Zoo Med Bag

Implementation Date: 10/2021

Date of Last Revision: 1/2023

Next Review Due: 1/2026

 

Reviewed by VTH Administrative Team: 10/2021

Reviewed by VTH Board: N/A

 

Approved by VTH Director: 10/2021

Reviewed by Biosecurity Subcommittee: N/A

Subject to modification by the VTH Director without approval.

Policy

The only controlled substances for zoo med, other than patient specific medications, that may be stored outside of the Cubex machine are those described below. They must be maintained in accordance with the guidelines below.

Guidelines

Background:
The zoo facilities house some drugs (controlled and non-controlled) on site. Some medications, including most anesthetics, will be housed at the VTH and transported with vet staff. Whenever possible, drug needs should be anticipated prior to the zoo visit to facilitate accurate and appropriate medication access while working off site. All zoo facilities will maintain pentobarbital, telazol, xylazine, and a small amount of atipamezole on site; Scovill Zoo and Peoria Zoo will also house etorphine and naltrexone on site for escape and emergency response purposes. 

Guidelines: 
Standard anesthetic drug stock held at VTH Medication Dispensary: 

• Drugs will be maintained in a locked bag which will be stored in the VMSC Cubex machine whenever not in use. The bag must be removed from the Cubex immediately prior to leaving for the zoo and returned to Cubex or the Medication Dispensary immediately after return from the zoo. The person removing the bag from Cubex is ultimately responsible for its security until returned.
• Drugs will be maintained as ward stock for the Zoo Ambulatory Service. This drug stock is not to be utilized for any zoo patients treated on site at the VMSC/VTH. In the event a zoo animal is presented to the VMSC/VTH for care, all drugs should be drawn up from the Cubex/Medication Dispensary as per VTH/VMSC protocols for any inpatient under care. 
• Drugs will be logged on the yellow log sheet and charged to each Zoo facility as they are used. 
  o Drugs with short expiration after puncture (i.e. propofol) will be charged the entire bottle at initial puncture. This charge can be split between multiple facilities if its use is anticipated at multiple facilities while the drug is still within its usable period. 
  o Drug charges are consistent with the drug markup used throughout the VTH but lack a minimum volume charge. 
  o Zoo Ambulatory staff are responsible for entering in drug charges as medications are used. 
  o The drug’s yellow log sheet will contain the animal’s zoo identification number and zoo location (owner), as well as drug utilization records. 
• Zoo Ambulatory is responsible for safely housing the bag of controlled drugs while it is out of the Cubex. 
  o Bag should be securely locked and never left unattended during transport or while at off-site facilities.
• Drugs in the transport bag will be audited by a pharmacist weekly at a minimum. 
  o If an UNOPENED bottle is noted to be nearing its expiration date (within 3-4 months of that date), the pharmacy will swap that bottle out for one with a later expiration, allowing the original bottle to be used elsewhere in the hospital and minimize waste.Zoo Med Bag
  o If an OPENED bottle is noted to be nearing its expiration date, we cannot swap that bottle out and any effective cost wastage will be absorbed by Zoo Ambulatory. It is up to ZooAmbulatory to utilize these drugs in the most cost-effective manner.
• Stocked drugs include:
  o Midazolam 5 mg/mL (10 mL)
  o Dexdomitor 0.5 mg/mL (10 mL)
  o Ketamine 100 mg/mL (20 mL)
  o Butorphanol 10 mg/mL (10 mL)
  o Buprenorphine 0.3 mg/mL (1 mL)
  o Hydromorphone 10 mg/ml (1 ml)
  o Propofol 28 (20 mL)
  o Alfaxalone 10 mg/mL (10 mL – 1 bottle)
  o Antisedan 5 mg/mL (10 mL)
  o Naloxone 0.5 mg/mL (1 mL)
  o Flumazenil 0.1 mg/mL (10 mL)

Checking of drugs in ambulatory bag at VTH

• Drugs in the Zoo Ambulatory bag will be checked every Wednesday unless it is required for an emergent or scheduled zoo visit on that day. The Zoo Ambulatory service will be responsible for bringing the bag to the Medication Dispensary for these weekly checks.
  o If restocking is needed sooner, the bag will be brought to the Medication Dispensary and the medication needed will be indicated.
  o The bag will be checked and returned to Cubex prior to the pharmacy staff leaving for the day unless Zoo Ambulatory has indicated the bag will not be needed the following day.
• When checking, every medication in an opened bag will be drawn up and logged as an actual draw on the yellow sheet.
• After draw is complete, medication will be put into a new bag.
  o If there are any discrepancies, email Dr. Sam Sander and cc Dr. Lauren Forsythe
• If vial leaks, log on the sheet and review to see if it has historically been leaking; Those drawing out should be marking if it leaks when they draw as well.
• If a vial leaks a large volume or is over pressurized and squirts out during the checking process, close out the yellow sheet, alert Drs. S. Sander and Forsythe, and provide a new vial with new log with no charge
  o To decrease leaking, use smallest needle possible and do not over pressurize

Controlled drug stock maintained at Miller Park, Scovill, or Peoria Zoo

• Drugs are to be logged on ZIMS as well as via paper logs as they are utilized. 
  o Care is to be made to ensure drugs are logged appropriately and identifying appropriate animal accession number, wasted medications, and appropriate drug vials.
• Drugs on site at each facility will be inventoried quarterly to ensure accuracy of record keeping. 
• All controlled drugs at any of these off-site facilities are listed under Dr. Sam Sander’s DEA license for each facility. 

Transport of non-controlled drugs for use at off-site zoo facilities

• Drug(s) and drug dose(s) are agreed upon by Zoo Ambulatory house officer and faculty
• House officer writes the prescription & pins off on the drugs
• Drugs are picked up from the Medication Dispensary (at VTH or VMSC) within 24 hours of the anticipated zoo visit. 
• Once picked up from the pharmacy, drugs are maintained in a secure location at the VMSC or in the direct possession of Zoo Ambulatory faculty, house officer, or technician until used or passed to Zoo staff for use as per the prescription label. 
  o Drugs requiring refrigeration will be kept in the refrigerator in the VMSC treatment room until transport to the zoos. Thereafter, they will be maintained in a Styrofoam cooler with an ice pack. 
  o Non-refrigerated medications are to be maintained with the zoo ambulatory equipment & housed in the VMSC until transport. Drugs are not to be left in the car unattended and care should be made to ensure drugs are not exposed to extreme temperatures. 
  o When at the zoo, there are times that animals must be treated or drugs transported 
  outside. During periods of extreme temperatures (hot or cold), drugs will be transported in a cooler with or without an icepack, as appropriate. 
• When returning to the University, if drugs are able to be returned to the Medication Dispensary at VTH or VMSC, similar transport practices can be maintained (i.e. refrigeration required drugs maintained in a cooler with an ice pack, non-refrigerated drugs maintained with other Zoo Ambulatory supplies, with care being taken not to leave the drugs in a car to be exposed to aberrant temperatures. 
• Unused drugs transported to the zoos CAN be returned to the Medication Dispensary as long as all procedures are followed in this SOP & per the Medication Dispensary policy (below)

Procedure (if applicable)

Medication Dispensary Medication Return Policy

Policy: Unused medications that are unopened (injectable medications and fluids) or are intact and were stored correctly (tablets and capsules) may be returned to pharmacy for credit prior to the patient being discharged from the hospital. No returns will be accepted once a patient has been discharged. Liquid medications poured from a stock bottle and compounded liquids are not eligible for return. Medications dispensed by the package (liquid Clavamox, Atopica, etc.) may not be returned for credit if opened/reconstituted. Compounded medications may not be returned for credit. No medications dispensed to a client may be returned for credit.

Guidelines:

1. All items must be returned to pharmacy prior to the patient being discharged for credit to be applied.
2. Medications must be returned in a state that allows for re-dispensing. 
   • Tablets and capsules must be intact and in correctly labeled bottles
   • Medications sold by the package must be unopened
   • Medications requiring reconstitution must not be reconstituted
   • Injectable medications must still have the plastic top or metal covering attached
   • Fluids must still be in the outer packaging (if dispensed from pharmacy that way)
3. Medications dispensed directly to a client are not eligible to be returned for credit
4. Items returned must contain patient information (name and MR#) to facilitate account credit

Medications that do not meet the requirements for credit should still be brought to the pharmacy for proper disposal.

To return medications to the pharmacy for credit:

1. Make sure each medication is packaged in such a way that it contains the patient name and MR# as well has having the medication name and strength clearly visible.
2. Bring the medications to pharmacy and place in the return bin. If the patient is being discharged shortly, notify pharmacy staff so processing the returns can be prioritized.
3. Pharmacy staff will process the returns for all eligible medications (see above requirements) and properly dispose of all medications that are not eligible for credit.
4. If the patient has already been discharged from the visit for which the medications were dispensed, pharmacy staff will dispose of the medications and no credit will be issued.

Definitions (if applicable)

Veterinary Teaching Hospital (VTH): The collective clinical services of the Large Animal Clinic, Midwest Equine, the Small Animal Clinic, and the Veterinary Medicine South Clinic.