Do routine, non-controlled meds need to be behind double lock?

[cathyrn01]

Just wondering if anyone knows if there is a national standard on this issue, or does it vary by facility? Thanks!

[subee, MSN, CRNA]

Are we talking propofol?

[Meriwhen, ASN, BSN, MSN, RN]

We lock up some of our non-schedule meds because of their abuse potential.

[sunnycalifRN]

All of our meds are either in a locked med cart or in the Accudose machine. Are you from JCAHO?

[CNL2B]

I don't think they do. Some of our drugs are in the pyxis in the med room I (I guess, technically a double lock -- the med room door and then the Pyxis) and some are out unsecured in the med room, which we get away with because the med room is in a "controlled" traffic area -- behind our desk. We can't have meds in the room anymore because it isn't secure, but as long as there is ONE method of control, it's considered safe.

The big deal at my facility comes from an RN giving a "now" or "stat" medication with a verbal or telephone order. We have many drugs of all types stocked in the Pyxis that are all available on "override", so a nurse can just grab whatever she wants to and administer it. The problem originates from the pharmacy bypass in that situation -- technically according to our policy an order needs to be written, then approved by the pharmacist, and then given by the RN, in that order, for safety reasons. The "locking up" of the medications is less of an issue -- it is more of an issue that the appropriate policies need to be in place and followed to decrease the incidence of medication errors.

[NamasteNurse, BSN, RN]

we lock up lyrica...

[Not_A_Hat_Person, RN]

I've seen units lock up nicotine patches, Viagra, and Cialis. My old job locked up Lyrica and Tramadol because the pharmacy considered them controlled substances.

[Meriwhen, ASN, BSN, MSN, RN]

I've seen units lock up nicotine patches, Viagra, and Cialis. My old job locked up Lyrica and Tramadol because the pharmacy considered them controlled substances.

Lyrica is a controlled substance: Schedule V.

Tramadol may or may not be controlled depending on the state--in my state it is not. But in Kentucky, it's a Schedule IV. But because of the abuse potential, we lock it up.

[cathyrn01]

LOL, no I'm not from JCAHO. We are having a bit of a disagreement at my facility regarding locking up routine meds (not controlled meds). Our policy is under review and no one can agree if there is a common standard to follow. As of now, we are required to keep everything under double lock, even Lasix. I was just curious how it's done at other places.

[tewdles, RN]

When I worked in community health each health center had a "pharmacy" which was basically a large variety of non-controlled prescription medications. Our protocol called for the door to that room to be locked and accessed by appropriate staff only. It was double locked then after hours, etc.

In un-manned offices for hospice or home care the minimum requirement is double locking all medications...because there is no one to supervise them.

[Whispera, MSN, RN]

I've worked in 3 different hospitals, and all meds were supposed to be behind two locks at each place. One lock included the lock on the door to the room where the med cart rested if not being pushed around (that wasn't always locked) and the other was on the med cart. If the med cart was out in the hallway, it had to be double locked if the nurse wasn't right there with it.

There is a point to it, since someone might find the cart interesting, and rummage through it, take things, see who gets what, etc.

[kids]

I believe it's a combination of State & Federal regs.

In WA & OR sched II and III must be double locked, beyond that it's facility/pharmacy policy. Some facilities double lock the schedule IV and V but in my experience the facilities who do that have had a diversion problem in the past or have a lot of agency nurses.

In WA & OR aA locking med cart with a locking drawer that takes a different key satisfies the 2 locks rule as does a locked refrigerator in a locked med room.