How do you count liquid narcotics?

[Plagueis]

I know that this may seem like an odd question, but this is something that wasn't covered in school, nor in orientation at my current job. I have heard of places that use unit dosing for liquids, which makes it easier to keep track of, but what if the bottle is colored white with no unit doses? If it's, for instance, a 100 ml bottle, and a nurse uses 10mls during a shift, how can one "count" what's left if the bottle isn't clear with measurements on it?

One nurse I asked recently told me that they cannot pour the remainder in a separate measuring container, as it could spill, so she doesn't really measure what's left; she just subtracts what she uses on the narc sheet. Plus, I would think that even with careful use, some of the liquid could spill, as it does when I measure cough syrup (especially if I'm interrupted during a med pass). What happens if one spills some of the liquid narcotic? Basically, what is the correct way to count liquid narcs when there's no unit doses available?

[medicrn13]

I don't know of any place in my area that actually uses liquid narcotics, I'm guessing for the reasons you've outlined above.

In fact I believe this may not have been covered in school because maybe there aren't many places that still use liquid narcotics? I know my nursing program never covered it...perhaps someone else can weigh in...very intriguing.

[PolandM]

The only liquid narcotic I have ever dealt with is Roxanol(morphine) and it's usually prefilled in measured syringes by pharmacy and the whole dose is given. I've never had to waste or count or anything.

[ghillbert, MSN, NP]

In the olden days we used to mark on the bottle where it was up to after each dose. Haven't done it for years that way though.

[Up2nogood RN, RN]

They do make liquid narcotics for those who can't swallow pills as in esophageal surgeries, tube feeders, etc. In the hospital we use unit dose, in LTC you will see it supplied in sometimes up to 300 ml of liquid hydrocodone/apap or roxicodone. These bottles are marked , I believe at every 25 or 50 ml for measurement purposes. Roxanol and lorazepam comes in 30 ml bottles. Both are never accurate measurements, you do the best you can to guesstimate the larger bottles. Just be on the lookout for suspicious amounts being used and signed out. From my experience there is always more in the bottle than what the count says should be. And the liquids are very thick and syruppy so I'd think it would be possible to tell if someone added water to the narcotic to divert. And no you can't pour it out to measure that would be contamination. Hope that helps.

[morte, LPN, LVN]

most commercial bottles, such as the ativan, may be solid white but have a clear stripe down one side so you can "guestamate"....when dispensed by the pharm, usually in translucent amber with measurements ....

[ayla2004, ASN, RN]

we use liquid narcotics frequenlty.

each dose volume is just deducted and recorerded in the controlled drug book as we would a tab. we are allowed by pharmacy to go over or under by 5%. we use syringes so we tend to have accurate doses each count we eyeball the bottle and guess the volume.

we use oramopth(morphine sulphate ir) and oxynorm(oxycodone ir).

[Katie5]

Put it on a flat surface, eye-ball it and read it off.

Pour into a measuring cup?!!!Is she trying to contaminate the medication? So how often would she expect to do this.

[pagandeva2000, LPN]

This is something I have always wondered as well. One of the clinics I worked in kept DepoTestosterone in the narcartics closet and the bottle is dark, the fluid is very thick and syrupy. This is interesting...

[bigbub3000]

They can put a man on the moon but - you know the rest.

Yes, counting liqs is primitive - a guesstimate - when they are not in pre-filled syringes or some other type of unit dose. Kind of amazing that the DEA lets this situation exist but is so intent on controlling every other aspect of narcotic usage.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

we guestimate. no one really actually cares it seems...

[dannyc12]

In the olden days we used to mark on the bottle where it was up to after each dose. Haven't done it for years that way though.

My parents tried that with the booze.

It didn't work!