How Hospitals Can Comply With CMS' Medication Storage Requirements

Meeting medication management requirements set by CMS and The Joint Commission is challenging for healthcare organizations because of the amount of regulations and the coordination necessary for compliance. In particular, hospitals and other facilities often struggle with medication storage, which has three main components: security, safety and integrity. Patricia Kienle, RPh, MPA, FASHP, director of accreditation and medication safety for Cardinal Health's Pharmacy Solutions business, provides guidance on how hospitals can meet medication storage requirements.

1. Security.
Hospitals should refer to CMS and accreditation organizations to determine the proper standards for medication security. In general, medications must be secure — in most organizations that means locked — and available to only authorized healthcare professionals. 

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2. Safety.
Healthcare practitioners can ensure medication safety by being aware of high-alert drugs as well as reports and studies that discuss unsafe medication use. Ms. Kienle suggests that all organizations develop a list of five to 10 high-alert medications, such as anticoagulants and concentrated electrolytes, which clinical staff should be aware of and monitor closely.

3. Integrity. Temperature and dating are the two main elements of medication integrity. Manufacturers typically set the temperature required for medication storage. One of the biggest challenges with medication integrity is CMS' interpretive guideline that mandates providers date medication based on only the manufacturer's information, which is typically more conservative than other data. In contrast, historically healthcare providers were able to refer to peer-reviewed literature and scientific studies when determining the beyond-use date of medications.

"It's the worst possible storm because it's restrictive, in that we know there's good science that allows better dating for many drugs, but we can't use it. And, it occurs at a time of a huge drug shortage," Ms. Kienle says. This restriction affects primarily anesthesiologists, which are facing a shortage of drugs and who need to administer certain medications at room temperature, which shortens the time to expiration. The Institute for Safe Medication Practices also says CMS' guideline exacerbates the drug shortage and wastefulness in healthcare, and is currently soliciting pharmacists and other healthcare practitioners to complete a survey on the medication guidelines.

Communication between the pharmacy and anesthesia department are critical for managing medication under these requirements, Ms. Kienle says. She suggests the pharmacy and anesthesia directors meet face-to-face to discuss their needs and how they can work together to use the medications appropriately. This communication will help the pharmacy and anesthesia department coordinate the advance preparation of drugs that are in short supply and those that need to be administered using room temperature expiration.

In addition, Ms. Kienle suggests pharmacists provide physicians with ready-to-use medication whenever possible, as this practice can reduce the waste from unfinished multiple-use vials and avoid the need to manipulate the medication during the case. While single-dose vials are generally more expensive, she says the benefit of decreased waste and increased patient safety make the investment worthwhile.

Learn more about Cardinal Health.

Related Articles on Medication Storage:

Do CMS' Medication Storage Guidelines Worsen Drug Shortages?
7 Top Noncompliance Issues in Medication Management

Joint Commission Adopts ASA Recommendations on Medication Management

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