Fentanyl/Versed on locked pumps ?

[SusanRN321]

Our SICU runs Fentanyl and Morphine infusions on an AIMS PCA pump. It's locked for security and we document wastage just as we do other controlled drugs. My question is does your facility practice this also? What about Versed drips? Who mandates this? We need to develop a policy and need to benchmark with other facilities. I welcome your input.

[cardiacRN2006, ADN, RN]

Ours are on regular pumps. Morphine is of course on a PCA, but not Fent or Versed. However, we do have to document wastage just like any other narc.

[RoxanRN]

Here, Morphine, Dilaudid, Demerol (rarely used), and Ativan go in PCAs. Fentanyl and Versed go in locked epidural pumps. Don't ask me why, that's just the way we do it.

[ZASHAGALKA, RN]

We run all our 'narc' gtts through our locked PCA pumps and disable the PCA button if they aren't actually getting the drugs PCA.

Also, such drugs should be given w/ 'portless' tubing.

Who mandates it? I think it's a 'standard of care'. The DEA mandates that hospitals keep accurate security and documentation on narcs. Simple safety measures for the control and rate of narcotics would demand such care.

Without it being locked, ANYBODY can steal the drugs. Or, simply, change the rate of infusion.

If you put me on a stand and asked me if a 'prudent nurse' would run narc gtts without a key lock (not just a button pushed on the back of a pump) on both the physical drug and the ability to change the rates: I'd say no, a prudent nurse would NOT do such a thing.

I'd say that it's a violation of the standard to provide safe care. A quick search did not reveal any online results to definitively answer this question. I'll look at the AACN procedure manual next time I'm at work.

I think the key concept though is that these are 'CONTROLLED' substances. We have an inherent legal and safety obligation to ensure that they remain controlled throughout the administration process.

~faith,

Timothy.

[begalli]

PCA/PCEA locked, IV gtts not locked. Straight epidural narc gtts are not locked either UNLESS it is patient controlled (the PCEA).

Waste is according to the remaining vtbi when the gtt is d/c'd.

[ICURN_NC]

So... We very occasionally get PCA pumps- rarely, even. We do have the occ. morphine or fent gtt, but it's run on a regular pump. We just have paper documentation- like, when it was hung, by who, when it was d/c'd and the amt wasted (with witness) or when the bag ran dry, and signed by that nurse.

[dfk, RN, CRNA]

i have used everything on an imed pump (not locked), as an infusion, including morphine, versed, fentanyl, ativan, atracurium(unless ordered as a pca) etc... especially for vented pt's... i have used dilaudid on a pca only.. whatever the med, epidurals are always on a pca.. i like the fact that i can titrate many drips to help the patient convalesce...

[begalli]

Timothy, it looks as though that standard of yours may not be the actual standard of care.

I've been in quite a few ICU's and have never seen fentanyl or versed drips locked. I've not been employed in a lot of ICU's, but I've seen several in a couple different states in both a professional and a personal capacity.

[lifeLONGstudent]

timothy, it looks as though that standard of yours may not be the actual standard of care.

i've been in quite a few icu's and have never seen fentanyl or versed drips locked. i've not been employed in a lot of icu's, but i've seen several in a couple different states in both a professional and a personal capacity.

i am glad you mentioned this begalli. the 2 hospitals that i have been at, both level i trauma centers and teaching facilities, didn't use locked pumps/pca for narcs in icu.

i think you are always safe to provide a higher standard of care than what is required, and that is great, but don't lump the rest of us as "substandard" if we follow the institution standard or instead of your personal standard.

lifelongstudent

[LCRN]

The policy at my hospital is that all narcotic continuous infusions are to be run on PCA's however all of our benzo's and paralytics are just on regular pumps...

\

LCRN

[jbp0529]

We have PCA pumps for morphine, dilaudid, and fentanyl. However it is not uncommon for us also to use morphine, atvian, versed, fentanyl on unlocked syringe pumps - in fact that is usually what we do. The PCA's are kept for the post op patients that can actually push the button.

Don't know if this is the truly correct way, but its what the all the ICU's do at my place, and its in our P&P. I guess if they took us to court, they would need a big room since everyone would be there :-)

[ZASHAGALKA, RN]

Timothy, it looks as though that standard of yours may not be the actual standard of care.

I've been in quite a few ICU's and have never seen fentanyl or versed drips locked. I've not been employed in a lot of ICU's, but I've seen several in a couple different states in both a professional and a personal capacity.

I concede the point as I have been unable to find any literature to support my previous assertion.

In Texas, at least, one of the decision models for practice is - does the literature support the decision? It certainly doesn't contradict the position that narcs should be locked through delivery. But, in regards to IV gtt admin, I can find no literature that mandates such practice.

So, pursuant to new information that I don't currently possess, I concede the point. But, that's how you learn things.

~faith,

Timothy.