Frustrated With New Narcotic Rules

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I just need to vent. I am very frustrated with the new narcotic rules. The rule is now even Norco's we have to have a valid script and a code before getting into the E-box. Some may say well that is not unusual. BUT when you work nocs and new admits come in or a med is out.....it really ties your hands. You cannot get their pain meds etc so if they are hurting or cannot get their routine anxiety meds etc then the resident is punished and you may get in trouble for not controlling pain etc. Your damned if you do and damned if you dont. You may also say that the ones that have been here SHOULD had it already taken care of or the ones that come from hospital SHOULD have a valid script with them, but the sad fact (as those who work LTC know) this just does not happen. To me, THAT is what the E-Box is for! Maybe you might have to get a code etc, ok I understand. Nope, now they are saying if you do not have a valid script it is a NO and illegal. What are you supposed to do for your patients? Very frustrating....

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Specializes in Cardiac Step down/ LTC.

I work PRN at a LTC and I know for new admits the discharge med list including prescriptions for any narcs are faxed or called into the pharmacy prior to the patient arriving. That way we are able to pull starters from the narc box along with any other med that has to be given prior to their meds arriving. Ask your DON or who ever deals with this if they can get the meds list and any narc scripts faxed prior to arrival.

LTC can be very frustrating at times. It's hard not having the resources 24/7 that I have at my full time job at the hospital. Best of luck!

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Specializes in Pediatrics, Emergency, Trauma.
I work PRN at a LTC and I know for new admits the discharge med list including prescriptions for any narcs are faxed or called into the pharmacy prior to the patient arriving. That way we are able to pull starters from the narc box along with any other med that has to be given prior to their meds arriving. Ask your DON or who ever deals with this if they can get the meds list and any narc scripts faxed prior to arrival.

LTC can be very frustrating at times. It's hard not having the resources 24/7 that I have at my full time job at the hospital. Best of luck!

This. :yes:

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We have been told, this can't be done. that we have to wait till the patient is physically in the building.

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Specializes in Assisted Living nursing, LTC/SNF nursing.

Also, some with major pain issues from surgeries come without prn pain med's, not even APAP. No pain all day but when trying to sleep at night, frustrating when a block decides to wear off. Lately I've been lucky with good repositioning to get me through the first night but shame on the discharging hospital Dr. to not include anything for the pain that will occur eventually. The admitting nurses are so busy getting things clarified as it is and in some cases is not taken care of right away or they did fax the admitting for orders which should have come back 3 days ago (Fridays/weekends are the worst, no on-call wants to sign admitting orders). They can call and talk to the Dr. or Dr.'s nurse with confirmation that it will be sent back 'today' but,... you have to call again and again. I digress, hopefully I won't have to call a Dr. in the middle of the night for a new pain medication that I would need ASAP, hopefully I could have a one time order for something or an added dose of something they're taking now.

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you are correct! so you don't know they do not have the script till too late. OR if someone has increased pain at noc (even for established residents) if you do not have a script you still cannot get into narc edk. So yeah these new rules may be helping to control abuse or whatever but it really hurts the ones who need it and can't get it and as a nurse to see a resident in pain and not be able to help is heartbeaking :(

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Specializes in Geriatric Psychiatry.

At my facility the doctor can speak directly to the pharmacisit to gain the order for weekend/nights. Then they can give you the code to get into the e box or send the medication. I assume your pharmacy is the same way and they have not notified the nurses of this. It is unethical to allow a patient to suffer with pain.

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Specializes in LTC.

We have to have a physical Rx (triple script) that is "D.E.A. approved" to fax a copy to the pharmacy before we can pull Norco. We used to be able to just fax over the T.O. or call it in as a MD rep, but the new rules won't allow for it. I work 2p-10p so do not have access to the MD, so the best I can do is leave them a note requesting the Rx. And hope it's not a Friday evening. If the resident is in a lot of pain, I can call the MD and get an order for something that isn't a Schedule II and try to make my resident comfortable until the Rx is written.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Ask your DON or who ever deals with this if they can get the meds list and any narc scripts faxed prior to arrival.

In the area where I live, nurses are no longer allowed to order medications prior to the resident's physical arrival.

A local nurse diverted $10,000 worth of Norco and Xanax over a 12-month period by ordering medications prior to arrival. She would secretively slip the narcotic punch cards and count sheets into her large handbag to take home. The remote pharmacy caught on to her scam nearly one year after she started diverting the medications.

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Specializes in LTC, Hospice, Case Management.
In the area where I live, nurses are no longer allowed to order medications prior to the resident's physical arrival.

A local nurse diverted $10,000 worth of Norco and Xanax over a 12-month period by ordering medications prior to arrival. She would secretively slip the narcotic punch cards and count sheets into her large handbag to take home. The remote pharmacy caught on to her scam nearly one year after she started diverting the medications.

And this is why it is so difficult to get pain medications for our residents/patients that actually need them. Such a sad world.

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Never assume things because it does not work that way where i work. For CII they have to have a copy or the original valid script or you are not allowed to get into the EDK. It is illegal. period. They used to be able to send us a 3 day supply without a script from back up. Not anymore since the rule change. I would NEVER intentionaly let someone suffer, but what are we supposed to do? Also, It is not like we give them NO pain meds but if they are to the point of needing a CII (which now includes all hydrocodones!) you are screwed with no valid script. Here they do not accept scripts from PA's either. We can do tramadol without a script but that is as far as it goes narc wise.

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My pharmacy has always required a valid script and a authorization code to get into the ekit. They implemented this years ago. We can order meds before the resident arrives using the hospital dc orders as long as all the signatures are in place along with DEA number. Chances are the meds aren't going to arrive before the resident. We have scheduled runs and we tell them to send the meds on the first run. If the resident arrives and they require a PRN we may try Tylenol (which is in our standard admit orders, or something alternative if they are allergic). If the orders aren't correct then we contact the facility MD and have him/her call the pharmacy with orders. Then the pharmacy faxes us the order after its been signed or they call us with an authorization code.

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