DEA regulation to be inforced and I&O

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So nurses were told this week that dea regulations were going to be enforced now. Any narcotics ordered must be called to pharmacy by md or his agent , which we are not, or faxed from md's office. No narcotics may be given from e-kit without a permission slip from pharmacy. I feel sorry for patients that admit after 5 pm or on the weekends. It will be bad for them if they come post-op with no pain meds available to them. Can't see some of our docs calling the pharmacy after hours. Some barely call us back after hours.

Was also told by admin nurse that any patient on lasix should be on I&O. Olay what about aldactone? hctz? Any diuretic? or just lasix? That would be almost all of my 22 patients. Would they be on I&O at home? Check for edema,yes. I&O no.

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Specializes in Geriatrics, Transplant, Education.

The DEA regulation regarding schedule II meds and the narcotic e-kit is going to be nothing but a pain in the neck for nurses and cause extra hassle and an unecessary wait for pain medication for so many post op patients in my facility. It's in effect at my facility, hasn't effected any patient of mine yet, but the thought of all the trouble makes me cringe. Takes long enough all ready to go bother the nurse who has the e-kit on her cart for Oxycodone or whatever for my new admit---now all this business about the doc calling the pharmacist is just going to make things worse. :down:

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This is one pain in the butt, and certainly conflicts with good nursing practice. We've been dealing with it for 6 months. First it was the schedule 2 meds, then they added schedule 3 and 4. It sucks big time.

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The narcotic rules are not new, just now being enforced. I had a hard time accepting the new rules when I came back after maternity leave a few months ago.

I totally get the frustration about the getting prns in the off shifts. It is esp hard when there are docs on call and your medical director has someone and someone else for that person taking call. Yesh!!

After much frustration and discussion, what has to happen is that the DON needs to discuss these regs with the MDs that use your facility. A script should be sent with them from the hospital or the MDs need to know that we will be calling them up and making them call in the new orders themselves.

As far as the lasix and I/O...that would be over half of my residents. We only do I/O if they are ordered it my the MD or placed on "strict" I/O

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Specializes in Hospital Education Coordinator.

ER docs can write orders for pain meds.

I have always practiced strict I&O on any patient with diuretic. It is not that hard once you get in the groove. Don't think of it as a change, just an adjustment. Somehow that sounds less threatening.

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Specializes in Gerontology, nursing education.

I & O. In LTC.

This one kinda frosts my eyeballs because in LTC, the point is to make the facility as home-like as possible, not like a mini-hospital, because it is the residents' HOME. As you said, calliesue, how many people do accurate I & O at home?

Reminds me of one time I was concerned about a resident with nocturia and thought maybe it had something to do with the person's fluid intake patterns in the evening. I asked, begged, pleaded to do an accurate I & O on the resident for just three days so we could see a pattern. Nope. Can't do it. Too much of a hassle. The CNAs weren't used to doing I & O so they just couldn't manage to do it, not even for a couple of days. Got a lot of rolling eyeballs at my suggestion---I mean, how utterly outrageous to try to figure out if there could be a fluid intake pattern problem that's making someone piddle all night. (Oh, well, at least the staff complied on my shift but on the other shifts, eh, fuggedaboutit.)

Methinks your institution may run into similar problems with nurses and nursing assistants who don't see the reason for accurate I & Os. And, frankly, I don't see the reason, either, unless there's a problem that needs to be solved.

The narcotic issue is going to be a real pain, sorry, pun intended. Just seems bizarre that the regulations have been in effect for some time but are just now being enforced. Again, there will be compliance issues, not because of sloppy practice or drug diversion, but because nurses just aren't used to it. Hope the management will give your staff a bit of time to get used to this change and not start decapitating people immediately.

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Specializes in Gerontology, Med surg, Home Health.

If the resident has been on a stable dose of a diuretic, there is no clinical reason to do an I+O. Maybe you could argue with a dose change ...maybe but not necessarily. We don't do I+O unless it's absolutely positively necessary. They used to do them here if someone had an antibiotic but no one could explain why. And then they would do them but wouldn't measure the output...they'd chart x 4 or 5. Made me crazy so we got rid of most of them with the blessing of the medical director.

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Specializes in Gerontology, nursing education.
If the resident has been on a stable dose of a diuretic, there is no clinical reason to do an I+O. Maybe you could argue with a dose change ...maybe but not necessarily. We don't do I+O unless it's absolutely positively necessary. They used to do them here if someone had an antibiotic but no one could explain why. And then they would do them but wouldn't measure the output...they'd chart x 4 or 5. Made me crazy so we got rid of most of them with the blessing of the medical director.

CCM, at least they charted the number of times the resident voided. Shoot, in the situation I described, no one could figure out why it might be necessary to specify if the resident voided a large amount X times during a shift or small amounts at a time...and no one could understand why I thought it necessary to state how much the resident drank, how often, and what kinds of fluids (i.e., coffee as a diuretic.)

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Specializes in LTC, ER, ICU, Psych, Med-surg...etc....

In my experience, I and O is nothing but trouble unless it is for some specific reason and only for a perscribed length of time.

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Specializes in Med-Surg, LTC.

The DEA regs on narcotics are simply ridiculous. I know they are not new, just now being enforced, but it is simply another major hassle to be dealt with in order to provide patients with adequate care. Not even superior or good care, just adequate. There are ways that the facility can plan around it-getting scripts in advance, etc., but sometimes things do come up. I am charge on the weekends-can't tell you how many times the mgr during the week forgot to get scripts signed. Now Mr. Smith with bone ca has run out of his oxycodone and his doc is at a baseball game, asking me why it wasn't taken care of or why the pharmacy can't take a VO from a nurse (when they know the regs). It's simply silly that I can take a VO from a doc to do all kinds of invasive things, but can't get a percocet. And Mr. Smith and the rest of the patients suffer. Mr. Smith has to wait hours for his pain pills, and I can't deal with the rest of the patients because I've spent hours trying to get scripts.

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Specializes in Med-Surg, LTC.

My fave, though, is when we were on top of scripts, and the physician wrote for 30 of MS Contin (or something like that) on a prescription sheet, faxed it to the pharmacy, thought everything was A-OK. several hours later we do not have MS Contin and it's because the script was for 30mg MS Contin. There is no 30mg tablet. the pharmacy wouldn't release a 10 and a 20 because the script wasn't written that way. :mad:

The MD is supposed to know what pill form every med he prescribes comes in? That's out of hand, IMO.

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