Pharmacy IV/Drug Box Exchange FAQs

Pharmacy IV/Drug Box Exchange FAQs

General Pharmacy Exchange Information

We know things can get busy out there and we must often leave the hospital sooner than we’d like, but the pharmacy exchange process must be completed before you leave the hospital and it should ideally be completed as soon as you’ve completed patient turnover.

We all know that it’s much more convenient to be able to exchange our boxes in the ED, as opposed to having to go to the pharmacy, but we must remind you that ability is a privilege and not a right.  If we do not comply with their requirements, they may revoke our privilege and we would have to go to the pharmacy for all our IV/drug box exchanges.

General reminders:

  1. A pharmacy exchange form must be completed for each box that is exchanged—one form per box.
  2. The ALS provider who was the AIC for the call must sign the pharmacy exchange form; since ALS procedures/medications were performed/administered, a BLS provider cannot sign as AIC.
  3. The pharmacy exchange log must be completed for each box that is exchanged.

Frequently Asked Questions

If you’re ever not sure how to proceed, contact a duty field supervisor for guidance.

What is the process for exchanging an unused/expired IV/drug/RSI boxes?

  • As soon as you have determined you have an expired box, contact a field supervisor to provide notification and determine the steps he/she wants you to take at that time.  You may be instructed to go out-of-service to exchange the box at the hospital.
  • Do not take an IV/drug box off another ambulance as a temporary solution, if it’s avoidable, because that ambulance will now be out-of-service and unavailable for last-minute needs.
  • Go to the nearest hospital (see the below exception for Sentara Independence) and follow the IV/drug box exchange procedures for that hospital.
  • An ALS provider does not have to be present to exchange an unused IV/drug box — BLS providers can complete the exchange of unused/expired IV boxes.

Where do we go to exchange unused/expired IV/drug boxes?  Does Sentara Independence exchange unused/expired boxes?

  • Unused/expired IV/drug boxes can be exchanged at any facility, with the exception noted for Sentara Independence:
    • Due to limited pharmacy resources available at Sentara Independence, the following process is in place for weekends when a drug box exchange is needed and the patient was NOT transported to the hospital: on weekends, if you use a red drug box and the patient is not transported to the hospital (and Sentara Independence is your closest facility) you should call the ED at 757-363-6869 and request to speak with the Charge Nurse.  The Charge Nurse will advise if they have enough boxes to exchange in order to accommodate you (once they have three or fewer they will not exchange for non-transports); if they don’t you will be notified to go to the next closest facility.

Where can used or expired RSI kits be exchanged?

  • For RSI medics, RSI kits (used or expired) can be exchanged at the following facilities (to which we primarily transport):
    • Sentara Virginia Beach General Hospital
    • Sentara Leigh Hospital
    • Sentara Princess Anne Hospital
      • SPAH requests that expired/unused RSI kits be exchanged during business/daytime hours when their staffing can better support this task; used RSI kits may be exchanged at anytime
    • Sentara Norfolk General Hospital

What happens if a box is accidentally opened during an ambulance check-off or on a call by a BLS provider?

  • Accidents happen, so there’s no need to worry.
  • During ambulance check-off:
    • If a box is inadvertently opened during ambulance check-off, you will need to immediately notify a field supervisor
    • The opened drug box will need to remain secured in the locked compartment of the ambulance or, if it cannot be completely secured, a crew member will need to remain with the opened drug box.
    • Simply follow the instructions above for how to handle a situation with an unused IV/drug box.
  • On a call:
    • The opened drug box will need to remain secured in the locked compartment of the ambulance or, if it cannot be completely secured, a crew member will need to remain with the opened drug box or the box will need to remain with the crew (for example, if you cannot secure the box, take the box with you when you take the patient into the Emergency Department).
    • Crew members are responsible for the security of the medications — do not leave a drug box unattended — a crew member must remain with the drug box (or vice versa) until the exchange can be completed and the boxes (both old and new) have been secured in their respective locations.

What should happen if an IV box is found open during a check-off?

  • Immediately notify a field supervisor.  The box will need to be exchanged per the above guidance for handling a situation with an unused IV/drug box.

What should happen if a drug box is found open during a check-off?

  • Immediately notify a field supervisor.  The box will need to be exchanged per the above instructions for handling a situation with an unused IV/drug box.  The pharmacy will need to verify the presence of the schedule II-V medications (Diazepam, Lorazepam, Midazolam, Morphine).  If any medications are missing, immediately notify a field supervisor.  The TEMS drug diversion forms will need to be submitted.

Are BLS providers even allowed to exchange an expired box?

  • Yes, BLS providers are allowed to exchange unused/expired IV/drug boxes.  Simply write “expired/unused” on the Pharmacy Exchange Form so the pharmacy will know it was not used.

Where is the pharmacy at Sentara Norfolk General Hospital and what forms do we use there?

  • The pharmacy at SNGH is located on the 2nd floor, near the Lion’s Eye Bank.  One tip is to exit the ED using the doors near the charge nurse’s station, take the elevators to the second floor, follow the signs to CHKD (the two hospitals are connected), and the hallway for the pharmacy window is located on the right just before you get to the SNGH-CHKD crossover.
    • When returning from the pharmacy, if you are unable to re-enter the Emergency Department, turn right and take the exit towards the helipad.
  • If you do not have any VBEMS Pharmacy Exchange Forms with you, use Norfolk Fire-Rescue’s form and note on the form that the exchange is for a Virginia Beach EMS unit.

What is the process for exchanging boxes at Chesapeake Regional Medical Center?

  • IV boxes are located in the Emergency Department in a locked room and you will need a key card from a staff member to access the room.  Drug boxes are exchanged in the pharmacy, which is located on the 3rd floor.  To get to the pharmacy, you will follow the signs leading you from the ED to the pharmacy and you will utilize the south elevators.
  • If you do not have any VBEMS Pharmacy Exchange Forms with you, use Chesapeake Fire Department’s form and note on the form that the exchange is for a Virginia Beach EMS unit.