Unsafe narcotic drawers

[Nurseheart18]

Narcotic drawer in my unit

63 items, so full that one can barely physically access them or fit them back in. Literally.

Husband and wife with same last name back to back in drawer that's too full

Packages rubber banded together that hold 60 narcs and stick to other cards on both sides when counting

1 patient with 180 days worth of same narc in drawer (is that even legal?)

3 liquid narcs (aren't they supposed to be refrigerated?)

2 fentanyl patches

3 pill bottles

1 oddly shaped card from another facility

54 remaining cards from our pharmacy

The Count:

1st, patches, liquids, oddly shaped card (in back) all are removed during count, then getting them back in is practically an art and science.

2nd, vertical count of right side going 1/2way down drawer

3rd: horizontal count starting from left to right in back portion of drawer

â—¦4th: vertical count going down left side 1/2way down drawer

Honestly. This is ridiculous and unsafe.

[amoLucia]

I'm guessing you work LTC, so can you use your pharmacy consultant for recommendations?

[quiltynurse56, LPN, LVN]

We keep our liquids, our patches and bottles locked in a drawer in the locked med room. These have to be counted too. Our liquids are Roxanal and are not refrigerated. This frees up the drawer on the cart for those cards. We receive between 30 and 90 doses for our narcs, depending on the order, etc. The cards are made for these numbers. I would think 180 days is too many. We would probably lock the extra cards in the med room too if we had that much extra.

We also have a husband and wife where there cards are right by each other and twice in the last year, meds were mistakenly given to the other one. We do have dividers separating each resident's meds which does help.

I agree with the above poster to have the pharmacy consultant weigh on in more efficiency with these meds.

[amoLucia]

Just remembered - when you take off new orders (particularly, upon readmissions when all the duplications most likely happened) we could tell pharmacy DO NOT SEND. They'll usually refrained from sending repeats.

[Adele_Michal7, ASN, RN]

This is concerning! I've seen this before. It is more than just a inconvenience! Sometimes those meds can pop out accidentally when jammed and crammed too close together.

I agree with the poster who mentioned calling the pharmacy! When our carts break we call them. They even sent a replacement cart once so maybe you can look into one with a double drawer :)

[Nurseheart18]

Thanks to you and all for the replies. There are many unsafe issues with Ltc. I have resigned, this is not for me. Chronic understaffing, unsafe ratios, lack of accountability by management, nurse aides with no work ethics whatsoever, continual use of agency, outrageous turnover, and constant added responsibilities. Our elders deserve better and so do nurses.

without bedside nurses, there are no profits for these industries. As a matter of fact, without us, whom are the fundamental foundation of patient care, there ARE no health care industries. Something has got to change. Thanks again.

[xoemmylouox, ASN, RN]

You should not have 180 days worth of narcs in your drawer. You need to lock up most of that in your med room/DON office/etc. The married couple's cards needs to be kept in separate drawers. Not all liquid narcs need to be kept in the fridge (thank goodness). Our older patients have been done a disservice. We over medicate them, make them dependent on narcs, make them take every vitamin on Earth, etc.