Follow up to Narcotic question

[gsstover]

I am trying to find out if other hospices require their nurses to count controlled substances and for families to keep a log of each dose of these medications. Is this an appropriate measure to take? How much responsibility does the nurse have as to what happens with these medications in the patients home? Thanks

[GrumpyRN63, ADN, RN]

We don't count narcs in the home, the families are taught the dosing and administration and it pretty much ends there. Sometimes they keep track/log on their own, but the only time we count is at the time of pronouncement , list the meds and amnts wasted and the family witnesses and cosigns. I'm trying to think of what you would do with a discrepancy- write up the family member ??

[tewdles, RN]

I do count opioids in the home. I want to make sure they have enough to get them through the weekend, or holiday, or until the next delivery, etc. I DO want to know if there is a discrepancy as diversion can be an issue in my region and the POC must be augmented to provide for patient symptom management if a family member is diverting drugs.

[dosamigos76, RN]

I counted the narcs every visit. I only had the family keep a log of when it was given if there was a question of diversion or if there were a lot of caregivers in the home so that everyone would know when meds were given. It was easier to know when to increase the long lasting medication when PRN usage went up.

[rngolfer53]

I check to make sure the Pt has enough meds on hand, or if I need to get the pharmacy to deliver more.

Some families are good at keeping a log of what's given, others less so.

We document the amount of meds destroyed at TOD (and I doubt if anyone ever looks at it).

[tewdles, RN]

Interesting point about opioids at death of client...we also document medications destroyed, and observe family member destroying them (never by flushing down toilet). That form, signed by RN and family member becomes a part of the chart.

I agree rngolfer53, some families are good at logs some are not. The logs are mostly for my convenience or to help the family keep track so they are not stressed when I asked them how often they are using this or that med. I present it to them as a tool to make their lives easier...not a task for my convenience. Interestingly, the log that I use is one that was actually developed by a patient's family! I like it better than the agency log...I just keep a master and make copies. The bottom line is that I count meds not because I must but because I feel that it helps me better assess the situation and plan for pt/family needs.