2. Quick Tips  Close out all cases if narcotics administered, even if you give all the narcotic.  Make sure you have selected the correct patient in the Omnicell  Make sure that you have documented all controlled meds correctly in Epic  Make sure that what you enter on the waste screen in Omnicell = what is entered in Epic

3. Quick Tips  Don’t pass of narcotics when you are relieved for a case except drips or brief break  Don’t add temporary patients except for STAT cases, Log out of the system and let the data refresh

4. Omnicell Workflow Checklist  Select the correct patient  “Complete the case” for all cases involving narcotics  Review Epic to ensure that all administered meds are documented  Ensure that what you enter on the omnicell waste screen = what is entered in Epic  Draw up waste in labeled syringe to verify correct volume  Place bag with receipt and syringes in omnicell right side box  When technical problems occur, return waste to pharmacy window

5. PICK YOUR PATIENT  Pick your patient from either the Global list or the Local List. Use 2 types of identifiers to double check patient: patient’s name and MRN.

6. ADD TEMPORARY PATIENT  If you do not see the patient name in either list, then you may need to add a new patient (this should be needed VERY rarely mainly for STAT cases). Before adding a new patient, always verify that the patient is not in the Global List. Only enter real patients, CSN number is the patient ID number.

7. REMOVING MULTIPLE MEDICATIONS  You can begin the process of removing items from a patient’s record using the tabs at the bottom of the patient record. Scanning the barcodes on the vials is recommended. For Controlled Substances, you HAVE to select the medication from the list and wait for the drawer to unlock.

8. RETURNING MEDICATIONS Please ensure that unopened vials are returned back to the bins in the AWS before performing Post Case Reconciliation. Please do not waste unopened vials.

9. POST CASE RECONCILIATION FOR CONTROLLED SUBSTANCES ONLY. Enter total amount administered and AWS will calculate the waste. This has to be done for all cases.

10. DO NOT FORGET TO COMPLETE THE CASE Do not forget to complete the case. Please ensure that you have all waste ready to drop in the waste bin before you answer YES to this question since the bin only opens once for a few minutes. All Partial doses and vials must be returned to Pharmacy to verify. Please accompany the waste with the printed receipt.

11. Controlled Substance Discrepancy  Pharmacy will reconcile wastage placed in the return bin against what were documented in AWS (case complete)  Unresolved controlled substance discrepancy will be followed up with the anesthesia provider, carbon copy (cc) to Dr. Thomas Shaw  Anesthesia provider should check TCH email and provide timely response to CS discrepancy email

12. RETURNING/WASTING MEDICATION  Unopened vials have to be returned back into the cabinets (not in waste bin). Opened vials and syringes with medications need to be returned to the waste bin with the printed receipt.

13. DO NOT DO THIS

14. CAUSES OF DISCREPANCIES

15. PHARMACY EXPECTATIONS  Pharmacy will reconcile wastage  Pharmacy will contact user if there is an UNRESOLVED discrepancy  User’s responsibilities: respond to the email within 24 hours  All unresolved discrepancies will be reported to the CEO, per The Joint Commission Medication Management standard.

16. Communication Regarding Discrepancies  The pharmacy will communicate discrepancies to you and the service chief via TCH email. So it is essential that you check your TCH email daily.  You can check it quickly using the Microsoft outlook icon on any computer that you are logged into:

17. Personal Responsibility  Please be meticulous regarding controlled substances documentation and accountability.  The following screens will detailed the escalation of response when discrepancies occur.

18. After 1st discrepancy  The trainee will be required to re-read the Pharmacy Omnicell education packet  The trainee will be required to print a copy of the Omnicell workflow checklist and review at the end of all cases

19. After 2 nd discrepancy  The trainee will be required to re-read the Pharmacy Omnicell education packet  The trainee will pass a written test to verify comprehension process for handling controlled substances  The trainee will be required to keep a daily log of all patients to whom they administer narcotics and submit to Dr. Shaw’s mailbox daily before leaving the hospital

20. After 3 rd discrepancy  The trainee’s program director will be notified  AWS access will be discontinued until a reeducation meeting with Dr. Shaw, Dr. Tjia, and Pharmacy to assess the difficulty with compliance.