Quote from rockchalk_jayhawk
[font=Comic Sans MS]We do not currently have "comfort pacs", but we want them. What are your protocols? Our pharmacies are willing to make them up for us and want to know about CII accountability and monitoring? If drugs are not used prior to patient expiring or dismissal or drug expiration, how are drugs disposed of? Is there any in home drug accountability? Do you as the nurse using the med, sign out for it?
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[font=Comic Sans MS]Completely sort of unrelated issue.... What are your Hospices standing orders and would you mind sharing them?
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[font=Comic Sans MS]Thanks... Peajay
The drug disposal thing is a weighty issue for us working in a residence/facility. This is with respect to narcs. Other meds are just logged on a sheet and sent back to pharmacy, if thats where they came from, or just disposed of, if they came from home. With narcs, the state law says that after someone dies we have to dispose of them that day. Our policy is to put them into a locked cabinet and then two nurses (the charge nurse and staff nurse) dispose of them on the midnight shift. The thing is, we have continual problems with miscommunication leading to pharmacy not getting us meds on time for when patients need them. This leads us to "borrowing", signing out meds as "wasted", from one patient for another; or, hoarding certain narcs from deceased patients that take a long time to get here, or which we are continually short. A lot of nurses have a problem with the drug disposal law because it leads to so much waste. It seems that pharmacy either sends us too little of something, or too much. It seems terrible to destroy 60 or so DRA gel packets when they have to be compounded by HP and take 2-3 days to get here. We know that we could get a new patient, or one of our patients could develop sudden intractable N/V which would be greatly helped by starting this med right away.
As for standing orders, we have a whole lot of them. We have several standing orders for almost any symptom that presents itself. The ones that we institute most often are: Roxanal, compazine, ducolax suppositories, haldol, ativan (which leads to much controversy between the nurses and the medical director), atropine, scopalamine patches, Morphine inj., and procedures such as, wound care and foley catheters (also leading to controversy).