Expired Drugs Found on Ambulance

[Lone Star]

When I was on the road (and when I'm on the road again); everything was checked/counted, and I made sure that we had at least the state mandated minimums.

There were some that called me 'anal' about it, but I got no problem 'downing a truck' until such point that it's ready to be out on the road.

As for drugs, if one does their job properly (and this includes checking your drugs for damage/expiration dates, etc) there should be no reason that you find the 'surprises' like being out of a drug or it being out of date.

Another thing that I would do is try to keep a running 'inventory' of what was used on each call, so if we had a chance to get to supplies, those used items could be restocked.

[DwayneEMTP]

Only at the very last place I worked street EMS did we ever use cabinet tags. It's a great idea in theory. But like CrapMagnet, everything is still getting checked, if it's not my initials on the current tag. I've seen the system fail one too many times.

I work the night shift and we trade off our truck with the same day shift every rotation so I think it's probably different than it might be at a larger service. We all get together when the day shift comes on on Sunday morn and go through everything and tag it. After that I'm confident that they feel the same responsibility that I do to make sure that they don't end up on a hinky call without something necessary.

It's not sanctions that cause me to check the truck, it's the thought of having the other crew coming to me and saying, "We trusted you to look out for us by doing a simple job well but we got our assess handed to us on that MCI. What happened?" Yeah, I can accept that I may lose pts to an error, but have nightmares thinking that my team mates can't trust me to do a job a child could manage without significant issues.

I seem to be weird in today's EMS in that other than the suction and monitor, I don't really care what's in the cabinets. I work out of my bag always. Most pts I try and improve before moving if they're hinky, and if not I remove them to the truck and still work out of my bag. It seems most like to work out of the 'office', but I learned the other way and really like having my finite number of critical things at my fingertips. I just restock out of the cabinets...Yeah, probably stupid, but that's just how my little practice works.

I absolutely agree that tagging is not an aswer, but it does create some accountability. I would rather see those that need significant oversight moved down the road and replaced with the many that don't.

But that's not a popular management strategy these days...

Dwayne

[FireMedic65]

Before start of every shift, we do an equipment check. This includes checking to see if there are enough gauze pads, o2 is sufficient, enough fuel in tank, and medications. I not only check to see if they are there, but expiration. Inventory is done as a whole by someone else, medications and tracking of which ambulance they are on, is done VIA computer and can be logged in by the provider when they used something.

Expired medications such as epi, dopamine, D50, and such... are tossed in the sharps box. Other meds, such as the morphine, fentanyl, etomidate, valium, etc etc.. are taken the the ER and disposed of/wasted there with witness of an RN or MD. The MD then signs off on it and are replaced if needed. Also, narcs MUST be signed for at the start of every shift.

[Kaisu]

So do you check your box out from a pharmacy at the beginning of the day? Not just hand off from the last crew?

No, we do get a hand off from the previous crew, but our service is so dynamic we are rarely assigned the same partner twice, let alone the same rig. I get a hand off from the off-going medic but I am one of the few that checks each drug. One of the things that happens a lot is the medic on a prior shift uses a drug and gets a replacement from the pharmacy. The replacement drug may have an expiry date earlier than the sticker on the box.

The system is far from perfect, but a thorough conscientious rig check before every shift is something I need to feel prepared to do my job. I can't say for the others.

[spenac]

I check dates every shift. We are required to write the dates on the check sheet each Monday so there is written proof dates were checked. Then the last day of the month we have to write the dates and replace items expiring.

I was once accused of having expired ET tubes but turned out they were looking at the manufacture date not the expiration date.

[emtannie]

I can see where occasionally, someone could miss an expired med, but it should be caught by the next crew coming on shift. To have a number of meds expired shows that the crews are not doing their due diligence in maintaining their truck.

We do vehicle checks at the start of every shift, including drug checks. On the 25th of each month, the crews on duty do a specific drug check, and any drugs that will be expiring in the next month are ordered from pharmacy. A sheet is done for each truck, so when the drugs come in from pharmacy, on the 1st of each month, we then go and replace those drugs that will expire. Narcs have to be signed off every day, double signature.

Are some people slack, and don't check their stuff? Of course. Even with control mechanisms in place, sh** happens - but we should be trying our best to minimize those events. Like Dwayne said, I want to look out for not only me and my partner, but I don't want to be the one who misses something and the crew that replaces me has to catch it, or worse, they find out something is missing when they are already on a call.

[Quakefire]

We do unit checks every morning (and now night after it took a little too long to find a stolen blue bag/drug kit) to make sure everything is there. Our units are deep cleaned weekly at which time all the expiry dates are checked from IV fluid to preloads. Generally we remove anything that expires at the end of the month and replace it

[Medic One]

We require daily checks on every in-service unit at the beginning of shift. We also do a load/test dump on the LP12. Each car also has all essential equipment tagged with a number (suction units/O2 regulators/etc...) these numbers must be placed on the check sheets turned into the duty supervisor. We also have a very detailed mechanical check. A few years ago we ran into a problem and our crews check sheet saved us from a potential lawsuit. We retain the check sheets for 30days.

We as supervisors also have some tricks up our sleeve by randomly placing luggage tags on the oil dip stick or in a compartment/bag advising the crew to turn it into the supervisor. It seems to work well knowing the oil is checked daily, the suction unit is actually opened to see if it is charged, or the IO Gun case has been open to see if all items are in it. We tried "Tagging" the bags closed but thats where we ran into a satelite division not checking bags and on a spot check the bag was found to have about 15 meds out of date by about 15 days. We tracked back all crews working those 15 days and they received a write-up for not checking there gear.

SO as far as expired meds in a bus..it can happen...and thats poor practices on the medics and services shoulders.

[brentoli]

We as supervisors also have some tricks up our sleeve by randomly placing luggage tags on the oil dip stick or in a compartment/bag advising the crew to turn it into the supervisor. It seems to work well knowing the oil is checked daily, the suction unit is actually opened to see if it is charged, or the IO Gun case has been open to see if all items are in it. We tried "Tagging" the bags closed but thats where we ran into a satelite division not checking bags and on a spot check the bag was found to have about 15 meds out of date by about 15 days. We tracked back all crews working those 15 days and they received a write-up for not checking there gear.

Damn!

Those are some balsy supervisors. How does stuff like that go over with the crews? Do you have good relations?

[EMS49393]

When I worked for MEMS in Little Rock, I got a different truck nearly every shift. I checked it from top to bottom at the beginning of the shift only stopping if I was put in service for an emergency. I usually got to work 30 or so minutes early just for this reason.

At least once a week I found expired drugs on the truck. They are supposed to be "majored" every month on the day of the month that corresponds with the truck number, however that rarely, if ever, happened. The most outdated drug I found during my time there was an EPI 1:1,000 that was four years out of date. Of the six required to be on the unit, four were four years out of date. I have no idea how that slipped by state inspection, nor do I want to know.

I work for a much smaller service now and we are all very diligent with the stock. We have two drugs that have to be rotated out monthly because they are only good for 30 days outside refrigeration. They are marked on the dry erase board for both ALS units and every one of us checks them at the start of our shift to ensure the dates are correct. Drug date checks and inventories are generally done once a month, at the first of the month and the drugs that are expired are replaced. We also note any drugs that are going out in the next two months inventories so we can insure we have adequate stock to replace them.

You know what works really well to keep from having expired drugs on your ambulance? Responsible employees that take their job seriously and do it correctly. This also works well in regards to having adequate stock and equipment that is checked to make certain it is in good working order.

Responsibility. Have the eliminated that word from the vocabulary of the grammar schools?