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AUTOMATED DISPENSING CABINETS – DOWNTIME AND EMERGENCY ACCESS

DOCUMENT TYPE: PROCEDURE

Site ApplicabilityThis procedure is applicable to all areas at BC Children’s Hospital and BC Women’s Hospital and Health Centre, including Sunny Hill Health Centre and Healthy Minds Centre where Automated Dispensing Cabinets (ADCs) are used for distribution of medication.

Practice Level/Competencies Access to ADCs is limited to authorized health care providers, as outlined in Appendix A – ADC User Access Groups. Limits to medication access are based on the user’s profession and C&W approved role.

Policy Statements

All ADCs are plugged into the C&W Emergency Power plugs. In the event that the main BC Hydro power is off, the cabinets should still run on the Emergency Power system (C&W backup generators).

If both power sources are compromised, medications in ADCs are accessed by using the manual override keys. Hard copies of procedures and ADC inventory list are kept on each C&W Nursing Unit.

ADC keys are stored in the following areas: BCWH: Operating Room in the Women’s Hospital Building, Labour and Delivery in TACC BCCH: Anesthetic Care Unit, Emergency Department, Pediatric Intensive Care Unit Sunny Hill Health Centre Main Pharmacy Narcotic Vault (contact Pharmacy at 3282 from 0700-2400 hr or the on-call

pharmacist from 2400-0700 HR) Security of all drugs including Controlled Substances is maintained throughout downtime. When unable to access Controlled Substances electronically during downtime, a manual (paper) perpetual inventory record is maintained and physical counts are performed at each shift change by two regulated health care providers.

Equipment& SuppliesAutomated Dispensing Cabinets

Procedures Refer to the Omnicell Quick Reference Guide for how to perform the tasks.

STEPS RATIONALEI. TROUBLESHOOTING PROCEDURES FOR NURSING

IN CASE OF POWER FAILURE

Where possible, access medications from another ADC cabinet that is functioning

Notify your Clinical Nurse Coordinator/Leader/Charge Nurse

Medications must be obtained for continued patient care.

C-0506-12-62540 Published Date: 30-Jul-2021 of 11 Review Date: 30-Jul-2024

This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.



Contact Pharmacy and ask to speak to a supervisor during regular hours or contact the pharmacist on-call from 2400-0700

If a system failure or complete power outage occurs, start downtime and emergency access procedures (see section III below – Emergency Cabinet Access)

Manual Reset of the Omnicell may be required after power failure. (see Appendix A)

NOTE: Each ADC has a back up battery that will function for approximately 20 minutes.

IN CASE OF SYSTEM COMMUNICATION ERRORS

If there is a temporary lapse in communication between the Server (Omnicentre) and ADCs, all transactions are stored and the necessary information is exchanged when the communications are re-established

If the Server fails or is taken off-line, the ADCs are not impacted since every ADC can store and queue all data until the Server is online again

NOTE: During server downtime, pharmacy does not have access to Omnicell restock reports. Please call pharmacy if Omnicells restocks required urgently.

IF SCREEN IS BLANK

Check power switch that should be green Check power plug at wall

Ensure that the unit receives power.

IF SCREEN FREEZES

Turn off power switch, wait a few seconds, turn back on

IF PRINTER IS NOT PRINTING

Check if paper is out and replace Check if paper is jammed, remove and

reinsert





IF MEDICATION NOT ON THE LIST

Check alternate name(s), items are listed by generic name

Medication might not be stocked in ADC. Contact Pharmacy to determine how best to acquire medication

Medication might be in patient specific drawer

Refresh ADC display by logging off and back on

IF THE PATIENT IS NOT ON THE LOCAL LIST

Check Global List, if there, can select If not on Global List, add temporary patient

NOTE:Discharged patients will remain on the Global List for 4 hours.

IF THE DRAWER IS JAMMED

Check if medication package is stuck, attempt to release

If unable to resolve, contact Pharmacy Technician Supervisor from 0700 to 1500 hr or Pharmacy Dispensary at 3282 from 1500 to 2400 hr

NOTE:Never force anything open.

A Pharmacy Technician will try to resolve. If not able to resolve, Pharmacy will contact the Omnicell Technical Support.

II. TROUBLESHOOTING BY OMNICELL REPRESENTATIVE1. Upon arrival on site, the Omnicell

representative reports to the Pharmacy Department.

Omnicell representative may need cabinet keys from Pharmacy.

2. Pharmacy staff escort the representative to the nursing unit and observe the representative while the ADC is open. Observing to be shared between Pharmacy and Nursing depending on the length of time to resolve the issue.

To ensure security of medications while the ADC is open and medications exposed.

III. EMERGECY CABINET ACCESS1. In case of a complete power outage,

unlock the cabinet manually as per Appendix B.

2. Put the record sheet (Appendix C) on the ADC so that non-controlled items removed from the open ADC can be documented manually.

3. Use the record sheet (Appendix D) for documenting controlled drug transactions, i.e. addition or removal of Controlled Substances. When the system is functional again, these transactions will

Controlled Substances should not be kept un-attended. A staff member may be assigned to stay at or near the automated medication cabinet to control access to narcotics and controlled drugs.




DOCUMENT TYPE: PROCEDUREbe entered into the ADC system. Controlled drugs could also be locked in an alternate

location during downtime.4. Relock the ADC when system is restored

and conduct a full count of the controlled drugs with a witness. Take the manual record sheets to Pharmacy.

Pharmacy will record and charge the drugs removed during downtime.

ReferencesInstitute for Safe Medication Practices (ISMP), Guidelines for the Safe Use of Automated Dispensing Cabinets. 2019.

Lower Mainland Pharmacy Services policy, Automated Dispensing Cabinets (ADC) – Pharmacy Services – LMPS, March 2020

Definitions

Automated Dispensing Cabinet is a device that electronically dispenses medication as requested by an authorized user, tracks medication usage and controls inventory. At C&W, the vendor for ADC is Omnicell®.

AppendicesAppendix A – Manual Omnicell Reset ProceduresAppendix B – Manual Unlock of Omnicell Cabinet ProceduresAppendix C – recordAppendix D - record

Version HistoryDATE DOCUMENT NUMBER and TITLE ACTION TAKEN13-JUL-2021 C-0506-12-62540 Automated Dispensing Cabinets –

Downtime and Emergency AccessApproved at: Pharmacy, Therapeutics and Nutrition Committee

DisclaimerThis document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA.





Appendix A – Manual Omnicell Reset Procedures

A) Pull down Omnicell Panel above keyboard.

B) Press the Reset Button.



PULL DOWN

PRESS RESET



Appendix B – Manual Unlock of Omnicell Cabinet Procedures

A) Unlock the Fridge Flexlock:i. Locate the Omnicell keys labelled FR 1 (#2202) and FR 2 (#2232)

ii. Corresponding locks are located on the side of the Omnicell Flex lock

B) Unlock the Cabinet Door:i. Locate the key labelled Door (#2333)

ii. Insert the key into the lock located to the top right of the cabinet

C) Unlock the Omnicell Drawers:i. Unlock the locking bar with the corresponding keys labelled #2232 and #2202

ii. Pull the locking bar to the RIGHT and lift to remove

iii. Pull the red release lever towards you (it extends 10-20o from the vertical position) while pulling the drawer toward you (open one drawer at a time)





D) Unlock the Locking Lid Drawers: i. Fully open a drawer and locate the red locking lever at the back

ii. Lift the red lever from its original horizontal position to a vertical upright position (pivot it 90o)

iii. On the left side, under the grasp handle of the drawer, use your index finger to slide the release tab toward you





iv. Along the bottom-left side of each locking lid drawer, slide the silver release tabs (resembles the pull tab of soda cans) towards the left for EACH row of locking bins

v. When the tab is pulled out, you may access all bins for that row

vi. Repeat the steps above (under D. Unlock the Locking Lid Drawers) to access the bins for each locking lid drawer





Appendix C - ADC Emergency Access –Removal of Non-Controlled Medication Record

Removed Non-Controlled Medications

Nursing Unit: _____________________________

Date: ___________________________________

MEDICATION (name, strength, form) QTY PATIENT NAME RN SIGNATURE





Appendix D - ADC Emergency Access –Removal of Controlled and Narcotic Medication Record

Narcotic and Controlled Medications (record all transactions – removal and additions)

Nursing Unit: _____________________________ Page #:_____

Date: ___________________________________

MEDICATION(name, strength, form) QTY DOSE WASTED PATIENT NAME PHYSICIAN

NAMERN

SIGNATURE WITNESS



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