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- by LMTRN Oct 28, '09I work for a small hospice. We recently had an incident, 2 nurses sign narcotics in from the pharmacy, but only one signiture is required to sign them out to give to patients. Our medication room is locked, and the medication cabinet is locked, but all nurses on the floor have access to all medications.
Does anyone else have as archaic a system as this? And if so, how is it handled?
- Nov 2, '09 by HospiceRN08I work for a larger hospice and our inpatient unit handiling of medications is just as ancient. We have full-time pharmacists but when they are not here we charge nurses have access to the pharmacy and only one signature is required to remove medications (including narcs) from the pharmacy. Two nurses signatures are required for wastes of one-time use vials. Our stock narcs (so we're not constantly taking meds out of the pharmacy) are in locked medication carts and every nurse on the floor has access to them (part of shift change is handing off your set of narc cabinet keys to the oncoming nurse). Part of shift change is counting the entire narc cabinet with one of the oncoming nurses. Talk about a pain in the butt.
It becomes problematic because we have a lot of multi-use vials of IV/subcut drugs like Nembutal where it's only possible to guestimate the actual amount left in the vial and no one knows the count is off until someone goes to draw up a certain amount of medication and realizes that there's not as much medication in the vial as the count sheet says. Then we have the oral liquid medications like Roxanol, Oxyfast, Methadone where the count can often be off not necessarily because of anyone's dishonesty, but because of small spills or sometimes what looks like 100cc to one nurse may look like 95cc to the pharmacist. Then somtimes you have a pt in severe pain and you might rush to pull out a vial of Dilaudid without signing it out, figuring that you'll come back and sign it out later (pt care, not paperwork is always my priority) but then you forget and somebody freaks out about a missing vial of Dilaudid. Fortunately, the nurses have a good relationship with the pharmacists, so we generally can ask one of them to come sign off on an adjustment of medication amounts and such.
- Nov 2, '09 by Ginapixiall i can say is: you are lucky! - so the count is off, at least you have acces to meds you need for the patients.
we get every thing delivered; either to the pts homes or to our small inpatient facility; if some one forgets to order in time we are down the famous creek with out a paddle! last Friday we called a local pharmacy that is open 24 hrs, they help us out quite a bit on off shifts when our delivering pharmacy is closed; they called 5 of their branches, not ONE had Roxanol in stock! and a pixys in our office would solve a lot of that! so yes, there are a lot more behind the times hospices! sad!
- Nov 3, '09 by HospiceRN08Wow, I can't imagine having to order everything like that. Especially on an inpatient unit. The whole purpose of the inpatient unit is to be able to deal with those acute issues, but if you have to sit around waiting for Roxanol to be delivered then the patient might as well be at home in pain waiting for it to be delivered.
- Nov 3, '09 by schroeders_pianoI haven't worked hospice, but I worked in an ICU that still had a nacr cabinet that had to be counted each shift. We had every possible narc you could imagine in that cabinet and every RN had access to it. To make it easier when it came to counting roxanol and other liquids the pharmacy started providing it in unit dosing. You can get commercially produce unit dose roxanol. For the other meds, they drew up a standard dose in an oral syringe and capped it off. With shift count, we just counted the number of syringes left. It actually made everything go easier and faster. It took the guessing out of it.
It might be an option for you.