgeon/Operating Cl
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Generic Theatre Standard No 16 - St
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Generic Theatre Standard No 18 - Us
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3. Planned over-running sessions
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Generic Theatre Standard No 23 - Bo
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Generic Theatre Standard No 25 - Co
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Generic Theatre Standard No 27 - Ph
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Generic Theatre Standard No 29 - Vi
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Generic Theatre Standard No 31 - Th
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• Advice should be obtained from
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8. Harassment and Bullying • Dign
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Appendix 1. Governance Information
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Appendix 2. Initial Equality Impact
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