Narcan and PCA's

[dosamigos76, RN]

Do you tape a vial of Narcan to the PCA or in the room with someone that has an epidural? I read an article about doing that and the other night on our Surgical floor another nurse's patient that had an epidural went south on us three different times and we had to get the Narcan from the Acudose.

Cheryl

[meownsmile, BSN, RN]

Im confused,, if the patient wasnt tolerating the narcotic, and had to have narcan administered, i assume the dr was called but why wasnt there drastic changes made on the PCA program? Did this patient have narcan administered 3x's in the course of one evening or only after the 3rd episode? If the patient just wasnt tolerating the medication why wasnt it changed, how much was the dosage decreased after the first and second call and what happened after the third call to the doctor?

But, no we dont tape vials of anything in a patients room. That is just a dangerous practice to get into. You have it available from the accudose or pixis and as long as it is available there is no need to leave it in an area where it may be tampered with.

Also, it doesnt leave a patient feeling to secure with their medication or their doctor if we have to keep something to counteract what they were prescribed that close at hand. It would make me feel very uneasy about what my doctor had prescribed.

[dosamigos76, RN]

The patient was on an epidural and the epidural was stopped per the CRNA's orders. In one of my magazines (don't know which one), it was stated that Narcan should be taped to the PCA, so was just wondering if that is practiced anywhere. I would also be concerned about patient tampering, but in some cases we do keep the antidote in the room, I just can't remember what it is at the moment.

[lsyorke, RN]

We used to do this years ago when PCA's first came out. Not anymore!

[suzanne4, RN]

You never leave any drug in a patient's room unless it is under lock and key.

Period.

And as stated above, if the patient had three different documented problems with the epidural why wasn't something done after the first time?

[dosamigos76, RN]

The epidural was stopped and 0.4 of Narcan was given.....still unable to arouse.....more Narcan given with the CRNA there..... Later he had severed nausea and become unresponsive again. More Narcan......

I'm sorry if I confused anyone.

[fab4fan]

If the pt was in that much distress, why not just bring the crash cart into the room instead of running back and forth? What if he'd needed more than just Narcan? Valuable time is lost doing that.

We used to tape Narcan years ago to the PCA if it was an epidural, but I don't think it's done any more (not working at that facility, so I can't be sure).

[SnowymtnRN]

No on our neuro floor we don't usually do that. USUALLY with epidurals its not an instant thing, and we do frequent monitoring (1/2 hr to hourly) so we see it coming. I honestly think that narcan taped to the epidural case isn't a bad idea tho. But on our tele floor, we have locked drawers in every room, so lots of times we store meds in there just to be safe.

Great topic tho!

[PeachyOrthoRN, RN]

I was told that some time ago they used to tape the Narcan to the PCA's and epidural's ( I've only been a nurse a few years). We don't do that now. We are not allowed to leave any medication in a patient's room.

[VivaLasViejas, ASN, RN]

We keep the Narcan in a locked drawer in the patient's room. Years ago, we kept it at the bedside---not taped to the PCA---but that was deep-sixed by JCAHO, so we just went to using the drawer. It's safer there, and we can still get to it quickly if we need to.

[P_RN, ADN, RN]

Years back we did the tape to the pump for Narcan, but that was before we had a Pyxis on the unit. Back then it could take quite a while to get it from the pharmacy. Of course it was in the code box too so that was an option.

Also remember that Narcan has a short effect time. Many times it must be repeated with the doc/HCP order. Was there a suggestion that perhaps a narcan admixture be used for more continuous effect?