Narcotics at the bedside in t he PACU

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    Does anybody have a policy in their institution regarding narcotics at the bedside in the PACU? Do you waste the narcs each time you give one dose? Do you leave your narcotics at the bedside? Have you ever had issues with JAHCO regarding this?
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    We don not waste our narcs every time we give a dose in the PACU. HOWEVER, policy reads that narcotics should never be left unattended. We are to tag the narcotics with the pt's name and keep them in front of us at all times (we are permitted to place them in our pockets). To my knowledge this has never been a problem with JAHCO. Hope this helps. :spin:

    azhiker96 and pinkfloydfreak like this.
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    How could you realistically waste narcotics after each dose? We keep them at the bedside and waste after the patient has moved on. We have lock boxes at each bedside that we're supposed to lock them in when we're not using them - but no one ever uses them - again not very realistic. I keep an eye on them, but sometimes I have to leave the bedside to grab something else. Sometimes I'll put them in my pocket, but we were told JACHO doesn't approve of that either. We've never had a problem.
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    We've just had a memo from pharmacy which essentially says that you don't give anything from a syringe that you haven't drawn up yourself (even though we always check each others narcotic draws and the syringes are labeled,double signed)...this would mean that if you go to break (15-45 minutes) you discard your syringe,they discard theirs on your return, and you draw up a new syringe....does anyone do this? No one. It's ludicrous.

    This is an example of a make-work project for people who sit behind desks all day...
    CCL RN likes this.
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    is unavoidable.

    I wish there was a realistic system; I've been doing this for a long time--haven't figured it out yet.
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    We have lockboxes as well, they work wonderfullythey are quite realistic...as opposed to taking narcotics home from being forgotten in your pocket! Besides i would hate to keep charging my pts for all these meds we are wasting and wasting
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    I am a PACU nurse at a small hospital. Until about a month ago, we have always titrated narcotics as needed and then lock them up and waste them (labeled correctly) at the end of our shift. We recently had a meeting that informed us that this is no longer acceptable. This has become a real problem for us nurses because often times there is just one nurse in recovery room, and being able to "defend our waste" is impossible unless we are staffed with 2 RN's or at least an LPN. Herein lies the problem. We all know ASPAN standards state that 2 RN's need to be in the PACU when there is a pt. present, regardless of their sedation level and acuity. Administration refuses to staff 2 RN's routinely (they only allow it on very busy days, and then only for a short time), yet expects us to manage our narcotics responsibly. It's like they want us to follow one standard, but not the other. We already had one nurse quit over this, and I don't blame her. But I really want to want to be a part of the solution. We have tried pulling nurses from other departments and supervisors to come in to pacu when we are using narcotics, but they can't stay the whole time, it's unreasonable to say the least.

    Has anyone else ran into this problem, and come to a solution?
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    Hairjm, how many theaters do you have, and what kind of cases do you get? You should have at least 1 staff member on duty for each theater running, if you are dealing with anaesthetized patients. Does your hospital have a policy that the anaesthesia provider wakes the patient up before transfer to the PACU?
    Last edit by GHGoonette on Feb 27, '11
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    We use the carpujects so the med is still in its original labed container for anything we can get that way. The meds are labeled with a pt sticker and kept at the bedside, in our immediate supervision. We have been told that with our upcoming survey expected any time, we will need a lock box at each bedside. It is NOT possible to waste after every dose, and a complete waste. Peole making the rules need to understand the situation in order to help make solutions
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    It would not be logical to waste after every dose, because if that was necessary, we would use an infinite number of vials of fentanyl and dilaudid.


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