Which drugs are you required to count?

[Emergent, RN]

We have new owners of our hospital. New, stricter controlled substances policy coming down the pipe. We'll now have to count toradol, flexeral, tramadol, in addition to what we already have to account for in our dispensing machine. I also heard from nurses on the floor that they are going to have to count the dispensing machine controlled substances at every shift change now. I'm figuring that ER will also be required to do so.

I've done agency work at a few places where they don't even have to have a witnesses waste for Ativan. I also did agency at a place that counted pepcid. One of the nurses there told me it was because employees were stealing it. That hospital was so understaffed, I guess everyone there had stomach problems!

What's the policy where you work? the memo said that these new items that I mentioned are popular for diverting.

[turnforthenurse, MSN, NP]

Flexeril, all nebulizer treatments (I guess because people were stealing them for their own home nebulizer machines) and a new one - IV Benadryl. Apparently it can be an ingredient to make crystal meth so now we have to count that, too.

Then of course your typical stuff - narcs, benzos, barbs...

[TheCommuter, BSN, RN]

Although we do not count Flexeril and Zanaflex, we are to be very careful when pulling these medications because people are prone to divert muscle relaxers for that 'feel-good' feeling.

We've started to count Tramadol within the past year. We also count Soma, Lyrica, all benzodiazepines, Lomotil, all narcotic pain killers, etc.

We are also required to count some high-theft non-narcotics such as regular strength Tylenol, Lexapro and Cipro. If one of these pills is missing, it appears as a Pyxis discrepancy that must be resolved.

[psu_213, BSN, RN]

Narcs, benzos, tramadol...I think that's it.

A lot of RNs are surprised that they don't need a witness for a waste/return on propofol, but except for the obvious (MJ), I don't really think this is an abused drug.

[TiffyRN, BSN, PhD]

We are also required to count some high-theft non-narcotics such as regular strength Tylenol, Lexapro and Cipro. If one of these pills is missing, it appears as a Pyxis discrepancy that must be resolved.

Tylenol? Seriously? Geesh. Our unit stocks bottles of generic tylenol and advil for staff use. That's insane. Might as well be counting gauze, tegaderms, alcohol swabs (just thinking of other things I've commonly seen "diverted").

[Fiona59]

Anything narcotic and testosterone patches.

We used to count Immovane but no longer. We've never counted tramadol, tramacet, toradol, or antihistamines.

[BrandonLPN, LPN]

I'm surprised by some of these.

Even from a strictly financial point of view, it seems to me that time spent counting tylenol every shift would be a much larger cost to the company than any "diversion".

[TiffyRN, BSN, PhD]

Even from a strictly financial point of view, it seems to me that time spent counting tylenol every shift would be a much larger cost to the company than any "diversion".

Hey remember, it theoretically costs nothing to add an additional task for nursing to perform. We don't charge by the task and if we can't get an additional task completed within our designated shift it's likely to just generate another memo about time management; intolerance of overtime . . .

Sent from my iPhone using allnurses

[TheCommuter, BSN, RN]

Might as well be counting gauze, tegaderms, alcohol swabs (just thinking of other things I've commonly seen "diverted").

Actually, the hospital where I work does 'count' gauze and tegaderms via charge stickers. I know it is not like an end-of-shift narcotic count in the traditional sense, but our central supply manager will send a nasty email memo to all staff if too many supplies are unaccounted for.

[applewhitern, BSN, RN]

Our medicine dispense machine decides what we count at the end of each shift. Usually, we only have to count whatever we used during that shift. If we used dilaudid, morphine, and Norco, that is what we would count at the end of the shift. As frugal as my facility is, I am surprised we don't have to count Tylenol.

[Twinmom06, ASN, APN]

we only count weekly (the majority of our pt's meds including Tramadol and Toradol are not in the Pyxis). We count Narcs, Benzos, Fentanyl patches, and sleepers (Ambien being the one I remember the most).

[psu_213, BSN, RN]

By "count," I mean document a count each time the medication is removed from the Pyxis. It would take us forever to count Tylenol each time, as there can be up to 60+ individually wrapped pills at any given time. Tramadol is pretty easy to count as it comes in sheets of ten. Presuming someone isn't being a turd, and they randomly pull the sheets apart (it's be known to happen), it is pretty easy to count.