Do you have to count lyrica at your LTC facility?

morte, LPN, LVN · Oct 20, 2012

I know you can't write on the LABEL, I have never been told I can't write anywhere else on the card. Hve seen this done for ABT frequently. Just ran into a dose change that wasnt being followed. How do I know? because i marked the dose i gave and not enough was gone when i next checked.

It is illegal to make marks on a card of medication. If you don't think the residents are getting their meds, I suggest you speak to the nurse in question or the DON.

CapeCodMermaid, RN · Oct 21, 2012

People do all sorts of things they shouldn't including writing on the card.

morte, LPN, LVN · Oct 21, 2012

surely so, but i have never seen/heard anyone get in trouble for this.....in fact marking the ABT is house policy in some places.....at least used to be, lol. and this wouldn't be a state difference, because a good part of my work life has been spent in MA.

People do all sorts of things they shouldn't including writing on the card.

edmia, BSN, RN · Oct 21, 2012

Yes to counting Lyrica.

I'm ignorant on LTC, but really curious about this card you are talking about. If anyone feels like educating me a little, I'd love to know what it is. Is it a card with medication in it that you pop off? Or is it a mini MAR for each med? Just having a hard time visualizing this. Thanks!

morte, LPN, LVN · Oct 21, 2012

A cardboard rectangle, about half the size of a piece of typing paper. It is made in layers, it has holes in it for blisters containing a single tablet/capsule, so there is cardboard on both sides, with the plactic blister sheet inbetween. commonly they hold 30 tabs, for small tabs sometimes they will hold 60 or ninety. oh there is a foil like layer closing the bubble, on the back. Frequently the narcs have a more solid backing. these cards are in the "portrait" orientation, with the label that would ordinarily be on the bottle, in the upper right corner, with manufacturers info to the left.

Yes to counting Lyrica.
I'm ignorant on LTC, but really curious about this card you are talking about. If anyone feels like educating me a little, I'd love to know what it is. Is it a card with medication in it that you pop off? Or is it a mini MAR for each med? Just having a hard time visualizing this. Thanks!

LTCNS, LPN · Oct 21, 2012

Lyrica and Tramadol are counted here as well. I'm in MS. Oh and I generally don't write on the cards. If there is a doseage change a new label is requested from the pharmacy and the change made on the MAR of course.

morte, LPN, LVN · Oct 21, 2012

we have "order change" stickers. small, and not obvious enought. I wonder if I could get the pharm. to send me a totally new label...would this not be considered dispensing?

Lyrica and Tramadol are counted here as well. I'm in MS. Oh and I generally don't write on the cards. If there is a doseage change a new label is requested from the pharmacy and the change made on the MAR of course.

CapeCodMermaid, RN · Oct 21, 2012

The pharmacy would mostly likely not send you a new label. They might think you would put it on the wrong card. Our change of order stickers are not not very large,but they are such a noxious shade of lime green, they are difficult to ignore.

ClearBlueOctoberSky · Oct 21, 2012

Order change stickers are one of my pet peeves. NOBODY puts them on. It's not that hard to slap a sticker on the card. That and leaving d'cd cards in the patient's slot. Ugh.

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CT Pixie, BSN, RN · Oct 21, 2012

We have semi-large Order Changed labels we put over where the original printed orders were. You can't miss them. The cards are white and the labels are an eye hurting shade of fluroscent yellow/green with large, bold black type in a font totally different than the normal card order print.

And yes we count Lyrica. It's in the narc drawer so its counted. Also, we were counting Ultram when one of our patients was on it.

Blackcat99 · Oct 21, 2012

At my LTC, we do not even have any order change labels period. I wish we had some since I keep finding cards with the wrong current dosage on them. We do not count Ultram at my LTC facility.

txredheadnurse, BSN, RN · Oct 21, 2012

In 1 state (Tennessee) I know that Ultram is considered a controlled substance. In all 50 states Lyrica is a controlled substance. At least here in Texas it is against state pharmacy code for a new lable to be printed for a medication already dispensed. Hence the order changed stickers. The appropriate place to put those stickers is over the pre printed directions. The idea is to direct attention to the MAR which should have the correct dosage available.

As to writing on the blister pack/bubble packs nothing can be written on any area that has pharmacy generated printing (in other words nothing can obscure the pharmacy directions, patient name, drug info {except the change stickers}) but generally the surveyors will be tolerent of a notation in a blank area of the card such as r/o followed by a date ( reordered) or dates & initials beside each blister for accountability tracking. Also it is considered poor practice to remove more than 3 doses max from an ekit. The info that a dose(s) has been removed from an ekit when ordering the med from the pharmacy should be given so only the needed remaining amounts are dispensed. By following this procedure neither the facility nor the patient gets charged for excessive meds.

I have seen the accounting for Coumadin done frequently because the lab work shows patients weren't receiving the correct dosages. This way if the lab continues to stay outside desired parameters it can be more easily determined if that has occurred due to dosage errors (ie under or over dosage). Yes it does result in an excessive amount of counting and double work. But unfortunately when you have nurses and med techs not following the basics and comparing lables & MARs and paying attention to med changes patients don't receive their meds correctly. Then a facility has little choice except to put extra accountability tracking into play.