Ward inspection - How to

INSPECTION OF WARDS WITH REFERENCE TO DRUG STORAGE

In every hospital there are a number of wards and with every ward there is a satellite pharmacy in which medicines are stored for usage. Being pharmacist it is our duty to inspect wards and satellite pharmacies regarding safe use of medication and their storage. It is also necessary to ensure that all medication in wards and satellite pharmacies are neat, clean and well organized and free of all expired or deteriorated medications.


Importance of Inspection:

The main importance of this inspection is to ensure that medications are stored and administered in a proper way otherwise they are deteriorated and can ultimately cause toxic or undesirable effects in patient. Proper storage ensures safety and stability of the medicine.


Role of Pharmacist:

The director of pharmacy will maintain a list of all the wards throughout the hospital. A pharmacist will inspect the ward and document  it in  ‘WARD INSPECTION FORM’. The pharmacist shall be responsible for ensuring that the storage and usage of medications are proper.


Inspection of Satellite Pharmacy:

The following parameters should be checked while doing an inspection:
  • All medicines are placed in order (Alphabetical or code no. sequence)
  • Medicines are separated from disposable
  • Medicines are stored in shelves or racks (not in stocked form)
  • Drug storage area is neat and cleaned by proper disinfectant
  • Bin cards are displayed and update
  • Proper environment control(proper temperature, light, humidity, ventilation, sanitation)
  • Cold storage area is provided
  • Temperature of the room is maintained i.e. 25oC
  • Temperature of refrigerator is checked regularly
  • Controlled substances are stored separately in locks
  • Medicines are protected from sun light and dust
  • Arrangements for rodents and insects is provided
  • Access to storage area is restricted or not
  • Externals should be separated from internals.

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REFRIGERATORS:

  • Refrigerators containing medications must be checked physically to ensure that
  • They have a working thermometer with the alarm switch set to ‘ON’ position. The
  • refrigerator temperature should be between 2-8oC.
  • No foods, beverages, or culture media are to be stored with medications.
  • All refrigerated medications should be checked manually.
  • Also ensure that refrigerator is free from
    • Expired medication
    • Any open single-dose or multiple dose medicine
    • Any unlabeled medicine


Inspection of Wards:

DRUG REMOVAL FROM PACKAGING:
Remove all the medication (Tab.,Cap.,Injectibles) from its packing just prior to use otherwise it will be contaminated.


DRUG ADMINISTRATION:

During inspection a pharmacist should check that whether the dosage form being administered has appropriate route, dosing frequency and dose (no under or over dosing) Administer drug to one patient at a time.

It is also necessary to check that the drug to be administered is not expired or deteriorated.
For I/V medicines ,ensure that the syringe should be free from air bubble prior to administration as air bubble can cause thrombosis.


ASEPTIC APPROACH:

Pharmacist should check the aseptic approach during handling and administration of medication. The area should be made aseptic by spirit, isopropyl alcohol, or with any disinfectant. I/V medications, solid dosage forms and liquid preparations should be placed separately in trays.
Injectibles:

Pharmacist should check that either I/V injections are being injected under aseptic conditions. The appropriate way is to clean the site of injection with spirit by cotton swab and do not palpate after cleaning the site. Also check that I/V Injections are Injected at the appropriate rate and at appropriate time. 


VIALS & AMPOULES:

Pharmacist should check that Vials and Ampoules have proper labels. If ampoule is open then discard it and if aluminum sealing of vial is open then do not use it. Check that vials and injections are stored at given storage conditions and are protected from sunlight and heat.


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RECONSTITUTED AND NON-RECONSTITUTED:

During bed to bed checking, inspect that reconstituted and non-reconstituted medicines are placed separately. Check the expiry and storage conditions of each medicine. Also ensure that for reconstituted drugs Water for injection (WFI) is available and wrong practice of reconstitution with boiled tap water is not being carried out. Check the physical stability of reconstituted drug by examining the color, or by the presence of precipitation or crystal growth in the formulation. As reconstituted medicines have short expiry so they are used immediately with in specified period.


DISPOSABLES:

Syringes and other disposables should be in packed conditions. Unpacked syringes and disposable should not be used. Unwrap them just prior to use. Check that filled syringes are properly labeled if recommended to be placed. Check that burettes are labeled properly .Catheters, I/V cannulas are properly connected to I/V line, and burettes are properly attached to injection bottle.


Disposal

Medicines:

Pharmacist should check that empty packs or strips of tablets or capsules are not present on stand of patient bed. Throw these packs or strips in yellow bags. Disposal of cytotoxic medicines should be strictly carried out because these are toxic for human cells. They are placed in specialized cytotoxic bags and are properly tied by tape  after completely filled and are also labeled and then disposed off. Stool of patient receiving cytotoxic drugs are also disposed of properly as they are also harmful.


Disposibles:

After injection, syringes and needles should be cut or crushed by cutter and   disposed off in sharp containers. Ampoules, Vials, surgical blades, I/V cannulas, should be disposed off in sharp container immediately after use.
  • Check that all the Administration sets, Burettes are disposed off immediately after use.
  • Check that sharp containers are properly tied after completely filling and placed in separate area.
  • After observing all the above parameters record them in inspection form to promote rational use of drug, Sign it and forward this inspection form to Director of Pharmacy.

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