We have new owners of our hospital. New, stricter controlled substances policy coming down the pipe. We'll now have to count toradol, flexeral, tramadol, in addition to what we already have to account for in our dispensing machine. I also heard from nurses on the floor that they are going to have to count the dispensing machine controlled substances at every shift change now. I'm figuring that ER will also be required to do so.
I've done agency work at a few places where they don't even have to have a witnesses waste for Ativan. I also did agency at a place that counted pepcid. One of the nurses there told me it was because employees were stealing it. That hospital was so understaffed, I guess everyone there had stomach problems!
What's the policy where you work? the memo said that these new items that I mentioned are popular for diverting.
We've started to count Tramadol within the past year. We also count Soma, Lyrica, all benzodiazepines, Lomotil, all narcotic pain killers, etc.
I've never understood the need to count Lomotil. Are there that many people out there with diarrhea stealing it. Or are there people who get off on self induced constipation. Inquiring minds want to know.
I've never understood the need to count Lomotil. Are there that many people out there with diarrhea stealing it. Or are there people who get off on self induced constipation. Inquiring minds want to know.
Lomotil contains diphenoxylate, which is opioid agonist. Lomotil contains a very small amount of atropine in it. Therefore, if people took enough to get the opioid effects of the diphenoxylate, the would also consume enough atropine that one would get the anticholinergic side effects (such as tachycardia) from the atropine.
Off the top of my head, we only really count narcotics and expensive drugs (e.g. milrinone bags). Things like tramadol, ativan and lyrica are pullable without an accurate count. It's really different from where I did all my nursing school clinicals---at that hospital, everything was counted (supplies like IV pump lines, chlorhexidine swabs, kerlix, etc. were all kept in an omnicell/pyxis and only very common floor stock stuff like flushes, alcohol pads, needles and syringes weren't.)
By DEA regs all Schedule 1-4 drugs must be counted at every shift change and documented and counted per dose. Most states have now moved tramadol into controlled drug status and Lyrica has been a controlled drug since a year or two after it was released mass market. Any other drugs that are counted per shift change and dose given are at a facility's discretion. FYI to PP Ativan is a controlled substance so each dose must be accounted for and signed out per dose given.
As to counting the controlled substances inside the automatic dispensing devise that is only necessary if every nurse with access to the device also has a key to manually open the controlled substance storage portion. Generally those keys are only one set per machine and are either given to the DON or the onsite pharmacy. Otherwise those meds are secured by the machine and the machine keeps a running count of all amounts dispensed so doing a visual count at shift change is not necessary.
I'm surprised about the places that count Tylenol, etc. We do count Tramadol and Lyrica as other posters mentioned as well as schedule 1-4 drugs. Our Pyxis keeps a running count, and a full manual count is done weekly.
At one of my PRN jobs, we count ALL narcotics, ALL pain relievers except Tylenol, ALL oral antibiotics, Benadryl, and Pepcid. The soda and disposable linen savers are kept under lock and key in the house supervisors office, signs are posted that indicates absolutely NOTHING in the pantry is for staff usage. This is a facility staffed by all RNs except for the last remaining LPNs (3 or 4 left), respiratory therapists, one monitor tech, 4 CNAs, and one physician. Such a SERIOUS lack of trust and child-like treatment of staff!
I always believed that most nurses carried their own supply of pain relievers anyway....we can actually hear the pills rattling in the bottles as staff secures their personal belongings...
KeepItRealRN, BSN, RN
379 Posts
I've never understood the need to count Lomotil. Are there that many people out there with diarrhea stealing it. Or are there people who get off on self induced constipation. Inquiring minds want to know.