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Discussion

? about narcotic admin

Back in the day, it was very common just to keep the same syringe around for a patient getting repeated doses of narcotics or benzos over a given length of time. Now with stricter guidelines, we are not able to just have syringes filled with controlled substances around. How do you all handle it at your facility? For example, if you have a 2mg dose vial of versed but you're only giving 0.5mg at a time, do you waste every time? Or do you know of a method of securing the drug? Thank you!

Featured Replies

  • Expert

We have to waste every time. It seems...wasteful.... :) but it's the best practice for sterility as well as avoiding problems with narc diversion.

  • Expert
We have to waste every time. It seems...wasteful.... :) but it's the best practice for sterility as well as avoiding problems with narc diversion.
This is the only way I have seen narcs handled with the exception of an area performing multiple conscious sedation, one after the other. In that environment they do use the vials for multi dosing.

I agree, it is wasteful but is necessary to prevent contamination or deversion.

We waste every time unless we're "actively treating or titrating". Basically it comes down to: if you feel confident enough about your patient to leave the bedside you should waste. That is, if you're actively treating chest pain or acute agitation and you wouldn't want to leave the room, you can hang on to and re-use the syringe.

A lot of the older nurses think that wasting is wasteful, but one of our NMs posted a little tidbit of drug cost to the patient vs. court costs for a potential lawsuit and it opened many people's eyes.

  • Expert

We are one on one and we usually use infusions for narcotics but in the rare occasions that you are using PRN we will re-use but change the needle/access device and discard at the end of shift or if you leave the patient.

We have bedside carts of supplies. The top drawer is locked and we keep the key on ourselves somewhere. Don't know if this is JCAHO legal?????

I work ER ... have a bit more leeway than most probably ... but most of us will load up and dilute a whole syringe ... start low/go slow with narcotics. Put a patient label & contents on the syringe and hold onto it until the patient is discharged. I'm not as concerned about the cost to the patient as I am the cost in time to me to have to keep heading to the Pyxis.

If we are giving the narcotic frequently, ie q 1-2 hrs we will make up a syringe and use it over the shift and then waste whts left. Otherwise we waste with each dose.

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