Narcotic question

[NurseLoveJoy88, ASN, RN]

Hello,

I work on an ALF unit where many residents self administer their medication. Some of the residents that self administer their medications have narcs that the nurse will keep in the med cart double locked and we sign them out on the narc and the MAR.

Well we have a resident that takes a narcotic BID. The nurses have been signing out 2 narcotics in the narc book and Do not sign in the MAR. I told the resident I didn't feel comfortable giving out 2 narcs at a time since she is scheduled to get them BID. The resident was upset and said " well the other nurses do it". I went to my supervisor and she referred me to ask a more seasoned nurse.

Am I wrong for thinking any thing we administer to a resident should be done by the six rights which is : Right dose,right medication, right patient, right time, right route and right documentation..

Am I wrong to not want to sign out 2 narcs at a time?

Am I wrong for me to think we should initial in the MAR?

Please help me clarify. Thanks

[CapeCodMermaid, RN]

Why would you sign off a med on the MAR when the resident self administers? I understand signing it out in the narc book since you have to have a valid count, but.....

I used to work in AL. I'd set up meds for the residents but they self administered and there were no MARs to sign.

If the woman is cognitively intact enough to take her meds, she probably is okay to get 2 pills at the same time.

[NurseLoveJoy88, ASN, RN]

Why would you sign off a med on the MAR when the resident self administers? I understand signing it out in the narc book since you have to have a valid count, but.....

I used to work in AL. I'd set up meds for the residents but they self administered and there were no MARs to sign.

If the woman is cognitively intact enough to take her meds, she probably is okay to get 2 pills at the same time.

Valid point. The resident have stated that her narcs have been stolen. The supervisor had to do a whole report about it. Since she is so capable of taking her own meds why do we have them in the first place ?

I do see your point though. When I mean self administer that normally keep the meds in the room.

[AtomicWoman]

Your supervisor should have answered your question. That was pretty lame to refer you to another nurse! Bottom line, this should be in your policies and procedures. It should not be up to the individual nurse to decide what to do. I am generally of the opinion that you can't be too careful or too by-the-book where opioids are concerned. But if this patient is cognitively intact, your facility may have a more lenient policy regarding giving out 2 at a time. If she were in her own home, she would have a prescription bottle with a whole bunch of them. But again, bottom line is what does it say in the policies and procedures manual? This cannot be the first time this issue has come up. You are right to at least question what you have been told!

[NurseLoveJoy88, ASN, RN]

Your supervisor should have answered your question. That was pretty lame to refer you to another nurse! Bottom line, this should be in your policies and procedures. It should not be up to the individual nurse to decide what to do. I am generally of the opinion that you can't be too careful or too by-the-book where opioids are concerned. But if this patient is cognitively intact, your facility may have a more lenient policy regarding giving out 2 at a time. If she were in her own home, she would have a prescription bottle with a whole bunch of them. But again, bottom line is what does it say in the policies and procedures manual? This cannot be the first time this issue has come up. You are right to at least question what you have been told!

Very good point. As soon as I get to work today I'm going to look through the policy book to clarify. I just think it defeats the purpose for the nurse to be in charge of the narcs if we are giving out 2 at a time. What if she loses one? Or what if someone " steals" one. She has made these allegations before. Thanks for all the advice. Both of you have very valid points.

[Babycatcher2Be]

It's always difficult when everyone is not following the same procedures. We have the same issue when people call on the phone inquiring about their family and don't have a HIPPA code. Some nurses will ask for a birthday as a substitue for the HIPPA code and I personally will only accept the HIPPA code. People sometimes get so upset with me because I won't give them info and they state "well the other nurses gave me information". It puts you in a difficult situation. I say follow policy as much as possible.

[merlee]

Since the entire reason that the staff is holding her narcs is that they were stolen before, I'd go with the one at a time routine. The facility needs to have a policy for this, or all the meds go back to the patient.

Can't have it both ways. Where is she keeping the second dose? Is it safe, or more likely to get lost or stolen again?

Tough position. Follow the policies, or have someone (risk management) write a new one.

[Whispera, MSN, RN]

I think if you give two at once, and she loses one, you will be responsible.

[MassED, BSN, RN]

Hello,

I work on an ALF unit where many residents self administer their medication. Some of the residents that self administer their medications have narcs that the nurse will keep in the med cart double locked and we sign them out on the narc and the MAR.

Well we have a resident that takes a narcotic BID. The nurses have been signing out 2 narcotics in the narc book and Do not sign in the MAR. I told the resident I didn't feel comfortable giving out 2 narcs at a time since she is scheduled to get them BID. The resident was upset and said " well the other nurses do it". I went to my supervisor and she referred me to ask a more seasoned nurse.

Am I wrong for thinking any thing we administer to a resident should be done by the six rights which is : Right dose,right medication, right patient, right time, right route and right documentation..

Am I wrong to not want to sign out 2 narcs at a time?

Am I wrong for me to think we should initial in the MAR?

Please help me clarify. Thanks

do what you know is right, other more "seasoned" nurses be damned.

You are right. Give as prescribed and ordered. So what if the resident gets mad and tells on you to the other nurses. They can do what they want (even if it's wrong) when they're on their shift. You cover your own orifice and your own nursing license, not theirs.

[CompleteUnknown]

Do you have an 'ability to self medicate' assessment at your facility? Part of ours is that the resident has to agree to keep their medications in their locked drawer at all times to prevent other residents accidentally taking them and to stop meds getting lost or stolen. We have to assess the resident's ability to self medicate at regular intervals and whenever there is a change in their condition or a significant change in their medication regime. Their doctor has to also agree (and document) that the resident is safe to self administer.

If a resident is self administering narcotics they do not appear on the facility count as we are not administering, we don't keep them in our storage, they are in the locked drawer in the resident's room.

Agree that the supervisor shouldn't have told you to ask another nurse, sounds like perhaps there may not be a proper procedure to cover the situation?

[GM2RN]

I would not be comfortable giving 2 pills at once if the order is for 1, regardless of what other nurses are doing. Think of it this way, giving 2 at once is changing the order to 2 pills daily, instead of 1 tab BID, even if she isn't taking them both at once. You just cannot know what is really happening to the second pill, especially if there are allegations of it coming up "stolen" or "lost."

[NurseLoveJoy88, ASN, RN]

I checked the policy today which is very vague. It states " All records on the narc sheet must be accounted as my documentation on the MAR"