Where can I find more information on how to appropriately store and handle controlled substances?

Additional information on appropriate practices relating to controlled substances can be found in the Canadian Society of Hospital Pharmacists’ document Controlled Drugs and Substances in Hospitals and Healthcare Facilities: Guidelines on Secure Management and Diversion Prevention.

The Drugs and Equipment Standard requires drugs to be immediately available to respond to a number of urgent and emergency situations — which specific drugs are recommended?

Medical Directors are responsible for ensuring that the OHP has the appropriate drugs needed to address the situations outlined in the Standard. This may be achieved in a number of ways but generally speaking the following drugs will support physicians in managing urgent and emergency situations:

Hypertension

• Antihypertensive IV such as Labetalol, Hydralazine or Nitroglycerine (at least 1 for circumstances where sedation or regional anesthesia is being administered, and at least 2 where general anesthesia is being administered)
• BETA Blocker IV such as Metoprolol, Propranolol, Esmolol
• Intravenous diuretic such as Furosemide

 Hypotension

• At least 2 of:
  • Epinephrine
  • Ephedrine
  • Vasopressin
  • Phenylephrine

 Anaphylaxis

• Diphenhydramine IV
• Hydrocortisone IV
• Epinephrine

Cardiac Events

• Epinephrine
• Amiodarone IV
• ASA
• IV agent for supraventricular tachycardia such as Adenosine, Esmolol, Verapamil, or Metoprolol (at least 2 for circumstances where sedation or regional anesthesia is being administered, and at least 3 where general anesthesia is being administered)
• Nitroglycerine spray
• Atropine IV
• Calcium IV
• Lidocaine 2% pre-filled syringe

Bleeding

• Tranexamic acid

Respiratory Events

• Bronchodilators

Malignant hyperthermia

• An adequate supply of Dantrolene, and other appropriate drugs as per MHAUS guidelines

Benzodiazepine Excess or Overdose

• Flumazenil IV

 Opioid Excess or Overdose

• Naloxone IV - if narcotics are stocked

Electrolyte Disturbances

• Magnesium Sulfate IV
• Calcium IV

Hypoglycemia

• Dextrose 50% IV

Other

• Neuromuscular blocking reversal agents
• Sodium bicarbonate IV
• Benzodiazepine IV such as Midazolam, Diazepam, or Lorazepam

What kind of equipment is appropriate to have immediately available for urgent or emergency situations?

Medical Directors are responsible for ensuring that the OHP has the appropriate equipment needed to address the relevant urgent or emergency situations outlined in the Standard. This may be achieved in a number of ways but generally speaking, depending on the types of procedures being performed and the level of the facility, the following equipment will support physicians in managing urgent and emergency situations:

• AED (Level 1 facilities) or cardiopulmonary resuscitation equipment with current ACLS/PALS - compatible defibrillator (Level 2 and 3 facilities)
• IV setup
• Difficult Airway Kit
• Adequate equipment to manage local anesthetic toxicity
• Appropriately sized equipment for infants and children, if required
• Assortment of disposable syringes, needles, and alcohol wipes
• Laryngeal mask airways
• Means of giving manual positive pressure ventilation (e.g., manual - self-inflating resuscitation device)
• Qualitative and quantitative means to verify end-tidal CO2
• ECG monitor
• Intubation tray with a variety of appropriately sized blades, endotracheal tubes, and oral airways
• Oxygen source
• Pulse oximeter
• Suction with rigid suction catheter
• Devices to provide active warming
• Torso backboard
• Cognitive Aids (for example, for difficult airways, ACLS algorithms, Malignant Hyperthermia, etc.)

The Physical Space Standard contains requirements around maintaining and inspecting equipment. Please see that Standard for more information.