11.N.4. Safe destruction or return of drugs

11. Pharmaceutical Services Standards

11.A. Pharmaceutical services are directed by a qualified licensed provider.
- 11.A. Resources
11.B. If the organization owns or operates a pharmacy, it is supervised by a licensed pharmacist.
- 11.B. Resources
11.D. Pharmaceutical services are provided in accordance with standards of care and prevailing laws and regulations.
- 11.D.4. Access to current drug information resources
11.E. The ASC must provide drugs and biologicals in a safe and effective manner, in accordance with accepted professional practice, and under the direction of an individual designated responsible for pharmaceutical services.
- 11.E. Resources
11.F. Drugs must be prepared and administered according to established policies and acceptable standards of practice.
- 11.F.1. Reporting adverse reactions to the physician
- 11.F.3. Oral orders for drugs and biologicals
11.G. Pharmaceutical services made available through a contractual agreement are provided in accordance with the same professional practices and legal requirements required if such services were provided directly by the organization.
- 11.G.1. A current contract is in place
11.H. The medication inventory is monitored to track the presence or absence of high-alert medications and medications with confused drug names.
- 11.H.1. Written monitoring process
- 11.H.2. Documentation of staff training
11.I. Procedures are in place to prevent errors from high-alert medications.
- 11.I.1. List of high-alert medications
- 11.I.2. Processes to prevent administration errors
11.J. Procedures are in place to prevent errors from medications with confused drug names.
- 11.J.1. List of confused drug names
- 11.J.2. Processes to prevent administration errors
11.K. Drug storage and security, including recordkeeping, are maintained to ensure the control and safe dispensing of drugs (including samples), to minimize medication errors, and to prevent diversion in compliance with prevailing laws and regulations.
11.M. If not administered immediately, all medications (injectable, oral, etc.) removed from the original container or packaging are labeled in a standard format in accordance with law, regulation and standards of practice.
- 11.M.1. Medication labeling policy
- 11.M.2. Medication labeling requirements
11.N. A written policy is present addressing the disposal or return of expired, damaged, and recalled medications in accordance with prevailing laws and regulations and accepted guidelines.
11.O. Procedures are in place for the maintenance, cleaning, distribution, and use of devices such as nebulizer units, intravenous infusion pumps, or other mechanical device used in the medication delivery process.
- 11.O.1. Adherence to manufacturer's instructions

Element of Compliance

Safe destruction or return of drugs

Documentation Required

Resources

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11.N.4. Safe destruction or return of drugs

11. Pharmaceutical Services Standards

Element of Compliance

Resources

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