POLICY All ADCs will be plugged into the C&W Emergency Power (RED) plugs. In the event that the main BC Hydro power is off, the cabinets should still run on the Emergency Power system (C&W back up generators). If both power sources are compromised, medications can be accessed from the ADCs by using the manual override keys. Hard copies of procedures, ADC inventory list, and medication log sheets will be kept on each C&W Nursing Unit. ADC keys will be stored in the following areas: BCWH: Operating Room, Labor and Delivery BCCH: Operating Room, Emergency Department, Pediatric Intensive Care Unit Sunny Hill Health Centre Main Pharmacy Narcotic Vault (contact pharmacy at 3282 from 0700-2400 HR or the on-call pharmacist from 2400-0700 HR) PROCEDURE ISSUE Power failure Communication error Blank screen Screen freezes Printer not printing NOTES AND ACTIONS Where possible, access medications from another ADC cabinet that is functioning. Notify your Clinical Nurse Coordinator/Leader/Charge Nurse. Contact Pharmacy and ask to speak to a supervisor during regular hours or call the pharmacist on-call from 2400-0700. If a system failure or complete power outage occurs, patient care areas will revert to emergency access procedures (see below). The ADCs have a back up battery that will function for approximately 20 minutes. If there is a temporary lapse in communication between the Server (Omnicentre) and ADCs, all transactions are stored and the necessary information is exchanged when the communications are re-established. If the Server fails or is taken off-line, the ADCs are not impacted since every ADC can store and queue all data until the Server is online again. Check power switch, it should be green. Check power plug at wall. Turn off power switch, wait a few seconds, turn back on. Check if paper is out. If paper jammed, remove and reinsert. Page 1 of 9
Cannot see medication on list Cannot see patient on local list Drawer is jammed Check alternate name(s), items are listed by generic name. Medication might not be stocked in ADC. Contact Pharmacy to determine how best to acquire medication. Medication might be in patient specific drawer. Refresh ADC display by logging off and back on. Check Global list, if there, can select. If not on Global List, add temp patient Discharged patients will remain on the Global list for 4 hours. If medication packaging is stuck, attempt to release. If unable to resolve call technical support. Never force anything open. TECHNICAL SUPPORT: 1 (800) 910-2220 NOTE: The online representative can ONLY resolve problems associated with ADC machinery or software. Contact Pharmacy for medication specific issues. 1. ACCESS BY ADC REPRESENTATIVE 1.1 Upon arrival onsite, the representative will report to the Pharmacy Department to obtain keys to the ADC. The visit is recorded in a log maintained by Pharmacy. 1.2 The representative will be escorted by Pharmacy staff and will be continually observed by Pharmacy or Nursing staff any time an ADC is open. 1.3 Upon arrival on the nursing unit, the representative will contact the Charge Nurse for information on the nature of the malfunction. 2. 2.1 When an ADC is inoperable (all problem resolution strategies have been tried), the manual lock override system will be used to unlock the unit during an emergency situation (see Appendix A). 2.2 The person unlocking the unit will be responsible for putting the Manual Sign Out Log (Appendix B) on the ADC so that items removed can be documented manually. 2.3 The Controlled Substance Administration Record form (Appendix C) will be used for documenting controlled substance transactions (i.e. addition or removal of controlled substances). A staff member may be assigned to stay at or near the automated medication cabinet to control access to narcotics and controlled drugs or narcotic and controlled drugs will be locked during down time. When the system is functional again, these transactions will be entered into the ADC system. Page 2 of 9
2.4 Upon restoration of the system, the person responsible for unlocking the unit will relock it and will conduct a witnessed inventory of all controlled substances, as well as take the manual sign out log to Pharmacy so that items can be recorded and charged. REFERENCES Institute for Safe Medication Practices (ISMP). Guidance on the Interdisciplinary Safe Use of Automated Dispensing Cabinets. 2008. Institute for Safe Medication Practices (ISMP). Medication Safety Self Assessment for Automated Dispensing Cabinets. 2009. LMPS Safe Automated Dispensing Cabinet Practice Guideline. August 2014. Omnicell Implementation Guide 67-3004 REV-G. 2015. Policy Master Equipment Cleaning List - BCCH Policy # E.01.1A Policy Cleaning of Non-Critical Medical Devices - BCCH Policy # E.01.1 Page 3 of 9
APPENDIX A A) Unlock the Fridge Flexlock: i. Locate the Omnicell keys labelled FR 1 (#2202) and FR 2 (#2232); these are stored in the locations listed in the first section of the policy ii. Corresponding locks are located on the side of the Omnicell Flex lock B) Unlock the Cabinet Door: i. Locate the key marked Door (#2333) ii. Insert the key into the lock located to the top right of the cabinet C) Unlock the Omnicell Drawers: i. Unlock the locking bar with the corresponding keys labeled #2232 and #2202 ii. Pull the locking bar to the RIGHT and lift to remove Page 4 of 9
iii. Pull the red release lever towards you (it extends 10-20 o from the vertical position) while pulling the drawer toward you (open one drawer at a time) D) Unlock the Locking Lid Drawers: i) Fully open a drawer and locate the red locking lever at the back Page 5 of 9
ii) Lift the red lever from its original horizontal position to a vertical upright position (pivot it 90 o ) iii) On the left side, under the grasp handle of the drawer, use your index finger to slide the release tab toward you iv) Along the bottom-left side of each locking lid drawer, slide the silver release tabs (resembles the pull tab of soda cans) towards the left for EACH row of locking bins v) When the tab is pulled out, you may access all bins for that row Page 6 of 9
vi) Repeat the steps above (under D. Unlock the Locking Lid Drawers) to access the bins for each locking lid drawer Page 7 of 9
APPENDIX B ADC Removed Non-Narcotic or Non-Controlled Medications Nursing Unit: Date: MEDICATION (name, strength, form) QTY PATIENT NAME RN SIGNATURE Page 8 of 9
APPENDIX C ADC Narcotic and Controlled Medications Nursing Unit: Page #: Date: MEDICATION (name, strength, form) QTY DOSE WASTED PATIENT NAME PHYSICIAN NAME RN SIGNATURE WITNESS Page 9 of 9