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Narcotic Security


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#1 streetsurgeon

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Posted 13 November 2008 - 08:35 PM

I am interested in knowing how different services secure narcotics and track their use and replacement (either from use or expiration). We currently secure them in the aircraft and have a utilization log that is kept in the aircraft. We also use our hospital's Pyxis for replacement. It seems haphazard at best and susceptible to abuse. Looking for any Best Practices you can share.
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Steven Malarchick, RN, FP-C

#2 Macgyver

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Posted 14 November 2008 - 03:30 AM

I am interested in knowing how different services secure narcotics and track their use and replacement (either from use or expiration). We currently secure them in the aircraft and have a utilization log that is kept in the aircraft. We also use our hospital's Pyxis for replacement. It seems haphazard at best and susceptible to abuse. Looking for any Best Practices you can share.


Personal acountability. Details varied with program but in general:

We sign out a pouch with Fentanyl/Morphine/Demerol (versed/valium/ativan are not controlled legally so kept in kits) at the start of a tour. At the end we sign it in. If used we fill in a standard date/used/waste/pt name (since changed to chart #)/given by/witness form. Numbers better tally or else. Random audits by CFN (show me your pouch + papertrail checks including utilisation appropriateness).

One possible diversion case in 16 years and I have no idea how many staff members. Identified early by CFN. Referred to licensing board.
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Ken BHSc, RN, REMT-P

#3 Mike Mims

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Posted 14 November 2008 - 04:28 AM

I am interested in knowing how different services secure narcotics and track their use and replacement (either from use or expiration). We currently secure them in the aircraft and have a utilization log that is kept in the aircraft. We also use our hospital's Pyxis for replacement. It seems haphazard at best and susceptible to abuse. Looking for any Best Practices you can share.

This is where honesty and trust is so important.
You don't want to have a complicated or restrictive policy for your controlled drugs.


We have a similar way:
- Stored in a lock-box in the AC
- Logged in our Drug log in the crew room. (usage and re-stock)
- Signed out by the off-going crew and signed accepted by the on-coming crew.
- We can't use the ED for the control drugs.
- For replacement: We have to take the Drug Log to the pharmacy and fill out a request, verify the drug, and witness signature by the Pharmacist and crew member.
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Mike Mims

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University of Mississippi Medical Center


#4 mjcfrn

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Posted 18 November 2008 - 07:28 PM

We have our own small Pyxis-type system. In it we keep narc "kits": small sealed boxes with several vials/amps of Fentanyl, Morphine, Midazolam, and Ativan, packed with a small log on which we can document administration & wastage of any meds. We sign out one box before the first run. If we haven't opened it, we can return it to the machine. [If we have, we document accordingly, take the log and remainders to the pharmacy. They refill and restock back into our Pyxis-type machine.] This covers maybe 90% of our transports. We also keep stocked in our machine ketamine, phenobarb, pentobarb, thiopental, etc, etc. and can sign those out individually before a given run. Expiration dates are tracked by the machine and pharmacy automatically removes / restocks, except for the kits, on which the earliest expiration date is documented on a sticker over the seal. This works well for us, but mgmt/pharmacy has to buy into keeping a machine in the transport quarters.

Btw, I thought there were some controls on Versed Valium & Ativan as Class IV narcotics that were just not as stringent as the controls on the Class II narcs - Fentanyl, morphine, Demerol.
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