Narcotic administration, storage and waste in the PACU

[Always learning]

How does your PACU handles narcotic administration and waste?

Let's take Fentanyl 100mcg/2ml for example......

If your order is to give Fentanyl 25mcg Q5 Min for pain. Do you give one dose of 25mcg and waste the remainder of the vial? Then get a new vial each time a dose is needed?

Do you give 25mcg and save the remainder of the vial for the following doses?

If you reuse the same vial, do you draw up the whole 2mls in a syringe, label it and then give in 25mcg doses as needed?

Or do you draw up 25mcg each time its needed, entering the vial each time?

How long would a vial/syringe be good for once entered or drawn up?

What do you do with the vial/syringe between doses?

Do you keep it in your pocket, on your computer work station, in a lock box at the bedside or is there another option?

Thank you ahead of time for those willing to answer my long question. I am new to the PACU and the way of handling narcotics in this unit is so different than what I am use to.

[kp2016]

Your unit really should have a policy on this. As you'r new to PACU you may want to review the unit specific policies.

If you have an order that only allows 1 dose which is unusual in PACU. Pull the vial, draw up the 25mcg and immediately discard the rest with a witness as you would on other units.

If your order allows multiple doses ie, 25mcg Q5 minutes for pain PRN, max 100mcg or 4 doses. Draw up the entire 100mcg. If you have the color coded drug stickers label a Fentanyl one with 100mcg/2mls or 25mcg/ 0.5mls. Date and also attach a patient ID sticker. You normally need to fold and stick it to itself a little so you can still read the markers on the syringe. Keep syringe in either the designated locked box beside the head of the stretcher or in the locked drawer of you computer. Don't ever place it in your pocket. If your unit doesn't have a locked box for each patient we use to keep them in a kidney dish on our work station but this really isn't best practice and will likely get flagged when your friends from the Joint Commission pay you a visit. It is way too easy to walk away for a second leaving the narcotic unsecured. 

Immediately before patient is discharged do the waste of any left over doses. We also regularly wasted immediately after discharge while cleaning the bay and closing out the charting.