3 Tactics for Safer Drug Storage

Proper medication storage is a key aspect in reducing the risk of medication incidents in your pharmacy. Pharmacy professionals play a vital role in ensuring the safe and appropriate storage of drugs to minimize the risk of medication mix-ups and potential patient harm. Examples of common contributing factors that raise the probability of an incident include pharmacy staff who select the next incorrect drug on the shelf, disorganized shelves that are crowded with different bottles of medications, and the lack of signs or dividers to separate look-alike and sound-alike (LASA) drugs.¹ You can use the following risk reduction strategies in your pharmacy to prevent incidents, make potential incidents visible, and minimize the consequences if an incident occurs.²

Tactic 1: Organize Your Drug Storage Area

• Always store bottles with their labels facing forward.^1,2 Avoid placing the product face down and use shelves with appropriate space to keep the products upright.¹
• Prevent crowding of medications by using dividers on shelves, in narcotic cabinets, and in refrigerators and create distinct, separate areas for different dosage forms and strengths of drugs.^1,2
• Ensure the prescription pick-up area is spacious and clutter-free to prevent any mix-up of medications that may go into the next basket or bin.¹
• Label the medication bottles or packages, including return-to-stock vials, with the drug name, strength, expiration date, and the DIN number or bar coding if possible.¹
• Avoid placing stickers or cross-out lines that block key information on bottle labels.¹

Tactic 2: Prevent Medication Incidents with LASA Drugs

• Separate LASA medications and frequently confused drug pairs.² Do not place LASA drugs in the “fast mover” section unless automation is being used.¹
• Use labeling and alerts whenever possible.² Create a sign that brings attention to LASA drugs during stocking and retrieval or add alerts in the computer system, such as “Check the indication” or “This medication has been often confused with…”.¹
• Use tall-man lettering and different font sizes or color to differentiate drug products.² For more information about the proper use of tall-man lettering for LASA drugs, please see the ISMP Canada resources at the following link: https://www.ismp-canada.org/TALLman/
• Avoid abbreviating the names of medications.²
• Use the generic names of drugs whenever possible, unless the medication is a combination product.² The alphabetical arrangement of drug products using generic names makes it simpler for pharmacy staff to stock and retrieve products.¹

Tactic 3: Restrict Your Drug Storage to Current Medication Supply Only

• Designate a separate area for drug delivery devices that are used for patient education or demonstration purposes, placebo medications, food, and potential adulterants, and ensure they are kept away from drug storage areas.³
• Eliminate potentially hazardous chemicals from drug storage, as well as any substances that are no longer necessary for compounding.¹
• Avoid storing non-medication supplies, including alcohol bottles, near products that require reconstitution.¹
• Remove recalled, discontinued, and outdated medication products from the inventory as soon as possible and secure them away from current stock.¹ 

References

1. Improving medication safety in community pharmacy: Assessing risk and opportunities for change. Institute For Safe Medication Practices (ISMP). (2009). Retrieved July 13, 2022, from https://www.ismp.org/sites/default/files/attachments/2018-02/ISMP_AROC_whole_document.pdf
2. Billstein-Leber, M., Carrillo, C., Cassano, A. T., Moline, K., & Robertson, J. J. (2018). Guidelines on Preventing Medication Errors in Hospitals. American Society of Health-System Pharmacists. Retrieved July 13, 2022, from https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/preventing-medication-errors-hospitals.ashx
3. Recommendations for Avoiding Medication Errors With Drug Samples. National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). (2008). Retrieved July 13, 2022, from https://www.nccmerp.org/recommendations-avoiding-medication-errors-drug-samples