SAFE AND SECURE HANDLING OF MEDICINES

Section 12:
Storage of medicines on the ward/department

12.1 In wards and departments the responsibility for the safe keeping of the medicines rests with the Nurse with continuing responsibility.

12.2
There shall be separate lockable ward storage as follows-

(a)

 Controlled Drugs Cabinet
(b) Internal Medicines Cupboard
(c) External Medicines Cupboard
(d) Refrigerator for medicines
(e) Freezer for medicines
(f) Medicine trolleys shall be lockable and immobilised when not in use
(g) Patient’s own medicines lockers, at the bedside if applicable.


Where computer controlled cabinets are used for medicines they should provide at least the same level of security as traditional, lockable cupboards.


Separate storage shall also be provided as follows –

(a) Cupboard for diagnostic reagents, including urine testing
(b) Area for intravenous fluids and sterile topical fluids
(c) Area for flammable fluids and gases

12.3
When there is use of Patient's Own Medicines or Self-Administration of Medicines by patients on the ward, each patient involved in this must have a lockable receptacle which is not readily portable.

Medicines intended for patients to take home on discharge will be a combination of the patients own medicines and those which have been obtained directly from the pharmacy on the authorisation of a doctor.  These shall be securely stored in a way which allows them to be readily identified and separated from ward stocks.

12.4


For clinical emergencies, e.g. cardiac arrest, all wards/departments must have access to a source of urgent supplementary medicinal products.  These must be clearly marked 'for emergency use' and held in tamper-evident containers at strategic and accessible sites. 

Nurses working in the community must ensure that they have up to date anaphylaxis packs for use in the case of an emergency.


12.5
The Registered Nurse/Midwife in Charge of a ward/department is responsible for controlling access to the medicine cupboards, patients own medicines lockers and trolley.  The responsibility remains with the Nurse with continuing responsibility even if he/she decides to delegate the duty.

The Registered Nurse/Midwife in Charge is responsible for ensuring that a duplicate set of keys for all medicines storage cupboards is stored in a secure designated location, approved by pharmacy.

12.6.1


Staff must be made aware of the possibility of the refrigerator failing to maintain cold conditions and the adverse effect that this could have on the stability of the medicines and the product licence.

The current minimum and maximum fridge temperatures must be checked at least once daily and recorded on a sheet with limits set at +2°C and +8°C.

CLICK HERE for the 'Wards and Departments Temperature Recording Log Book'.

The same applies to freezers used for medicines.

CLICK HERE for pharmacy freezer temperature log sheet.

If the temperature is outwith limits:

  1. Check the electrical supply to the fridge has not been accidentally switched off and ensure the door is properly closed.

  2. If the fridge/freezer has been switched off in error, switch it back on. Check and record the current, minimum and maximum temperatures after an hour.  Quarantine stock.  Do not use.  Contact Pharmacy to discuss action regarding medicines.

  3. If the door has been left open, close it and check and record the current, minimum and maximum temperatures after one hour.  Quarantine stock.  Do not use.  Contact Pharmacy to discuss action regarding medicines.

  4. A record of any actions taken must be made on the recording sheet. A signature is also required.

If the temperature is outwith limits (reason unknown):

  1. Check and record the current, minimum and maximum temperatures.

  2. Monitor and record the temperature after one hour.

  3. If the temperature remains outwith limits contact Estates Department regarding urgent fridge/freezer repair.

  4. Transfer stock to the nearest working medicine fridge/freezer.

  5. Quarantine stock. Do not use.

  6. Contact Pharmacy to discuss action regarding medicines.

  7. A record of all action taken must be made on the recording sheet. A signature is also required.

12.6.2

Room temperatures must also be monitored daily to ensure that medicines stored in stock cupboards, patient's medicine lockers and trolleys do not exceed the manufacturer's recommended storage temperatures (normally below 25°C).  The Pharmacist in charge must be contacted if there are any concerns about room storage temperatures.

CLICK HERE for ambient temperature log sheet.

12.7.1


Where changes to medicines storage are being considered (e.g. due to site refurbishment or new build), the Pharmacy Department should be consulted for advice at the planning stage.

Other sources of guidance on medicines storage are:
  - Medicines Storage on Hospital In-Patient Wards. CEL 28 (2013)
  - The Safe and Secure Handling of Medicines: A Team Approach, March 2005 (a revision of the Duthie Report [1988])
  - NHS Tayside Property Department
  - NHS Tayside Controlled Drugs Team

12.7.2


A storage risk assessment must always be carried out when planning new medicine storage facilities.

12.7.3
Cabinets used to store CDs must conform to the Misuse of Drugs Safe Custody Regulations 1973.  Cabinets must be constructed and maintained to prevent unauthorised access to the drugs.  During refurbishment or new build, it is recommended that metal cabinets are installed.

Additional security measures such as warning lamps or audible alarms are not required as standard equipment for CD Cabinets - but their use should be considered during a site risk assessment.

Cupboards used to store internal (non-CD) medicines should comply with CEL 28 (2013).  This effectively means that such cupboards will be:
  - metal
  - BS 2881 compliant

 
Any departure from these recommendations must be supported by the risk assessment.

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