Controlled Substances -- Overage and Documentation

Two items for providers this week: vials that have more than expected amount of liquid in them, and

documenting CS usage on Special Reports.

1. After a recent administration, it was observed that the vial contained more liquid than would be

expected. The discussion that followed centered around the "manufacturer's overage," and the

fact that the vials contain a minimum amount as labeled, but not a maximum amount. So it is

conceivable, although unusual, to see more than 1ml of medication in a vial labeled 1ml, or

more than 2ml in a vial labeled for 2ml.

If a provider discovers an overage, he or she should document same in the normal Special

Report. As it is unlikely a provider would discover the overage until they were either wasting

the contents following a partial administration, or while drawing up the remaining contents

during an administration, it is important the provider documents the volume of overage, and not

try to figure out the milligram or microgram amounts.

Such documentation would appear as:

"Administered 75 mcg Fentanyl on standing order for pain; wasted remaining 25mcg and

manufacturer's overage for a total of 0.7ml destroyed. Vial confirmed empty by EMT xxx."

2. We will be updating the cover sheets on the CS Log Books with the new logo. Additionally, we

will add new language to the CS Special Reports that will take into account the previous item,

and this will be displayed on the new cover sheets as well.

a. Subject: “xxx mg/mcg xxx drug used from CS Kit #xx” - Narrative: xx mg/mcg xx drug

administered on standing order and/or medical control order for xx complaint. No

adverse reactions (or report adverse effect). xx mg/mcg wasted (plus manufacturer's

overage, if any), total xx ml destroyed. Witness empty vial xx EMT."

b. Please make sure to mention if a medical control order was obtained, as it is necessary

to document that in our quarterly usage reports to the NY State DOH.