Need help defining research "key words" please!

[Student Mom to Three]

Hello-

I am a senior nursing student (in more ways than one!) and am doing some online research for a paper I need to write. Basically, I need to locate some research (actual experiment or meta-analysis) that has been done regarding appropriate management of multi-use narcotic tubexes. I'm referring primarily to those medications that are given as part of an operative procedure or in recovery.....the ones that are fentanyl, or hydromorphone or similar q 3-5 minutes. I need to find some research that indicates the safest way to maintain the actual narcotic between doses. Many anesthesia providers keep the partially filled syringes in their pockets....but what are nurses in recovery supposed to do with them? I can't imagine they keep them in their pocket. Do they keep them at bedside? Are they locked up? I know what should happen with them (ideally they would be locked), but I would like to find research backing that up.

Am I making sense?

I have gone to CINAHL and google and am having no luck finding any research. I have been looking along the lines of preventing diversion, managing narcotics in recovery/OR/PACU, etc and am getting nowhere. The only research article I found was done by pharmacy and is about safety measures taken with the ADMs.

Any ideas? I'm not looking for someone to do the work for me, just to share some ideas of key words that could point me in the right direction.

Thanks!!

[rn/writer, RN]

Normally we move student threads to the Nursing Student forums. This request, however, is not likely to be something other students, or even other med/surg nurses who read the student forums, would know much about.

If any of you experienced OR/PACU nurses subscribe to professional journals that have addressed the questions the OP is asking, or if you are aware of any research on the subject, maybe you can share your knowledge. Even if you don't have information about actual research, you could tell her how things are handled at your facility and if the rationales behind your current P&P are evidence based.

Thanks for your assistance.

[GHGoonette, BSN, RN]

The safest way is with patient-controlled analgesia, which administers a preset dose with a lock-out time. There are various types, electronic programmable pumps , which can administer the narcotic either automatically, as set by the anaesthesia provider, or manually, by the patient; and there are manual pumps such as the Viking Medical or Vygon pump.

Without the PCA pump, the anaesthetists usually give a loading dose in OR, bring the syringe to PACU and hand it to the RN taking the patient with instructions regarding the frequency and dosage. Normally it's something like 1-2mg Morphine at 5 minute intervals as required. On discharge from PACU any remaining substance is discarded in view of a witness. In such circumstances it's a matter of trust; after all, there's nothing stopping RN and witness from sharing it out between themselves Except ethics, of course.

I admit, I don't know of any specific study material governing this, other than regulations concerning the control of scheduled substances. You might find more help in that regard from the CRNAs.

[GHGoonette, BSN, RN]

Ha, I love questions like this, they prompt me to do my own hunting! Here's a lovely site which may give you some guidelines:

http://www.google.co.za/url?sa=t&rct=j&q=narcotics%2Bin%2Brecovery%2Broom&source=web&cd=9&ved=0CFkQFjAI&url=http%3A%2F%2Fwww.aspan.org%2FDefault.aspx%3FTabName%3DFAQs&ei=acOqTp6tL6jLmAXR_rDhDg&usg=AFQjCNH64jADqLcRVL7uSyi9SMbo_gsnOA&sig2=CH-STraTT-cN358YNJNXhg&cad=rja

Here's a British study:

http://www.google.co.za/url?sa=t&rct=j&q=control%2Bof%2Bnarcotics%2Bin%2Brecovery%2Broom&source=web&cd=5&ved=0CDoQFjAE&url=http%3A%2F%2Fwww.aagbi.org%2Fsites%2Fdefault%2Ffiles%2Fcontroldrugs95.pdf&ei=u8eqTrzJHczzmAWI100&usg=AFQjCNFzT7iZrlVKYlgHsrlvBBHlMyPcQw&sig2=SkpBvG2YI4mASUvSrzC6cA&cad=rja

Don't know if this one will help:

http://www.google.co.za/url?sa=t&rct=j&q=control%2Bof%2Bnarcotics%2Bin%2Brecovery%2Broom&source=web&cd=4&ved=0CDEQFjAD&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F8004735&ei=u8eqTrzJHczzmAWI100&usg=AFQjCNFduvH-nAbHwU-LocWFjH8240-CNw&sig2=0aIkArriYb17YDZ0tLqltA&cad=rja

[katkonk, BSN, RN]

Typically in PACU, when we get a med from the narcotics cabinet or Pyxis, the syringe is simply set on the bedside table by the patient, until it is no longer needed and is wasted, or all used. It has rarely ever been a problem, although the potential is there for problems. Ideally, the bedside table would have a drawer with a key lock, and it could be placed in there. I always put a name sticker on my syringes when I am working in a busy PACU. Things get very fast and frantic. In all my years of nursing, only a couple of times have syringes come up missing, and were likely simply knocked off into a trash can, or in a rush thrown into the sharps container without noting the waste, or dropped/kicked under a bed and simply not located at the time. Usually the syringe is quite happy to rest on the bedside table by the patient with no other problems. I can tell you, in the fast and furious pace of a busy PACU, with the management wanting us to receive, recover, dress, give discharge instructions and wheel them out or send to a room in 45 minutes to 1 hour, locking and unlocking drawers would slow us down, even though it is a good idea.

[brownbook]

I put the syringe in my scrub pocket like the anesthesiologists do. Some co-workers put the syringe in the patients chart/folder that is kept at the nursing station.

I rarely have a problem with the syringe being accidentally depressed and a fentanyl boob, but when it happens no co-worker has questioned me when I ask them to co-sign my "waste."