Controlled Substances 

Omnicell & Carousel

1. Cath Lab Restock Log 2022
2. Cath Lab Pre-Procedure 6.30.2021

1. Anticoagulation Monitoring Sheet 8.2019
2. Pharmacokinetic Monitoring Form 8.2019
3. TPN Monitoring Form 8.2019

1. Controlled Substance Invoice Audit Form 2023
2. Controlled Substance - Key Accountability Form   2017
3. Controlled Substance Admin Record - Downtime Document 6.10.2022

1. Carousel Expiration Date Checking Log  11.2022
2. Omnicell Cleaning Checklist 3.2019
   
3. Omnicell QA Log Form 5.2020
4. Omnicell Temporary Patient Log Sheet (For ED)
5. Omnicell Weekly Cycle Count Verification Form 2005
6. Weekly Omnicell Return Bin Log 2021
7. Omnicell User Type Access Table 4.2023

Liaison Forms

Silvis Override Lists by Unit

1. Adult and Pediatric Resuscitation Record (GMC Aledo, Davenport, DeWitt, Silvis, Select)
2. Crash Cart Defibrillation/AED Check List (GMC Davenport)2019                                  
3. GMC Aledo & Dewitt Locations 2019
4. GMC Davenport East Locations 2024
5. GMC Silvis Locations 2019

1. Crash Cart Log Form
2. Adult Crash Cart Medication Replacement GMC Davenport 2022
3. Crash Cart Replacement Process Flowchart (GMC Davenport) 
4. Crash Cart Supply List (GMC Davenport) 2020
5. Crash Cart Medications Pediatric (Silvis) 2019

1. Adult Emergency Medication Transport Kit Charge Form
2. Adult Emergency Medication Transport Kit (Cardstock card) 2023
3. CA Pharmacy Inspection Checklist 2.2023

                 GMC SILVIS Master Override Med List 2021

1. 1. 1. ICU
      2. MED SURG
      3. OB
      4. OPCC - INFUSION
      5. PACU

1. Chemo Drug Order Form
2. CSP Daily Batch Schedule 2024
3. IV Compounding Record - GMC 2019
4. Nonsterile Compounding Product Log 
5. TPN Log 2023

         2024 Checklists

1. Chemotherapy Checklist Rev.2.2024
2. Chemo Checklist Ado-Trastuzumab
3. Chemo Checklist Azacitidine
4. Chemo Checklist Bortezomib
5. Chemo Checklist Carboplatin
6. Chemo Checklist Carfilzomib
7. Chemo Checklist Cyclophospharmide
8. Chemo Checklist DOCEtaxel
9. Chemo Checklist DOXOrubicin
10. Chemo Checklist Enfortumab Vedotin
11. Chemo Checklist Etoposide
12. Chemo Checklist Fam-Trastuzumab
13. Chemo Checklist Florouracil Push
14. Chemo Checklist Florouracil CADD2
15. Chemo Checklist Gemcitabine
16. Chemo Checklist Irinotecan
17. Chemo Checklist OXALIplatin
18. Chemo Checklist PACLItaxel protein bound-Abraxane
19. Chemo Checklist PACLitaxel

1. Acute MI Alert Pharmacy Charge Sheet 2022
2. Anesthesia Radiology Procedure Tray (anesthesia box) 2022
3. Calfactant (Infasurf^®) Charge Sheet 2014
4. Day Rehabilitation Floor Stock/Charge Sheet 2014
5. Dialysis Floor Stock 2024
6. Employee Health Floor Stock Request 2023
7. Headache Clinic floor Stock/Charge Sheet 2024
8. Isopropyl Alcohol Charge Sheet 2022
9. Mississippi Valley Regional Blood Center Floor Stock Request 2021
10. NICU Transport Medication List/Charge Sheet 2019
11. Radiology Anaphylaxis Reaction Kit Charge Sheet 2020
12. Rapid Sequence Intubation  2013
13. Charge Sheet GMC Aledo, GMC DeWitt, GMC Silvis 2019
14. Rapid Sequence Intubation Charge Sheet GMC Davenport 2019
15. Wound Institute Floor Stock/Charge Sheet
16. Center for Breast Health Floor Stock/Charge Sheet

1. Discharge Medication Checklist / FirstMed Flier 
2. Patient Home Medication Control Substance Destruction
3. Patients Own Medication - Secured Storage Log
4. Patient's Own Medication - Controlled Substance Administration Log

1. Alteplase or TNKase (Not Administered) Returned Form
2. Cart Fill Quality Assurance West campus
3. Adult Emergency Medication Transportation Kit
4. Release from Responsibility / Liability Waiver Form
5. Accreditation Readiness
6. Accreditation Readiness Non-Patient Care Area