DC'd narcotics

Airidis · Nov 4, 2011

Contact the pharmacy directly ask for a pick up from the pharmacist?

Mom2boysRN · Nov 4, 2011

We can't send narcs back so we destroy them.

merlee · Nov 4, 2011

Call the pharmacy, and the DON. Next the BON.

xtxrn, ASN, RN · Nov 4, 2011

We are still having a problem with management not removing narcotics that dc'd pts had. I counted 26 blister packs dated back to August. Mngmt. does not care if we are hanging onto these narcs as long as we watch over them. They even gave us more space to hold them. We want them to take them, but they will not and I want to know what to do to let them know that they really should take all those narcs. Also, what is not funny, we get new patients with orders for narcotic pain meds and even though we have a supply of e-kit narcs, we are told that they don't have enough to give our new pts and our pharmacy is taking more than 24 hrs to send their narcs sometimes. We're all fustrated.

I'm guessing this is an LTC?

The regs re: destroyed narcs aren't any joke. Do you have a company you work for, with a pharmacy consultant? This is something they should also be monitoring. And, if they have been there since the August dates on the packs, they're falling down on the job, also. But at least with corporate, there is another way to get someone's attention. If you don't want to risk getting in trouble , an anonymous tip to them via snail mail is an option. The nursing consultant is also someone who should "get it" about how important this is.

With the pharmacy not sending meds, a call to the state health dept that sends the surveyors should get this solved. Some heads might roll....which it sounds like isn't a bad thing. Just make sure you can't take the fall. Make a copy, sign and date any notes (not calls/verbal reports) to the DON/ADON/Admin about this. Do this daily until the meds are removed. As long as the meds are there in a LOCKED place (technically 2 locks- not just the med room- if they're not in a locked place IN the med room, it's out of compliance), I'd still count them to cover your butt- and include the overtime to do so :) Maybe the bottom line will help a bit.

About not having enough meds? The pharmacy is required to provide meds; I didn't hear narcs on the list of things that are being run out of, so they need to get with the program or be replaced. Twenty-four hours isn't even close to acceptable. If they have them for the e-box and refilling that, they have enough. As hard as it would be to NOT use the d/c'd meds for this, DON'T (I understand about 'borrowing' and while I always hated it, it was always with someone whose 'loan' could be repaid....a broken seal on a d/c'd card can't be explained).

I can understand your frustration; it's WAY against federal narc handling. Even the state surveyors would drill nails all over this. I used to do the documenting of d/c'd meds (all types) and the narcs were a PITA- but at the same time, they were secured. And, when the pharmacy consultant came every quarter, we all (DON/ADON/me/pharm guy/lady) sat in the DON office and punched EVERY med into a bucket, then poured the MOM and lacutulose over it, destroying it's ability to be used- and sealed it up for the consultant to destroy. All witnessed and documented. And he/she always counted the cards before we popped them. If there are discrepancies, it's a very real possibility that the Feds could come in- and from what I've heard, that's a very unpleasant experience. This is beyond the BON - this is federal.

Look for the stuff for your state "nursing home narcotic destruction in _____ (state)" AND "Federal LTC narcotic storage/destruction guidelines" - those should help you with your pleas to have something done- and if not, you have the info you need to support whatever you need to do :)

What a cluster- I'm sorry you're having to go through this.

xtxrn, ASN, RN · Nov 4, 2011

And for anybody doubting the "destruction" of the narc to be used s/p MOM/lactulose 'bath'..... here's a visual..... Vicodin riding a bullet train out the back door...

Munch · Nov 4, 2011

We can't send narcs back so we destroy them.

Same thing here...destroyed. We do have another problem when we get a person with chronic pain on the floor and we try to get all their meds straightened out(first we call their prescribing physician to verify what they are taking, the dosage and frequency). We actually have a problem with patients taking certain narcotics that we don't stock because they are expensive and actually not prescribed very much. For example Opana(IR and ER). If a patient knows about the admission before hand(like if they are coming in for surgery) we tell them to bring the medication we don't stock to the hospital and our pharmacy will take it and relabel it to suit the patients needs(it's illegal to keep narcotics at the bedside, that's why its immediately taken to pharmacy...of course it doesn't stop some patients from keeping their own prescription narcotics or even street drugs in their bags).

If they are admitted through emergency and don't have any of their medications on them we will try to substitute it with something similar if we don't stock the medication. The unfortunate thing is sometimes when a patient brings in their own rare narcotic they sometimes forget to take it home with them(we wait till time of discharge to send it back to them from the pharmacy) like I said before it's illegal to keep narcotics at the bedside hence waiting until they are discharged to give it back to then. Some patients wait for their medication and leave with it. Then we have some patients that either forget or don't feel like waiting and walk out.(sometimes it takes a little while for someone from pharmacy to bring the meds down..they also have to sign something saying they received their medication back that way they can't call back later saying they didn't get their meds and try to get a physician here to give them another script for it..believe me some patients who are addicted to their pain medications will do anything to get more meds). The people that do walk out without waiting for pharm to bring their meds down...who knows maybe they have a stockpile at home..or they tell their doctor they left it at the hospital and they get a new script..but even after they leave we call the patient and tell them they left their meds at the hospital and they have 5 days to come back to get them if they don't then pharmacy is required to destroy the medication. Damn shame too because it could be used for another patient that comes in and is on the same medication instead of giving them a substitute. It's also a shame because a medication like Opana ER does NOT come in a generic form and it can cause 100 dollars for a months supply(that's with insurance)..I know this because I am prescribed this medication..it's expensive.

Anyway I know I went on a tangent(as I sometimes like to do)...but all narcotics that aren't used are indeed destroyed.

Forever Sunshine, ASN, RN · Nov 4, 2011

D/C'd narcotics used to pile up and never be taken and it got to the point where ..to be honest.. we wouldn't count them. They would just sit in the narcotic box until someone ..god knows who took them out.

This bit us in the ass and I'm not going to get into specifics here but our new DON is always asking for D/C'd narcotics so its not a problem anymore thank god!

Our pharmacy can be painfully slow sometimes. I sometimes think it would be quicker to send a pony to go pick it up. Just document when the order was placed and any follow up calls that you made.

NurseOnAMotorcycle, ASN, RN · Nov 4, 2011

Unsure how your facility works. I'm in a hospital and we can walk the narcs to pharmacy if they are piling up (usually at end of shift after report) or call pharmacy to come get them. RN and pharmacist signs a sheet for who returned them, how many there were, and who received them in pharmacy.