Narcotics Questions

Nurses General Nursing

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Specializes in HIV/AIDS, Dementia, Psych.

I have two questions regarding narcotics and the regulations we follow when dealing with them.

1. A patient of mine was admitted with an order for 70mg methadone BID. The pharmacy sent us blister packs with (3) 10mg tabs per blister (30mg). Then they sent a big bottle with 40mg methadone wafers. They sent 60 wafers to last the month. Here's my question...how do you count the wafers? What we have been doing is putting on gloves and transferring the wafers into a sterile specimen cup with as little hand contact as possible. Do any of you have any better suggestions?

2. When I am giving out medications, I first go into the room and do my morning assessment, take vitals as need be and ask my patient if there is anything he/she needs or wants. This way if they want a pain med or compazine or something, I can get all their meds ready at once. If at the time I am asking, they say they do not want their narcotic (one that is prescribed as a straight order) do you still have to pop and waste it? I never did that before. I always just didn't pop it....But recently someone told me that was wrong. What do you think?

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1) No, I can't think of a better way, except maybe to ask the pharmacy if they could please blister pack the wafers for you. Pharmacies have many options for creative unit-dose packaging! Perhaps someone in the pharmacy just didn't think through that the big bottle meant that multiple people were going to have to handle the tablets (to count narcotics) multiple times each day? I'm sure that, if you pointed that out to them, they would agree it's a bad idea.

2) I've never heard of having to waste an unopened narcotic (or any other unopened med) because the patient refused it in advance -- I would just document it as refused, same as anything else. Why should the patient get charged for the dose when s/he didn't want it and didn't take it??

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i agree w/elkpark totally.

it's much safer to keep the narc in the blister pack than to take it out and waste it. just circle and write "refused". if he keeps on refusing, the md may want to change it to prn.

leslie

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i agree w/elkpark totally.

it's much safer to keep the narc in the blister pack than to take it out and waste it. just circle and write "refused". if he keeps on refusing, the md may want to change it to prn.

leslie

Yep I third it! Call the pharmacy and ask them about packaging options.

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Specializes in Med/Surg, Ortho.

I fouth,, and if you are wasting a narcotic that is scheduled for the patient and they refuse it,, they are getting charged for it regardless. If you dont waste it they shouldnt be getting charged for that dose.

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Specializes in med/surg.
I have two questions regarding narcotics and the regulations we follow when dealing with them.

1. A patient of mine was admitted with an order for 70mg methadone BID. The pharmacy sent us blister packs with (3) 10mg tabs per blister (30mg). Then they sent a big bottle with 40mg methadone wafers. They sent 60 wafers to last the month. Here's my question...how do you count the wafers? What we have been doing is putting on gloves and transferring the wafers into a sterile specimen cup with as little hand contact as possible. Do any of you have any better suggestions?

I have a few questions/comments of my own:

  • What happens to the wafers when this patient leaves your facility? Does your pharmacist reuse them for another patient?
  • What happens if this medication is need for another patient who may be latex allergic and the RNs have been counting them while wearing gloves? Latex dust/powder from gloves would have long since contaminated the wafers.
  • What made your pharmacist decide to provide you with two (2) separate form of the same drug (that could be a cause for a med error)?
  • Three tablets per blister pack sounds like an inhouse packaging from your pharmacy, if so, they could have packed the wafers individually, packed the pills either as single dose (70mg) or single tablets.

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if the tabs are scorable,the pharmacy can split them and then provide the 70 mgs per blister pack.

leslie

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Specializes in HIV/AIDS, Dementia, Psych.

Thanks for the replies :)

Thanks for the suggestion of asking the pharmacy to repackage it, but it's impossible. We don't have an in house pharmacy and no one would feel comfy giving the methadone to a driver to take back to the pharmacy for repackaging.

I guess we'll have to tough it out until our next order when I'll make sure that man is taking 14 pills a day!! :rotfl:

In response to Pam...

1. I am in long term care. This patient unfortunately will probably not be leaving the facility and if he were to do so, we never send back narcotics, they are destroyed.

2. We are a latex and powder free facility and we also do not use meds for multiple patients. Mr. Jones uses Mr. Jones' methadone and Mr. Smith uses Mr. Smith's methadone etc.

3. We were provided with 2 seperate doses because I suppose the pharmacy thought it would be easier to take 8 pills a day other than 14. Methadone only comes in certain strengths.

:)

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Specializes in Skilled nursing@ LTC.

Hove you thought about using something like sandwich bags? Have them bundled up in groups of ten- that way you can see through the bag to count and ten is an easy number.

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Specializes in HIV/AIDS, Dementia, Psych.
Hove you thought about using something like sandwich bags? Have them bundled up in groups of ten- that way you can see through the bag to count and ten is an easy number.

That's an excellent idea! Thank you! I'll implement that tomorrow... :yeah:

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