1. Medication Security
12/9/2010

2. Maintaining Med Closet Security

3. Med Closet Keys Each medication closet will have 3 keys: cottage key
back-up key kept in Health Services
back-up key kept by Residential Supervisor

4. Key Storage
Keys are kept on the responsible medication cleared staff at all times unless locked
When not held by the responsible medication cleared staff they are locked in the wall mounted locked box

5. Under No Circumstances:
May keys leave the cottage
May keys be left in a drawer
May keys be left unattended and unlocked
May additional keys to med closets or cabinets be made
May non-med cleared or authorized staff have access to the keys (includes med cleared staff who are not authorized to give meds in your cottage)

6. What if keys are lost or locked in med closet by accident ?
If a nurse from Health Services or your Residential Supervisor is on campus they can help you access the med closet
If none of the above are present, call the AEC; they will be able to access back-up keys

7. Missing Keys Immediately contact:
Either the Director of Health Services or the Nurse On-Call
And
Your Residential Supervisor

8. Lock Box Codes Can only be changed by: Director of Health Services
Program Nurse
Residential Supervisor
Under no circumstances:
May the codes be shared with anyone who is not authorized to give meds in your cottage
May the codes be left in a place where unauthorized staff would have access to the codes

9. Countable Controlled Medications

10. Common Examples of Countable Controlled Meds
Ativan (lorazepam)
Valium (diazepam)
Diastat (rectal diazepam)
Klonopin (clonazepam)
Xanax (alprazolam)
Ritalin (methylphenidate)
Focalin (demethylphenidate)
Concerta (methylphenidate sustained release)
Phenobarbital
And more, ask your program nurse if unsure

11. Special Requirements Stored under a double lock
Two Person Counts done every 24 hours
One Person Counts are done on shifts without 2 Person counts
Counted every time it is poured
Certain countable meds are stored in Health Services, such as PRN meds for dental/medical appointments

12. Why do 2 Person counts ?
Quickly identifies if there is a possible drug loss or diversion.
Doing it consistently and correctly is for your protection.
It is required by the Department of Public Health

13. Two Person Counts Done by 2 med cleared staff, 2 nurses or 1 of each
Done together
Together match the count of the medication with the number listed in the Countable Controlled Substance Book
Together verify the count and sign the Book
Must be done at least once every 24 hours

14. One Person Counts
Count is done and updated every time the medication is poured
Done on the shifts without a 2 person count
Done daily for Diastat

15. What to do if the count is not correct ?
Re-count with a second med cleared staff or nurse, Check back of blister packs
Look for obvious and correctable reasons such as the count was not updated the last time it was given
Immediately contact the Director of Health Services or Nurse On-Call and Residential Supervisor

16. New Countable Meds and Refills
Checked immediately upon arrival in Health Services or Cottage
Two person count done as soon as possible (no later than end of shift)
If delivered to Health Services 2 Person count includes a nurse and med cleared staff
New countable meds delivered to cottage: call Nurse On-call and 2 med cleared staff do 2 Person count
Refills of countable meds delivered to the cottage: notify program nurse so a nurse is included in a 2 Person count on the next working day for Health Services

17. Sending Countable Meds Home for Weekends or Recess
2 Person count is done the day the student leaves for the weekend or break
2 Person count is done the day the student returns
Adjust the count to 0 when the countable med supply is sent home and re-enter count upon return
2 Person count is suspended until student returns with countable meds
If necessary ask a med cleared staff from another cottage or nurse to assist with the 2 Person count

18. Countable “Seizure Rescue Medications”
Includes but not limited to Diastat, Klonopin, Ativan
Meds kept present with student at all times
Protocols must accompany medications
Diastat: 1 Person count done daily by CRL/ACRL and documented in Countable Controlled Substance Book
Klonopin, Ativan or other countable oral/g-tube meds: 2 Person count at least once daily

19. Non-Countable “Rescue Medications”
Such as asthma inhalers, Epi-pens, Glucagon, steroid stress meds
Meds kept present with students at all times
Must be checked by CRL/ACRL daily
Protocols must be accompany medications
Do not require a 2 Person count

20. Countable Controlled Substance Book

21. Legal Document No white out Blue or black pen only
No cross outs except simple line with word error and your initials
No post-its, paperclips or rubber bands to mark pages
Never skip pages
Never remove pages
Return to program nurse for storage when completed

22. Index Pages All new medications must be added
Update page numbers as medications are transferred from page to page
Use it each time you do a 1 Person or 2 Person count
Your reference to be sure no countable medications are missing

24. Medication Pages One page per student’s medication
Only one medication per page
When the page is full, transfer the medication to next empty page

28. Verification Pages Signatures verify that all counts are correct
Signed after 2 Person counts completed
Signed after all 1 Person counts are completed

31. Diastat Verification
Indicate the amount of Diastat present on the student’s Diastat medication page in the Countable Controlled Substance Medication Book each time the daily Diastat checks are completed

33. Other Safety and Security Procedures

34. Staff personal medications must be kept is a secure place, not in a purse sitting on a chair
Contact the Director of Health Services, Program Nurse or Nurse On-Call any time there is a question, concern or something is unclear or out of the ordinary
Immediately report all discrepancies or errors, remember the person who may be harmed if not taken care of is the student

35. Thank you for your diligence and thoroughness in medication administration !!