Getting narcotics for residents is a pain!!!!!

[kappykatlpn]

Ok, the FDA has decided to make new rules (Or inforce old ones I think) that now to obtain narcotic for our residents our pharmacy has to have a actually written order from the doctor. Before if I took an order for Vocodin or any narc I could write the telephone order, fax to pharmacy and they would send. NOW its a big to-do. They need the written script! even when reordering these meds. It started out with just the Class C-II now its all the narcs! This is a pain, Residents are not getting their meds. We reorder, they fax DR he doesn't respond on time, and the resident is out of med for a couple of days! I know if state came in we would get cites for not giving the med. What do other nursing homes do? Is there a better system? The nurses are the ones calling doctor and pharmacy trying to get meds inbetween the med passes.

Thanks!

Kathy

[systoly]

First, be aware of Rx with no refills on them and allow extra time when ordering (3-5 extra days depending on weekend or holiday, 2 weeks for mail order pharmacy). Send fax to Dr.s office requesting script, for no response (allow 2 days) send second fax denoted "second request - patient supply low", for no response (allow one day), inform supervisor and family and request they contact Dr.'s office since Patient supply now critical. If no family, contact POA. Document all steps taken. When I say allow exytra days, this is on top of the usual 5 day supply when reordering. Remember, it's usually not the Dr., but the office staff who is dropping the ball.

[NotFlo]

Yes, we are having this same issue, but it's finally going smootly (mostly).

Someone on each cart has to put themselves in charge of ordering narcotics. I work days and have taken on the responsibility. No one can just assume that the pharmacy or someone else will stay on top of it.

Secondly, do you have omnicare? They have provided us with prescritption blanks for narcotics. We can write in the number of pills we want sent, up to a 60 day supply.

If you have a long term patient that eats percocet like candy don't just send a script for 30 pills, send it for 120 or as many as you can. The pharmacy will only send 30 at a time but you wont need another signed script until the 120 pills is exhausted. Someone will have to be keeping track of how many pills are left on each signed script.

Do your doctors come in at any regular days/times? I have it worked out now so that I get almost all my scripts signed when the doctors come in on their regular days. They hate dealing with tons of faxes and are happy to sign all the scripts when they're in the house. The only exception is new admits. If they come in on the weekend, we're SOL until Monday when the offices reopen, unfortunately.

The facility needs to establish and maintain a very well stocked narc ebox for the times when you don't have the narcs in.

Also, I don't just fax a refill to the pharmacy and wait for the pharmacy to get a script for the doctor. I fill out the script and then fax it to the doctor's office directly. The DON or someone needs to get the MDs on board so they know what a priority it is for them to sign the scripts and get them back to the pharmacy.

[RNgrrl09]

It is the same at the facility- I'm at a subacute/rehab facility. It is a big pain, especially when the admitting nurse doesn't even get tylenol ordered for the patient. It always seems that it is the NOC nurse who has to call the physician or the medical director so that these patients can have narcotics. I just don't understand why nurses who admit patients, especially ones with new hips and knees, don't think to get pain meds on board.

I just feel bad for the poor patient.

[CapeCodMermaid, RN]

Your pharmacy gives you blank prescriptions and YOU fill in the amount???? I believe that's outside the scope of practice for an RN unless you are an NP. If our docs order 120 we get 120. Trouble is they order 120 on someone who is ready to die and the dumb nurses accept them. No system is perfect.