Securing Controlled Meds

[18G]

What is the common practice for securing controlled medications on your unit. At my agency, the controlled meds are in a locked compartment but the key to open it is kept in plain sight only a few inches away on the action area. This totally defies my own logic but no one else seems to see a problem with it.

Would this setup be acceptable in your agency or more importantly acceptable with the DEA?

Thanks!

 

[MonkeyArrow]

It wouldn't be acceptable at my agency. In my agency, only certain people have access to the schedule meds in the station. If we need to restock, we must do it through them (it also helps with accountability to make sure one guy is in charge of the log). As far as it meeting DEA standards, well, it technically is locked. However, the DEA probably has a clause in there that the scheduled drugs must be reasonably safeguarded, or something to that effect.

On the rig, the drugs are in a locked pelican case, in a locked jump bag cabinet accessible from both the interior and exterior of the rig.

 

[Tigger]

Controlled substances are kept in a small "safe" on the truck, with each truck having its own code. The vials/carpujects themselves are each kept in a sealed shrink wrap packet. In theory the truck is kept in a "locked state" at all times, with the exterior doors locked if out of quarters.

The safes do not lock automatically, and some people are inclined to just leave them open, which is obviously not in compliance.

My part time operation uses a keyed cabinet, with the key accessible behind a coded lockbox. There are no individual codes.

 

[broken stretcher]

Each of our ALS providers has a key fob and they must scan and then enter their own personal code that corresponds with their key fob.

 

[Medic Tim]

We have to have narcs under triple lock in station and on our person or in a safe (single lock with tagged pouch) when in the truck. Luckily we don't have to deal with the dea.

 

[TheLocalMedic]

Sealed, numbered containers inside a number-sealed lockbox inside of a keyed safe on the ambulance wall. Four levels of security.

Basically the only recourse for diverting narcs would be to presumably open all of the locks and seals to access a vial and then not administer any of it while documenting that they received the entire dosage contained in the vial. Makes diversion a little more difficult, and frankly not worth the bother.

 

[Underoath87]

Our narcotics/controlled drugs are kept in clear plastic cases that are secured with a number-stamped zip tie.

During shift, they are assigned to the medic who places it in his/her drug bag (just a large textile jump bag), which is just secured with a small lock on the zippers and stays in an unlocked compartment in the truck. The drug bag key stays attached to their ambulance key, which is to remain on their person at all times.

 

[cruiseforever]

We are required to keep them on our body.

 

[DesertMedic66]

Plastic container sealed with a numbered zip tie. When the drugs are on the ambulance they are in a locked cabinet that has a key that is on the unit key chain that are held by the EMT (doesn't make sense to me). And then the unit is locked when we are not in it.

At station they are all secured in a bolted down safe that requires 2 keys to open. One key the medic has and the other is either a VST or supervisor.

 

[rails]

Sealed, numbered containers inside a number-sealed lockbox inside of a keyed safe on the ambulance wall. Four levels of security.
<snip>

That is probably prudent. A paramedic in my area tells a story of how a former paramedic had opened a bunch of vials, removed the contents, filled the vials with water, and then glued the caps on.

Now the vial caps spin as part of the original seal verification.

I haven't verified the story.

 

[DesertMedic66]

That is probably prudent. A paramedic in my area tells a story of how a former paramedic had opened a bunch of vials, removed the contents, filled the vials with water, and then glued the caps on.

Now the vial caps spin as part of the original seal verification.

I haven't verified the story.

We just had this happen in our area a couple of months ago. The medic fled when we was busted.

 

[lido]

Sealed, numbered containers inside a number-sealed lockbox inside of a keyed safe on the ambulance wall. Four levels of security.

Basically the only recourse for diverting narcs would be to presumably open all of the locks and seals to access a vial and then not administer any of it while documenting that they received the entire dosage contained in the vial. Makes diversion a little more difficult, and frankly not worth the bother.

This. Any system can be broken, but a system that requires documentation anytime you physically touch the narcotics and gives you no reason to do so unless you are giving them cuts down on potential abuse.

 

[UnkiEMT]

Relatively recently, I became my service's narcotics control officer, and many hours of research later, I can tell you what the DEA considers acceptable.

Basically it comes down to one of two options, either they have to be kept behind two different locks, or they have to be held in the direct control of a single accountable and authorized person.

The concept of two locks is simple enough, but option B is a little harder. The bare minimum is that the box has to be signed out by a person who can administer the drugs and knows exactly what they're signing out, either because they can perform a visual inventory (either by opening the case or by looking through translucent platic) or because a uniquely identifiable tag can be tracked back to to last time the box was opened. It then has to be signed back in by that same person with either no changes or with a use record and if applicable a restock record.

 

[mycrofft]

That is probably prudent. A paramedic in my area tells a story of how a former paramedic had opened a bunch of vials, removed the contents, filled the vials with water, and then glued the caps on.

Now the vial caps spin as part of the original seal verification.

I haven't verified the story.

This was a nursing sort of thing too. And discharging Tubexes then refilling with sterile saline.

 

[mycrofft]

Relatively recently, I became my service's narcotics control officer, and many hours of research later, I can tell you what the DEA considers acceptable.

Basically it comes down to one of two options, either they have to be kept behind two different locks, or they have to be held in the direct control of a single accountable and authorized person.

The concept of two locks is simple enough, but option B is a little harder. The bare minimum is that the box has to be signed out by a person who can administer the drugs and knows exactly what they're signing out, either because they can perform a visual inventory (either by opening the case or by looking through translucent platic) or because a uniquely identifiable tag can be tracked back to to last time the box was opened. It then has to be signed back in by that same person with either no changes or with a use record and if applicable a restock record.

How about counting narcs between shifts?
Went to a hospital for DESERT STORM, our admin officer was put to work checking the narcs, and despite their security measures they were fluffing the count each time a new pharmacy officer came in (accepting the "book count" as gospel and thereby forestalling a reckoning). She caught them short of scads of narcs. (HINT: off going person reads the book, oncoming person actually sees/counts the drugs and does not show the reader the real drugs to avoid the reader using that as a prompt).

Last time they tried to fob off that duty as a make-work!

 

[shfd739]

During shift the vials are in a pouch that is the medic's responsibility to keep up with.

End of shift if it's a 24hr staffed unit the pouch is passed to the oncoming medic. Non 24hr units and spare pouches are kept in locked ammo cans inside locked cabinets with the rest of the gear (monitor,ALSbag,radios etc). Lock combos are changed semi frequently.

Each pouch has a paper log for each medic to note/sign the count and track usage/restock on.

Pretty low tech but it works very well and we rarely have a narc discrepancy or diversion.

 

[MagicTyler]

Now the vial caps spin as part of the original seal verification.

I used to do this... Untill when I spun a cap on a vial of Valium and it came off. Then I had to write an in incident report, so I don't do that any more. :glare:

 

[mycrofft]

I used to hate when a narc was signed out but not given and instead of destroying it, they'd try to put it back in the counting device and "correct" the log.

These drugs are cheap compared to many, so waste properly and press on. Not worth your license and not worth the headache for the next shift to clean up your mess.

 

[NomadicMedic]

I used to hate when a narc was signed out but not given and instead of destroying it, they'd try to put it back in the counting device and "correct" the log.



These drugs are cheap compared to many, so waste properly and press on. Not worth your license and not worth the headache for the next shift to clean up your mess.

In the hospital, it's very easy to return a drug to an Omni Cell or Pyxis. Likewise with our field meds. Controlled substances accountability isn't some form of voodoo, it's simply making sure the record keeping is correct.

 

[mycrofft]

In the hospital, it's very easy to return a drug to an Omni Cell or Pyxis. Likewise with our field meds. Controlled substances accountability isn't some form of voodoo, it's simply making sure the record keeping is correct.

I was working in the stone age. We were just getting computerized drug management when I retired (2010). I understand they are still trying to make it work 100%