Narcan

[PsychNurseBoyMom]

I currently work at a jail and we are trying to advocate getting narcan for our intake nurses. My administrator told us that we could not do that because patients who receive narcan are supposed to be on continuous cardiac monitoring afterwards. I would assume that if I had to narcan someone in a jail then EMS would be called as well. Has anyone heard of this?

[ChristineN, BSN, RN]

We give it frequently on our Med/Surge unit and the protocol does not require cardiac monitoring after administration. We throw them on continuous pulse ox for a while just to be safe but that's not required per protocol. I think they are pulling a fast one.

Why are you giving it "frequently" in med-surg? I work ER and I have maybe given it 2-3 times.

[BostonFNP, APRN]

We give it frequently on our Med/Surge unit and the protocol does not require cardiac monitoring after administration. We throw them on continuous pulse ox for a while just to be safe but that's not required per protocol. I think they are pulling a fast one.

Who's writing the narc scripts on your unit if you have to use it frequently??

Per UTD:

"Monitoring Parameters

Respiratory rate, heart rate, blood pressure, temperature, level of consciousness, ABGs or pulse oximetry"

[annie.rn]

Who's writing the narc scripts on your unit if you have to use it frequently??

Per UTD:

"Monitoring Parameters

Respiratory rate, heart rate, blood pressure, temperature, level of consciousness, ABGs or pulse oximetry"

I apologize. I was too flippant in my response. "Frequently" was a bit of an exaggeration. I work nights at a non-teaching hospital and from what I have observed, the nurses seem reluctant to call the docs for things at night so they get a bit heavy handed w/ the narcs and prns at times.

Also, we have a few doctors that prescribe very heavy handedly, IMO.

Example: Post-op laminectomy: Dilaudid PCA (0.2mg dose /10min. lockout/4.0mg 4 hr. limit), Norco 10/325mg 2 tabs. q 4 hr. prn, Serax 15-30 mg q 4 hr. prn (which they want given in tandem w/ the Norco), Flexeril 10mg q8 prn, Nuerontin 600mg BID, Restoril 30mg @ hs prn.

These patients are frequently given all of these prn's every time they can. Most are not narcotic/benzo naive and can handle it but I have come on shift to find a few of them gorked out and hallucinating. BUT, better keep their pain score w/ in goal lest we get a bad survey!

You are right, though, about the monitoring and I stand corrected. And slightly embarrassed. I really was thinking about cardiac monitoring only. The other assessments, to me, were a given and don't require any extra equipment (w/ the exception of ABG capability).

BTW, per protocol, a rapid response is called any time Narcan is given so the patients are monitored closely throughout.