adding up my narcotics

lavenderskies, BSN · Jan 19, 2016

Um I would definitely want every mg accounted for.

Maybe keep a notepad in your pocket with a running tally of what you gave/wasted....little checkmark by charted done ones?

crazin01 · Jan 19, 2016

Are the doses given as partials? Like, each vial of fentanyl has 100 mcg, so you're able to cover a few patients with one vial (even though technically not supposed to)? Is it wasted for each patient, or somehow not documented, then pulling patient C's dose from patient B's vial, still setting on counter after patient moved from procedure room/area and next one brought in? It sounds like it's not just you, which is somewhat comforting, and indicates everybody seems to be prone to the same issue. I guess that sounds somewhat better than everyone having different issues with the same negative result. Less problems to solve.

Do no other colleagues have concerns or ideas about what it could be? Giving a dose right before patient leaves room? Somebody being more 'generous' with dosing than what is ordered? And it's always the same person pushing meds, that withdraws from multi-dose vial and then gives that dose? Versus nurse A drawing up med, setting down and leaving area to check on something else, so nurse B gives dose? Even with all trust worthy co-workers, simply miscommunication can happen. You float there on wednesday, is that the same every week? Different nurses also floated there on a regular basis?

Even with the rapid pace, is it possible to count narcs or balance med drawer between patients? Especially if the docs know an issue is occurring regularly, they should give a few extra moments to figure out what is going on. I would wonder about diversion issues, but if there are regular overages as well, that sort of rules out that scenario. Or could be a clever way to avoid drawing attention.

Sorry, too many questions and scenarios that could be simple cause of it, but hard to pin-point exactly. I agree with the PP suggestion of an extra sheet/personal record you document and place a check mark or line thru med given for each patient. On my report sheet (cuz I am a dork and love fun computer stuff) I had pre-filled boxes with previous history, labs, IVF, drips etc, to document thoroughly but very quickly. A simple highliter color, circle around HTN, CABG, AVR, or line through is a 1/2 a second way to be able to document extremely efficiently with a little prep time.

Good luck playing detective. I'm curious as well. If you figure it out, I'd be interested to hear.

lavenderskies, BSN · Jan 19, 2016

On my report sheet (cuz I am a dork and love fun computer stuff) I had pre-filled boxes with previous history, labs, IVF, drips etc, to document thoroughly but very quickly. A simple highliter color, circle around HTN, CABG, AVR, or line through is a 1/2 a second way to be able to document extremely efficiently with a little prep time.

Is there any way you could take a pic of that and post it? :)

brownbook · Jan 19, 2016

Thanks for your ideas, just by my writing to Allnurses, writing out my thoughts, helps me get some ideas, plus combining some of your ideas.

All your concerns and questions are of course appropriate, we are talking narcotics, the biggest reason nurses lose their license! This is an out patient clinic that offers all kinds of out patient services. Pain clinics are sometimes once a week sometimes once a month. So no one really gets to do it frequently, no one gets to get a good routine down! Only one nurse is in the room giving the meds, call me naive, but diversion isn't an issue.

But as I said, I think I've thought up some ideas, ways, to get my drugs ready for each patient, ways to keep the unused portions separate so it adds up at the end of the day! We don't waste between patients, we wast al the end of the day.

AJJKRN · Jan 19, 2016

But as I said, I think I've thought up some ideas, ways, to get my drugs ready for each patient, ways to keep the unused portions separate so it adds up at the end of the day! We don't waste between patients, we wast al the end of the day.

I don't think diversion is the problem either but regardless of it being the norm for the practice, the red flag to me and the common denominator seems to be not wasting in between Pt's and waiting til the end of the day.

How does anyone know for sure what they gave each Pt hours after the fact? I wouldn't be able to backtrack it on myself either I don't think...

brownbook · Jan 19, 2016

I agree with the red flags, it would be great if another nurse could come into the room at the end of each case and co-sign wastes, that would solve the problem. But with 8 to 12 short quick cases....it is just kind of hard?

I don't know if anesthesiologists are held to the same standards? I know when they are in an OR all day they just have their circulating nurse co-sign wastes at the end of the day....they don't waste at the end of each case?

crazin01 · Jan 20, 2016

I have it saved as a word document, so I just print it out & keep lots of copies in my locker/bag when I traveled. I tried to keep it thorough but maximize space, as I was CV & ICU when I started my own brain sheet, so I could really only squeeze 2 patients on one normal size piece of paper. But I felt that it worked for me. I'm not sure if I can upload an attachment, to a post, but I can definitely email it, if I can't figure out how to do it through AN. I have two boxes for assessment, writing down previous assessment and then my current one, to ensure accuracy in changes, etc.

(Trying to use the copy/paste feature here, allowing to paste from microsoft word, not sure if it'll work).