Log Narcotic Before/After

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  1. Log off Narcotic

    • 1
      BEFORE administration
    • 3
      AFTER administration

4 members have participated

Alright, I'm a third year student and it has always been consistent on my part that whenever I need to give a narcotic to a patient I must do the following:

1) Assess pain and rate to determine dosage strength

2) Look at the prescription order

3) Check the MAR for last dosage given

4) Have another nurse co-sign a draw

5) Write down on the medication log and room number on top to who you're giving it to

6) Then after administration, I would log it as "AD" in the MAR.

This is how I was taught and is the correct way... presumably.

However, it just seems that every nurse in the units I have clinical at, they would always log off the narcotic BEFORE administering the drug. They always say, "Well what if another nurse administered the drug to that patient, and you administered your drug to later come back to log off your med to see that it was already given. You double dosed the patient."

Well first of all, only the students seem to be even writing on the medication log properly and writing the room number on top. A double dosage is unlikely to occur because it's my patient and if another nurse wanted to give a narcotic; they'd have to go through me first (at least thats what I'd think). Also writing the room number on the log book will tell you which rooms were given narcotics... if you see your room number, then you'd immediately check up on it. Also, what if the patient refused the narcotic medication after agreeing to it (which has happened to me 4 times w/ confused pts.) prior to administration.... you can't simply delete "AD" without valid reason.

What do you guys think? Nurses on my unit kind of despise the students because we refuse to do the ways they do it, among other things.

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Specializes in ICU.

It honestly depends on the hospital, the unit, the patient...... There is lots to consider here. Remember, nursing school is not the real world of nursing. Since you say you are third year, I am assuming you are a first semester nursing program student. Nursing school is a perfect "nursing world bubble". You will learn as time goes on you will have your own way of doing things.

Don't try and point out what the nurses on your floor are doing wrong. You are a student, they have their license, and are a nurse. I guess I would have a problem too if nursing students were coming in to tell me how to do my job. They are there to learn from me. Do the documentation the way your clinical instructor wants it done. If the nurses on this floor are doing it wrong, someone will tell them sooner or later. But for example, if I was on a med/surg floor and the patient was on precautions, I would chart administered right before I went into the room because you have to gown up and you cannot leave every time. A regular patient, I would administer, then chart administered after. Some units are still on paper, and some are computerized. Like I said, it really depends. If a nurse does not have a COW available, then she may chart it beforehand, if she had several rooms to go to.

I don't know, because I don't know the hospital policy. But every hospital pretty much has a different charting system. I have never had to put AD after administered. We do other things. But absolutely do not pick out the what you think the nurses on that floor are doing wrong. It's not your place as a first semester student.

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It honestly depends on the hospital, the unit, the patient...... There is lots to consider here. Remember, nursing school is not the real world of nursing. Since you say you are third year, I am assuming you are a first semester nursing program student. Nursing school is a perfect "nursing world bubble". You will learn as time goes on you will have your own way of doing things.

Don't try and point out what the nurses on your floor are doing wrong. You are a student, they have their license, and are a nurse. I guess I would have a problem too if nursing students were coming in to tell me how to do my job. They are there to learn from me. Do the documentation the way your clinical instructor wants it done. If the nurses on this floor are doing it wrong, someone will tell them sooner or later. But for example, if I was on a med/surg floor and the patient was on precautions, I would chart administered right before I went into the room because you have to gown up and you cannot leave every time. A regular patient, I would administer, then chart administered after. Some units are still on paper, and some are computerized. Like I said, it really depends. If a nurse does not have a COW available, then she may chart it beforehand, if she had several rooms to go to.

I don't know, because I don't know the hospital policy. But every hospital pretty much has a different charting system. I have never had to put AD after administered. We do other things. But absolutely do not pick out the what you think the nurses on that floor are doing wrong. It's not your place as a first semester student.

Woah, sorry I didn't mean to make it out as if they are terrible in any way. I don't know what you mean by first semester student? My program is a bit different from most BScN programs out there. This is my second med-surg rotation and have one more year until graduation. I am a third year in the four year program.

the logging of medication must be done only after administration of the drug; that's something that is written in all my books, taught in school, and told by all the nursing instructors (all RN's by the way who work in the same hospitals).

I don't have any ill regard to any of the nurses on the unit because I think they're really great role models. I also haven't told the nurses that they are "wrong", but I tell them that I don't pre-log the medication even though they tell me to do so otherwise.

But I find it kind of disrespectful on your part to say "But absolutely do not pick out what you think the nurses on that floor are doing wrong. It's not your place as a first semester student."

That's like saying that all nurses are right, students are not.

Just because I'm a student, I don't have a say at all? I watched a nurse do a sterile dressing change without using sterile techniques.... because I'm just a "student" I keep my mouth shut and say nothing? I'm not trying to be a "smarty-pants".

I'm sorry but we ALL have a say one way or another; it's just how to properly do it.

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Specializes in ICU.
Woah, sorry I didn't mean to make it out as if they are terrible in any way. I don't know what you mean by first semester student? My program is a bit different from most BScN programs out there. This is my second med-surg rotation and have one more year until graduation. I am a third year in the four year program.

the logging of medication must be done only after administration of the drug; that's something that is written in all my books, taught in school, and told by all the nursing instructors (all RN's by the way who work in the same hospitals).

I don't have any ill regard to any of the nurses on the unit because I think they're really great role models. I also haven't told the nurses that they are "wrong", but I tell them that I don't pre-log the medication even though they tell me to do so otherwise.

But I find it kind of disrespectful on your part to say "But absolutely do not pick out what you think the nurses on that floor are doing wrong. It's not your place as a first semester student."

Just because I'm a student, I don't have a say at all? I watched a nurse do a sterile dressing change without using sterile techniques.... because I'm just a "student" I keep my mouth shut and say nothing? I'm not trying to be a "smarty-pants".

I'm sorry but we ALL have a say one way or another; it's just how to properly do it.

So you are getting 4 years in a BSN program? And no, you don't get a say to how a RN does her meds. You do what your clinical instructor and school want you to do. You do not critique, ever. They are employed by the hospital and do not answer to you. You answer to your instructors and school. Do you have any idea how hard it is to get a clinical site?

But hey, it's your choice. But don't be surprised when your school chews you out when a nurse complains about you. I do things the way I was taught, and how my clinical instructor wants me to do it. And I did my second med/surg rotation as a first year nursing program student last semester. I'm surprised that by your third year you haven't learned these things yet. I have been told every semester in the program, we do not care how the nurses where we are at do it. We are there on their unit to learn, and we are to do things the way we are taught. We have been told many times what I just told you.

Don't burn bridges in clinical. Often times, clinicals can lead to job opportunities.

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So you are getting 4 years in a BSN program? And no, you don't get a say to how a RN does her meds. You do what your clinical instructor and school want you to do. You do not critique, ever. They are employed by the hospital and do not answer to you. You answer to your instructors and school. Do you have any idea how hard it is to get a clinical site?

But hey, it's your choice. But don't be surprised when your school chews you out when a nurse complains about you. I do things the way I was taught, and how my clinical instructor wants me to do it. And I did my second med/surg rotation as a first year nursing program student last semester. I'm surprised that by your third year you haven't learned these things yet. I have been told every semester in the program, we do not care how the nurses where we are at do it. We are there on their unit to learn, and we are to do things the way we are taught. We have been told many times what I just told you.

Don't burn bridges in clinical. Often times, clinicals can lead to job opportunities.

I'm sorry we have our differences. Like I said, I don't tell any of the RN's/LPN's how to do it, as long as they respect the fact that I do what I do. For our hospital placements, it's really not much of a concern since it's a government-university-hospital agreement and it's a teaching hospital that can never deny student access. So no, I wouldn't understand (not to be rude).

I've had numerous clinical placements already, but my med surg rotations are pretty long though.

What specifically do you mean that you are surprised that I have yet to learn it by now? Am I surprised that nurses do some things differently? LOL NO. A lot of nurses do things differently than what was taught in school... but when it comes to pretty "straight-forward" skills -- i'd be hard pressed to think there would be variations.

During first med-surg rotation, this wasn't an issue since all the nurses did what we did. So I just found it interesting to see a difference on administration on this new unit. It's definitely not a policy change.

I know we are there in the unit to learn, but students deserve respect as much as the respect that students should show to their buddy nurses. We have unit managers that are the focus in education; if a student bad mouths a nurse, it will be treated the same way as a nurse bad-mouthing a student. So the school will never "chew you" out without the proper investigation on both sides. We are treated pretty equally, SURPRISE! I guess our teaching philosophy is different to where you are at. Otherwise, it's almost an unwritten rule to never 'bad-mouth' each other without resolving it firsthand 1-on-1 because it doesn't do good for anyone and everyone.

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You will very quickly find out that the way they "do it in the book" vs. real life is very different. My nursing instructor admitted that many nurses will cut corners because that's the only way they manage to get all their expected tasks done before the end of their shift.

Be very careful on how you approach these types of situations. Remember, you are guests on the floor. My personal response would be to not say anything unless the patient is in danger. They are nurses who have more experience than me and who have a routine down after doing it x amount of times. It may not be according to the textbook, though.

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Yeah, and I'm just more interested on how common this is more so than what is right or wrong.

I will never tell on a nurse :) I'd hate to be THAT guy

Unless you steal my food

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I find it more surprising that there are still hospitals that are doing paper charts... I've done clinicals at some very small very rural hospitals and every one of them have had computer charting with COWs that roll into the patient room.. scan their ID bracelet, scan the med, enter the route, pain level if necessary.. and boom charted.

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Specializes in Reproductive & Public Health.

I've been an LDRP RN for a few years (am now a CNM but still moonlight on the floor as an RN), and I frequently chart my meds before I administer them-even narcotics. Our MAR is still paper, and often when I go in to administer a med, it is more than likely that I will be in there for a decent amount of time.

I am not going to go to a patients room, administer a medication, run back down the hall to chart, then go back to the patient to finish answering questions, teaching, providing care etc. Not gonna do it. If I don't chart ahead of time, it might be an hour or more before I can get back to the nurse's station to make a note in the MAR, and I might have other patients that require my immediate attention. Progress notes are electronic, however, so I chart my pre/post assessments etc in real time whenever I can (computer in each room), and annotate the strip when I give a med.

if I pre-chart an administration and end up not giving the med, I just strike it out and make a note as to the reason. I absolutely understand why charting after admin might be best practice in an ideal situation, but tbh it is a relatively minor thing to focus on, and I am not sure why you think this is such an important issue that you are not willing to chart the way your preceptors are telling you. I'd have a chat with my student's clinical coordinator if they refused to pre chart a med on my patient if I had instructed him/her to do so. Charting per protocol is less of a priority than providing actual nursing care.

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Specializes in Reproductive & Public Health.
I find it more surprising that there are still hospitals that are doing paper charts... I've done clinicals at some very small very rural hospitals and every one of them have had computer charting with COWs that roll into the patient room.. scan their ID bracelet, scan the med, enter the route, pain level if necessary.. and boom charted.

I work in a teensy community hospital, and LDRP, ED and ICU are the only unit that uses ANY electronic charting at all! We are actually just now, this month, rolling out a comprehensive EHR and transitioning to 100% electronic hospital-wide. LDRP and ICU have computers in every room, but the rest of the hospital did not have any computers outside of the nurses station until just this past month or so.

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Specializes in Critical Care.

I know, not quite the same thing, but in the same vein....

Pull a narc from the Pixus, and I have the option to go ahead and log on the MAR that I administered the med, while I'm still standing in the med room. I've had many nurses get on to me for not logging "med administered" right there. But I won't do that. Not again. Because of course, I logged it into the MAR, only to walk straight to my patient, only to have a clogged NGT, or discover the IV was infiltrated, and after all was said n done, the med either was not given, or the timing was waaaaay off.

Moral of the story: don't record it as done till its done.

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Specializes in Neuro, Telemetry.

BScN. Are you Canadian? This might be where some of the miscommunication between you and Heather is coming from. I know Canada has 4 year Bacc programs that have clinical throughout the whole 4 years. So third year student would have quite a bit of clinical under their belt. In the US, whether you are ADN or BSN you have a couple years of pre reqs (the BSN has more than the ADN) and then generally 2 years of core program. This would mean a "3rd" year student hear would either be in the first or second clinical semester of a program. There are some 4 year programs that have nursing classes and clinical starting before the "3rd" year, but it is not very common anymore.

The US/Canada difference could also be why it is so "shocking" that you have a paper MAR since that is going the way of the dinosaur her in the US.

It sounds like you already know not to confront the staff nurses due to being a guest of the facility there to learn. But to answer your actual question, yes it is quite common to see nurses admin meds different then how we are taught in school. I see nurse waste narcs and get witness signatures without actually being witnesses. I have seen nurses pull and chart meds for multiple patients at the same time, then put them in bags or cups and administer without scanning to verify.

I think one this that may be different, or maybe you haven't touched on it is that once a med is pulled, it is pulled. You can't just put it back and strikethrough on the MAR unless it was individually packaged. Are these nurses popping the pill out an then attempting to pass, or are they leaving them in the package while pre charting. There would be a different reason for pre charting in both of those instances and different ways to correct the count when returning or wasting the med. I think a lot of it comes down to speed. The nurses have a lot of responsibility and a lot required of them. The pre charting probably shaves off minutes that allow them to pee once a shift or eat lunch real fast or whatever. If you don't agree with it, unless a patient is harmed then just let be. You can only control your practice and when you are a nurse, you can do it by the books.

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