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Drugs and Equipment Standard

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Standards

Drugs - General

  1. Medical Directors must ensure the following practices are undertaken in the OHP:
    1. a general drug inventory record is maintained;
    2. periodic inspection of all drugs is undertaken to ensure drugs are not expired;
    3. single dose vials of drugs are used wherever possible;
    4. if multidose vials of drugs must be used, they are dated on opening, disposed of according to manufacturer’s guidelines, and are used in accordance with Public Health Ontario’s Updated Guidance on the Use of Multidose Vials;
    5. drugs are labelled in accordance with the Food and Drug Act1 and the Controlled Drugs and Substances Act2 and any regulations made under those statutes;
    6. drugs are stored securely and in accordance with the manufacturer’s recommendations (e.g., refrigeration if required); and
    7. emergency drugs are stored in a common location3.
  2. In the event of the closure of the OHP, the Medical Director must ensure that any drugs are disposed of safely and appropriately.

Controlled Substances

  1. Medical Directors must ensure that controlled substances are:
    1. handled, stored, and administered in accordance with Food and Drug Act and the Controlled Drugs and Substances Act and any regulations made under those statutes;
    2. accessed by a qualified designated staff member4;
    3. stored in a designated fixed and locked cabinet to prevent theft and loss; and
    4. accounted for in a “Log of Controlled Substances”.5
  2. Medical Directors must ensure that at the beginning and end of each day that controlled substances are used, a balance of the inventory is calculated by physical count and verified.
  3. In the event of a discrepancy, Medical Directors must ensure that an investigation is conducted and documented with the action

Equipment – General

  1. Medical Directors must ensure the following equipment is available in the OHP:
    1. cleaning equipment as required for the specific procedure,
    2. sterile supplies and instruments,
    3. accessible anesthetic drugs and equipment, as required for the specific procedure,
    4. monitoring equipment appropriate for continuous monitoring of vital signs, including but not limited to, heart rate, respiratory rate, blood pressure and oxygen saturation monitoring equipment,
    5. table/chair that permits patient restraints and Trendelenberg positioning, where applicable,
    6. table/chair/stretcher that accommodates procedures performed and provides for adequate range of movement for anesthetic procedures,
    7. suction equipment and backup suction, for anesthesia provider's exclusive use, where applicable.
  2. For Level 2 and 3 facilities, Medical Directors must ensure appropriate equipment is available for the procedures being performed, in accordance with the Canadian Anesthesiologists’ Society Guidelines to the Practice of Anesthesia6, including but not limited to:
    • Apparatus to measure blood pressure, either directly or noninvasively;
    • Electrocardiography;
    • Apparatus to measure temperature;
    • A difficult airway kit;
    • Neuromuscular blockade monitor when neuromuscular blocking drugs are used;
    • Capnography for general anesthesia and to assess the adequacy of ventilation for moderate or deep procedural sedation;
    • Agent-specific anesthetic gas monitor, when inhalational anesthetic agents are used;
    • A second supply of (full cylinder) oxygen capable of delivering a regulated flow; and
    • Monitoring, suction, oxygen, difficult airway equipment and other emergency equipment for airway management, resuscitation and life support are immediately available in the recovery area.
  3. For Level 3 facilities, Medical Directors must ensure an anesthetic machine and anesthetic cart with appropriate drugs7 and equipment is available.

Drugs and Equipment for Urgent or Emergency Situations

  1. Medical Directors must ensure that staff are prepared to address urgent or emergency situations or resuscitate a patient using appropriate equipment8 and drugs, when necessary.
  2. For Level 1, 2, and 3 facilities Medical Directors must ensure that, at minimum, the following drugs are immediately available:
    1. Oxygen
    2. H1 antihistamines (e.g., Diphenhydramine)
    3. Epinephrine for injection
    4. Bronchodilators (e.g., Salbutamol)
    5. Atropine
    6. Intravenous lipid emulsion (e.g. Intralipid) if using Lidocaine/Bupivacaine/Ropivacaine.
  3. For Level 2 and 3 facilities Medical Directors must ensure that appropriate equipment and drugs are immediately available to respond to the following situations, relevant to the procedures being performed at the OHP 9.
    1. Hypertension
    2. Hypotension
    3. Anaphylaxis
    4. Cardiac events, including those covered in the ACLS Algorithms
    5. Bleeding
    6. Respiratory Events
    7. Malignant Hyperthermia, if using triggering agents10
    8. Benzodiazepine excess or overdose
    9. Opioid excess or overdose
    10. Persistent neuromuscular blockade, if using nondepolarizing muscle relaxants
    11. Acidosis
    12. Relevant potential electrolyte disturbances
    13. Hyper and Hypoglycemia
    14. Emesis.
  4. If services are provided to infants and children, the Medical Director must ensure that required drugs and equipment are available and appropriate for that population.

Endnote

1. Food and Drug Act R.S.C., 1985, c. F-27, s. 1

2. Controlled Drugs and Substances Act (CDSA)S.C. 1996, c.19

3. A crash cart may be appropriate in OHPs where procedures are done in multiple procedure rooms.

4. For example, an RN, RPN with medication skills, or a physician.

5. For additional information on appropriate practices please see the Canadian Society of Hospital Pharmacist’s Controlled Drugs and Substances in Hospitals and Healthcare Facilities: Guidelines on Secure Management and Diversion Prevention.

6. Please see the Advice to the Profession document for more information on the equipment that would be typically required within an OHP.

7. Please see the Advice to the Profession document for more information on appropriate drugs.

8. Please see the Advice to the Profession document for more information on the equipment that would typically be required for urgent and emergency situations.

9. The drugs required will depend on the type of procedures and anesthesia used at the OHP. Please see the Advice document for more information on the drugs typically used to respond to the listed conditions. 

10. For more information see Malignant Hyperthermia Association of the United States’ What should be on an MH cart?