Regional Drug and I.V. Box Program Information

In an effort to improve understanding and the daily use of the drug and I.V. box system, we are providing the following information as a resource and reminder to everyone. Where appropriate, related policies found in the TEMS Regional Medical Protocol Manual will be referenced in [ ]. The success of the regional drug and I.V. box exchange system is based on the full understanding and support of the system by EMS providers, hospital pharmacists, Operational Medical Directors and emergency department attending physicians. Please contact This email address is being protected from spambots. You need JavaScript enabled to view it. (757) 963-0632 if you have any questions or need assistance.

Drug and I.V. Box System: Ownership, Placing Boxes in Service - Updated 7-1-2006

There are over 400 drug boxes and 500 IV boxes in the TEMS system. These boxes are purchased by the individual EMS agencies. After the boxes are placed in service for the region, Tidewater EMS will take over the "Ownership" of the boxes for repair and replacement purposes.  The contents are supplied and owned by the hospital pharmacies. The content list, and related usage protocols, are developed by the Operational Medical Directors.

When an agency places an additional (new) ALS vehicle in service in the TEMS region, the agency is required to purchase two drug (red) boxes and two I.V. (orange) boxes, one set each for the vehicle and one set each to be placed in the local pharmacy for exchange. Before being placed into the system the drug and I.V. boxes are assigned an inventory control number and "tagged" by the TEMS office. [Appendix B - Drug And I.V. Box Policy] After receiving inventory control numbers and tags, the boxes are taken by the agency to the closest pharmacy for initial stocking. (In the event that the agency is placing more than four boxes in service, and where an agency transports to several hospitals, the new boxes may be distributed among the receiving hospitals. Advice will be provided by the TEMS staff.) Remember, after the boxes are placed into the regional system, ownership will be maintained by TEMS.

Drug and I. V. Box Quarterly Inventory

An inventory of all drug and I.V. boxes is performed on a quarterly basis. Each advanced life support agency in the TEMS area is responsible for conducting this inventory on the third Wednesday of each March, June, September and December and forwarding that inventory to the TEMS office. The TEMS staff and EMS Medical Operations Committee (MOC) monitor compliance with the inventory requirement. One failure to report inventory will result in a letter to the agency's administrator, with a copy to the OMD, outlining corrective action. A second consecutive failure to report will result in a panel convened to review the failures and make final determinations about the agency's continued participation in the regional IV and drug box exchange system. [Appendix B - Drug And I.V. Box Policy] 

Drug and I.V. Box Cleanliness

When a drug and/or I.V. box is used, the prehospital provider is responsible for disposing of all opened/used sharps and other trash that may be in the box prior to returning the box to the pharmacy for exchange. In addition, the boxes should be clean and free of blood or other body fluids. [Appendix A - Related Policies and Procedures, item #1]

Before accepting a drug and/or I.V. box for exchange, pharmacy staff should check to ensure that the box is clean and free of exposed sharps. If it is not, pharmacy staff should advise the prehospital provider of this and require the box(es) be cleaned before making the exchange. In the event that the box(es) were left at the hospital during hours the pharmacy was not open, or in a ED exchange locker, the name of the technician who exchanged the box(es) as well as the agency name should be easily readable on the Prehospital Patient Care Report (PPCR). The receiving pharmacy should contact that agency and request that a representative of the agency respond immediately to clean the box(es). Pharmacy personnel should also complete a TEMS Pre-Hospital Drug and I.V. Incident Report to the TEMS office in a timely manner.

Disposal of Partially-Used Controlled Medications

Partially used controlled medications not administered to the patient will be discarded at the hospital. The disposal must be witnessed by an EMT-I, EMT-P, registered nurse or pharmacist. The witness must counter-sign the Pre-Hospital Patient Care Report where the advanced life support provider has clearly indicated the medication wasted. [Appendix A, Related Policies and Procedures, item 11. Disposal of Unused Controlled Medications]

Damaged or Broken Drug/I.V. Boxes

Members of the MOC have agreed that if a box is damaged and cannot be repaired, TEMS Staff will be responsible for replacing the box within the system. If the box can be repaired, the TEMS Staff will make the  repair(s).

If the box is found to be damaged while in the possession of a pharmacy, pharmacy staff should contact the TEMS office with the box type and inventory number by using the web based Pre-hospital Drug and I.V. Box Incident Report . TEMS Staff will make the arrangements for pick-up and drop off of the box(es).

Drug & I.V. Box Exchange (General)

It was the decision of the Operational Medical Directors and the members of the MOC, consistent with state Pharmacy Board regulations, that a box-for-box system be used when exchanging drug and I.V. boxes rather than item for item. The policy for this exchange is very specific and must be followed in its entirety. [Appendix B - Drug & IV Box Policy.]

 Drug & I.V. Box Exchange (Special - Sentara Norfolk General Only)

As of 1-8-2007 The ER Remote Exchange is limited to Norfolk Fire-Rescue. ALL other exchanges need to take place at the main pharmacy on the second floor.

Please contact This email address is being protected from spambots. You need JavaScript enabled to view it., the EMS Regional Field Coordniator if you have any questions or concerns.


Drug & I.V. Box Content Problems

From time to time the field provider may open a drug and/or I.V. box to find certain medications, fluids or other supplies missing or the box may not be stocked appropriately. In these cases a TEMS Pre-hospital Drug and I.V. Box Incident Report should be completed by the field provider finding the problem. After completion the form will be submitted to the TEMS office. A "Drug diversion" form should also be filed if Schedule II-V Drugs are missing/damaged.

If the problem with a drug and/or I.V. box is found by pharmacy staff, the TEMS Pre-hospital Drug and I.V. Box Incident Report should be completed.

Complete Instructions can be found here