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Medication Management & Storage in Ambulatory Healthcare Settings


A view of medicine in a pharmacy.

By Maura Naddy, Senior Associate Director, Standards Interpretation Group

Arrangement of medications within a pharmacy and throughout the organization is key to reducing the chances of a medication error. 

According to American Society of Health System Pharmacists (ASHP), this means product arrangement should minimize unintended selection of the wrong product or dosage form. In ambulatory healthcare settings, it’s not always so simple. Many do not have on-site pharmacies so careful arrangement depends on the type of services offered at each individual location. 

Ambulatory healthcare organizations have a few key first referral sources, including:

  1. Specific laws and regulations associated with storage. Ambulatory surgery centers (ASCs) are required to meet a plethora of state, federal and other safety requirements because of the dynamic variable of services provided within these facilities.
  2. Manufacturer’s instructions for use, which are generally printed on the inserts found within the medication packaging.
  3. Overall security and safety of the medication’s storage location. 

Joint Commission Requirements
Safe medication storage and safety is addressed in the Medication Management Chapter of the Comprehensive Accreditation Manual for Ambulatory Care. The Joint Commission designed these requirements to:

  • assist accredited organizations in maintaining medication integrity
  • promote availability of medications
  • minimize diversion
  • reduce dispensing errors

Importance of a Risk Assessment
Our surveyors always advise—though it’s not required—that organizations conduct a risk assessment of the areas where medications may potentially be stored to help develop specific guidance on the complexities of storage and security, as well as to assist in implementing storage processes and designs. This step is especially helpful for ASCs as the variety of services offered can lead to additional challenges based on the complexity and risk level of the care provided. 

According to Association of periOperative Registered Nurses (AORN), “Perioperative medication use and administration, postoperative management, medication disposal, staff member and physician education, proper documentation in the medical record by all disciplines, pharmacoeconomics, pharmacy compounding needs, and controlled medication management and oversight are all important components of this segment of care.” Based on these services, it is important that healthcare organization’s leaders assess each area where medications may be stored to ensure safe medication practices within their facility. 

Recommended Actions
 ASCs can take some of the following actions to achieve safe medication practices:

  • Perform a security assessment to identify any gaps or risk points. 
  • Consider a multidisciplinary approach in security assessment to ensure all levels of staff are included.
  • Collaborate with a pharmacist or pharmacy consultant to ensure guidelines and safe practices are achieved for each individual medication available within the ASC. 
  • Use Automated Dispensing Cabinets for storage of high-risk or all medications available and limit override capabilities.
  • Separate look-alike and sound-alike (LASA) medications to reduce the occurrence medication errors.
  • Ensure proper medication storage based on temperature requirements and ensure they are consistently maintained at the appropriate temperature.
  • Address proper documentation and disposal of partially used medications.
  • Locate and make available required emergency carts/kits/medications. 

Interdisciplinary teamwork is imperative to ensuring safe medication practices within any healthcare setting. Ensuring safe medication practices will ultimately help healthcare organizations, including ASCs, promote and provide the safest quality care for their patients. 

Maura Naddy, MSN, RNC-OB, CJCP, is a Senior Associate Director in the Standards Interpretation Group at The Joint Commission.