Joint Commission's 2010 report targets medication preparation, storage, and security

Medication storage was one of the biggest problems that The Joint Commission found in hospitals in 2010, according to its new survey. During a webinar this week, sponsored by the Institute for Safe Medication Practices, Darryl Rich, PharmD, surveyor in the Joint Commission’s Division of Accreditation and Certification Operations, also described some new requirements in the Commission’s National Patient Safety Goals for 2011.

Its survey of noncompliance by hospitals in 2010 found that about one-third of facilities had problems with medication storage, Rich said. Unverified, ineligible, or incomplete orders caused 23% of noncompliance issues.

“The biggest issue in medication storage is medication security. Based on Medicare standards, CMS (the Centers for Medicare and Medicaid Standards) expects all drugs and biologics to be kept in a secure area and all scheduled drugs to be locked, even within a secure area,” Rich said. For example, medication carts are often left in a corridor with public access, outside observation by nurses. “We also occasionally see medications lying on counters and other areas,” Rich said.

The Joint Commission is also citing hospitals for not storing drugs according to the manufacturer’s recommendations. “If the manufacturer says the drug must be refrigerated, you really cannot store it outside the refrigerator, unless you get something in writing from the manufacturer,” Rich said. One example of the refrigeration requirement concerns lorazepam syringes.

Rich also clarified the Joint Commission’s views on safe preparation and administration of IV medications. “We do not care if there is a drug shortage. They [nurses and physicians] cannot reuse that single-use vial for multiple patients. They are also not allowed to store multidose vials in the patient room, operating room, or other immediate patient areas. There has been some cross-contamination between patients,” Rich said.

Pharmacists must also prepare all sterile admixtures (two or more drugs in the same container) besides diluents and IVs, according to the Joint Commission. “This is a big issue in chemotherapy clinics when nurses are making the … solution, even if a pharmacist is present on site,” Rich said.

In addition, pharmacists must review drugs used throughout the hospital, particularly in the radiology and nuclear medicine departments, for activities such as stress tests. “If a physician is not present during a cardiac stress test and the nurse is using a chemical stressor such as dopamine, then it does require pharmacist review,” Rich said.