opened multidose vials- when to discard??

I am an RN JCAHO Coordinator. Joint Commission doesn't tell us how many days any mdv can hang around opened. It tells us to use safe, best practice. My common sense tells me this would include manufacturer's instructions. Therefore, #1. I would discard any medication after the expiration date whether it is open or not;#2. I would date, maybe time and certainly initial any mvd I opened; #3. I would follow my hospital's policy as long it was the safest best practice possible and if it isn't I would see that that policy got changed.

You need to remember, JCAHO doesn't go around regulating how long each mdv of any given med can be used after opening. It tells us to do the right things right. Someone here (above) said "gee I can't tell if something is contaminated or not". Well, that's why we have Policies & Procedures, manufacturer's recommendations, the CDCP, because no one can "tell" if a solution is contaminated.

Where does JCAHO say that?

The policy here is to discard after 3 months from date of opening multidose vials. That is the JCAHO standard.

http://www.ismp.org/MSAarticles/Multidose.html

You need to stop always doing what you're told and find out what the right thing to do is!

I have always been told that the manufacturers exp date was for sealed unopened vials.

All multi-dose vials are marked when opened, usually insulin and such have a 30 day expiration date from date opened, but they never lasted that long on any unit I worked. If there is a change in color, nature, or if nurse feels vial was unsafe they were tossed. I have seen a multi-dose insulin vial be used up in one morning when the floor had several diabetics on large doses of insulin. Normal saline was never used again once it was opened, we all had a stash in our pocket, used what was needed and discarded the rest, usually there was just too little left in vial to worry about.

The story about the helpful nurse reminds me of one I worked with, she was caught after she forgot and left a vial and syringe at the bedside of a patient, it was the wrong med and she was too stoned to notice what she had done. She had been reported several times by different staff to the HN but no action was taken until this happened. I know this lady had a son who was an attorney, so I guess we really had him to thank for getting rid of our problem. Most, if not all, of the nurses I worked with were very careful to have another nurse actually watch, check, recheck and then sign for discarded medication. Double checking of insulin is normal and regular here. I only had one nurse refuse to check me, she was later fired for inapproiate medication compliance.

While I was taught the manufactors expiration date was the usual guideline to follow, any time a drug looked tampered with, we were to send it back for more detailed testing. I always had a good relationship with the pharmacists I worked with, they were always willing to check and answer any questions I had regarding medications.