Q: We have a couple of units that are locked down during medication pass/medication administration. Can you provide guidance on how these medications should be administered? We are confused on pre-pouring versus point of administration practices for these patients.
A: While NCCHC does not support pre-pouring of medications for the general population, limited circumstances may require modifications to the medication administration process. For example, patients housed in upper-tier units, restrictive housing, or lockdown behavioral health units may be unable to come to the medication cart or medication window. In these situations, medications may be prepared at the point of administration to accommodate safe delivery.
NCCHC distinguishes point of administration preparation from pre-pouring practices.
The practice of pre-pouring medications refers to removing medications from their original labeled containers and placing them into another appropriately labeled package for an individual patient before the scheduled medication pass, and well in advance of administration.
- Example: Nursing staff prepare medications in the medication room, or other designated area, before the scheduled medication pass by placing them into individually labeled medication cups or envelopes for later administration.
When used for the general population, this method is not supported by NCCHC and may conflict with state nurse practice acts and board of pharmacy regulations.
Facilities that pre-pour medications on a limited basis must follow Standard D-02 Medication Administration Services, compliance indicators #7 – #10.
Point of administration preparation refers to situations where medications are removed from their original labeled containers and placed into a temporary container (for example, small plastic cup or envelope) immediately before administration in the housing unit where medications are being administered.
- Example: When doing medication pass for upper-tier patients housed in a lockdown unit, a nurse brings the medication cart to the housing unit and prepares medications at the base of the stairs and immediately delivers them to each patient’s cell for administration.
This is the preferred practice for situations involving individuals that cannot freely come to the medication cart/window (for example, lockdown units when carts cannot access upper tiers) and is recognized and supported by NCCHC.
Wendy Habert, MBA, CCHP, is NCCHC’s director of accreditation. Send your standards-related questions to accreditation@ncchc.org.
