narcotic from e-kit..

Specialties Geriatric

Published

im working in an LTC facility..we received an order for MS Contin 30mg BID the night before my shift...i work 6-2..the pharmacy didn't deliver it yet..so i decided to take it from our "narcotic e-kit" so i can give it on my med pass that morning... then i saw that the 'e-kit' only has MS Contin 15mg. so i decided to take out 2 tabs.

is there a law that forbids what i did? taking out 2 tabs to make out the ordered 30mg? my fellow nurses from that facility said that it's not allowed. so im scared and worried.. :confused::uhoh3::confused::uhoh3:

please help me...

So sorry :(

I've never worked in any LTC that required permission to use the e-box :)

A more stringent enforcement of the "nurses can't dispense" rationale.....fairly new, and distinctly a PIA

Specializes in LTC.
So sorry :(

I've never worked in any LTC that required permission to use the e-box :)

We need an MD order to take a dose of a medication from the ebox. Its used when a med is out, or for a stat dose. Thats why the ebox is there OP- not to collect dust.

Did you take out the meds the night before for use the next morning? That, I would most certainly get in big trouble for.

At my job the "e-box" is in a pyxsus that only the RN Supervisor for the shift has the codes for. We have to call her and ask for what we need. She has to go get it from the pyx. and bring it to us. She isn't required to get "permission" from anyone or a special MD order to access the ebox.

I have never worked a LTC care where you did not need an authorization code to get a narc from the E-Kit. I think the best thing to do would be to call pharmacy or your DON for the right answer. After all, we here in AN land do not know the specifics of your facility.

You may also want to ask the DON or Education person if they can hold an inservice on this issue esp. for those that have been hired after the last inservice. If the older floor nurses are questioning what you did and they were there for the previous inservice, this might be something worth looking further into for you peace of mind and for future reference.

P.S I really hope your question was more regarding the use of the narc E-kit than giving 2 tabs to fill an ordered dose. Coz we all know from those pesky medication math exams we had to pass every semester just to advance into the next semester, it's not how many tabs you are giving, it's if you are giving the ordered dose.

Specializes in Gerontology, Med surg, Home Health.

You need an MD order and a script to take any narcs out of the e-kit. It's always been the law but only recently has the DEA started making an issue of it. It's considered dispensing. Honestly all it does is make it harder for those of us who work In long term care to take care of our patients.

Specializes in Geriatrics, Transplant, Education.

OP, seems the issue is whether you needed permission or not, which as CCM mentions, you should need it.

In my facility, the provider must call the pharmacy's narcotic dispensing number and obtain permission (which the pharmacist then calls to the nurse) to remove x number of tabs from the e-kit. This only applies for new patients/new orders as they don't see it as an excuse to not obtain scripts for old orders in a timely fashion.

Also, wish we had MS Contin and/or Oxycontin in the e-kit at my facility--we don't. I lobbied for a long time to get Dilaudid put in ours. Ours carries Morphine (injectable & sublingual), Phenobarb injectable (which I've never once used in 3 years..), Tylenol #3, Vicodin 5/500, Percocet 5/325, Oxycodone 5mg, Dilaudid 2mg, Ativan 0.5mg and Duragesic 25mcg

Specializes in Gerontology, Med surg, Home Health.

It practically takes an act of Congress to change anything in a narcotic e-kit in Massachusetts.....yeah I know we don't have our own Congress. What's in the kit is as regulated as everything else.

Specializes in LTC.

It's awful, but I try to pretend that the E-box here does not exist. It is HELL trying to get it open.

I must OK with supervisor, call pharmacy, have them fax a form, fill it out and refax, Call the DR, call the pharm again for confirmation number, Fill out a narc sheet, update all of the narc sheet numbers in the building to reflect the fact that I opened the box....

DO NOT WANT.

Seriously , it's quicker to request emergency delivery from the pharm.

Specializes in LTC.
You need an MD order and a script to take any narcs out of the e-kit. It's always been the law but only recently has the DEA started making an issue of it. It's considered dispensing. Honestly all it does is make it harder for those of us who work In long term care to take care of our patients.

Drives me up the damn wall

Specializes in Med/Surg, Rehab.

I believe you did the right thing in taking two tabs to equal 30 mg. What the other nurses may have meant is that with some pills, 1+1 does not equal 2. I went to a pharmacy inservice on this, and don't remember the exact example, but basically two 50mg tabs of Metoprolol do not equal the same dose as the 100mg tab. There is additional drug built into the coating of each one that breaks down in the body. However I think that is only the case with extended release drugs.

I believe you did the right thing in taking two tabs to equal 30 mg. What the other nurses may have meant is that with some pills, 1+1 does not equal 2. I went to a pharmacy inservice on this, and don't remember the exact example, but basically two 50mg tabs of Metoprolol do not equal the same dose as the 100mg tab. There is additional drug built into the coating of each one that breaks down in the body. However I think that is only the case with extended release drugs.

Augmentin would be an example of this.....http://augmentin.org/

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