# Narcotic logs and security



## rjz (Sep 14, 2008)

So I am curious what kind of security does your service use for your narcotics. How complicated are the logs and the restock? My service recently changed the entire way of doing things and it seems like it has been made more difficult to give narcs to pt. Do any of you feel the same way? Does the way we are required to track narcs sometimes make you feel like it is more trouble then it is worth to break them out and use them?


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## mikie (Sep 14, 2008)

We are an ILS, we carry Valium so that is locked up.  It's in a knox-box like unit with a digital key pad, next to it there is a large key that also has to be in/turned.

I know the vials had tamper-evident stuff on it, but that's all i got for ya.  I don't really know their logging, restocking procedures or even the code!  Valium requires on-line orders for us.


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## boingo (Sep 14, 2008)

We record the drug and lot # each shift in a drug log book.  If narcs are used, we also log the amount, patient name, run # and lot # in the book, as well as on an official controlled drug record sheet that comes from the pharmacy.  Restock is easy, we enter our ID in the PIXIS and take what we need.

As for security, our controlled drugs are in a locked box mounted inside our Pelican case, a box within a box.  Both medics carry keys.


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## KEVD18 (Sep 14, 2008)

when truck is in service:

narcs are in clear topped narc box, with lock.
narc box is in drug box, which is locked.
drug box is in the cabinet, which is locked.
keys are possessed by the medics.

when truck is not in service, the whole drug box is removed from the truck and placed into the als supply closet, which is locked.


as for the log, every shift records the amt and lot number of the narcs on hand. any deviation between what should be there and what is causes the whole operation to grind to a halt while the discrepancy is investigated. if a narcotic is administered, the date, time, lot number and run number are recorded. we then have to go to the pharmacy at our affiliate hospital to refill, which of course has to be logged in as well.


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## MMiz (Sep 14, 2008)

In Michigan we used a county-wide system, which had the narcs in the standard drug box (orange fishing box).

The box was stored in a small locking cabinet in the rig that was accessible from both the inside and outside.  It was rarely locked, but that all changed when someone tried to pry the doors off our units.

The whole box is turned into the security folks with a form at one of the county's hospitals, and they give us a whole new box.


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## rjz (Sep 14, 2008)

Matt, it sounds like that was a pretty nice system. We don't have to log the lot # but we do have to fill out a little 2 part slip that tells how much med was given, wasted, when, and what incident #. The you keep that slip until you get your restock. One plus is that we don't have to restock after every call, we can wait until we get down to a minimum par level. Other systems I have used where really simple and easy to restock. In fact proabley a little to easy. 

Thanks for all the feedback everyone, keep it coming.


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## Ridryder911 (Sep 15, 2008)

It should not be difficult or easy. Simply the laws state that it should be double locked or on person at all times. With that the count should be performed after each change of person or shift to assess accountability. 

When someone uses a narcotic, it should be documented and signed out as per whole or percentage wasted with witness. Then it should be replaced with appropriate signing out of medication from stock. 

How hard is that? 

Some use tabs or lock systems... so one still signs for it. 

R/r 911


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## Outbac1 (Sep 15, 2008)

Ours are carried in small leather pouches with a belt loop so you can wear it. Each pouch is signed out at shift start by the offgoing and oncoming medic or recorded as in stock. When it is used there is a place on the PCR to sign for how much you used. We restock from our own supply in a double locked box at the hosp. We record the run # and how much was used and/or discarded, and it is signed by both medics. We never record lot #'s, someone might but we don't. 

  There is at least one drug pouch per truck including our PCP (BLS),trucks. That way if an ALS medic intercepts for pain control for a fx for example they can use that trucks narcs. The medic doesn't have to stay if they don't feel it is necessary. That way they can stay in service without going to the hosp to restock.


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## bonedog (Sep 15, 2008)

On the left coast we are issued a personal Rx for narcotics, then are responsible for it on our person. Morphine and fentanyl. 
Benzo's are in the kit. For transports with the need for massive dose's we can get it through pxis.

Everything is restocked through pxis.


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## rjz (Sep 16, 2008)

pxis sounds interasting. I am familure with the in hosptial types, do private providers use these also? Do you perform all of your restock ie.dressings, c-collars, epi, etc. out of the pxis?


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## So. IL Medic (Sep 17, 2008)

My service keeps narcs in a narc box - tagged - locked in a drug box, locked in the drug cabinet.

Used narcs are given to the pharmacist with copy of run sheet with tag attached, separate sheet that documents drug, amt used, amt to be wasted by pharmacist. Pharmacist tests the wastage to ensure it's really the narc (not replaced by saline) and gives us a new prefilled. Sign replacement sheet, retag narc box, and leave...

Pretty straightforward to me.


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## Short Bus (Sep 17, 2008)

Ridryder911 said:


> It should not be difficult or easy. Simply the laws state that it should be double locked or on person at all times. With that the count should be performed after each change of person or shift to assess accountability.
> 
> When someone uses a narcotic, it should be documented and signed out as per whole or percentage wasted with witness. Then it should be replaced with appropriate signing out of medication from stock.
> 
> ...



Yup, pretty much what happens B)


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## Ridryder911 (Sep 17, 2008)

So. IL Medic said:


> My service keeps narcs in a narc box - tagged - locked in a drug box, locked in the drug cabinet.
> 
> Used narcs are given to the pharmacist with copy of run sheet with tag attached, separate sheet that documents drug, amt used, amt to be wasted by pharmacist. Pharmacist tests the wastage to ensure it's really the narc (not replaced by saline) and gives us a new prefilled. Sign replacement sheet, retag narc box, and leave...
> 
> Pretty straightforward to me.



Everytime it s tested to be sure it is narcotic?..Wow! I bet that costs a fortune! As well a Pharmacist is not the usual one to do so, it usually requires a lab to make the determination. Apparently, there had been a problem in the past. 

R/r 911


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## NESDMEDIC (Sep 17, 2008)

Narcotics are kept in a lock drug cabinet that has a digital combination lock. To access it has an employee ID number as part of the regular combination. The lock can store up to 125 different employee numbers and combinations and records each time it is opened and by what employee, the information can be access via computer. The rest of the drugs are kept in a pelican hard case box with numbered plastic locks that have to be broken to gain access to the box. The number of lock is recorded on a log each time the box is opened. As drugs are used they are recorded on a log sheet which has the patient name, how much of a drug given, what time given, lot number, expiration date and how much wasted with a signature line for a witness and another one for who administered the drug. The log sheet gets attached to the PCR.


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## bonedog (Sep 17, 2008)

We are a government service. 

The PXIS is in the hospital and we are registered as staff. Hospitals are part of the government system, not private. Only used for drugs.

It was trialed for all supplies but couldn't keep up with the volume and the larger stock inappropriate.


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## Jon (Sep 17, 2008)

Here is a Pyxis machine: http://www.cardinal.com/us/en/providers/products/pyxis/products/medStation3500/index.asp


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## mikie (Sep 18, 2008)

Jon said:


> Here is a Pyxis machine: http://www.cardinal.com/us/en/providers/products/pyxis/products/medStation3500/index.asp



They're pretty cool.  I have never used them, but saw them at the hospital I did my clinical time.  The RN would either enter their own password or put their finger on the finger-print reader.  pretty cool.

It also had an additional set of cabinets with windows, even one section with a fridge for larger meds (fluids, etc)

It's like a big medicine candy machine!


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## rjz (Sep 19, 2008)

Ridryder911 said:


> Everytime it s tested to be sure it is narcotic?..Wow! I bet that costs a fortune! As well a Pharmacist is not the usual one to do so, it usually requires a lab to make the determination. Apparently, there had been a problem in the past.
> 
> R/r 911




Our haz-mat team has a tester that can test whether or not it is actully Morphine. This can be done while it is still in the bottle or in a syringe. Doesn't cost anythng for the test except for cost of the machine itself. However the machine is used for many many different things and we would only test if there was a question or a problem.


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## So. IL Medic (Sep 20, 2008)

Ridryder911 said:


> Everytime it s tested to be sure it is narcotic?..Wow! I bet that costs a fortune! As well a Pharmacist is not the usual one to do so, it usually requires a lab to make the determination. Apparently, there had been a problem in the past.
> 
> R/r 911



Every time. They have a quick and dirty test that takes just a few minutes. There hasn't been a problem in our system that I heard but we did get a new lead pharmacist a couple years ago that is a bit paranoid about his license. His pharmacy, his rules.

I don't mind the added security. If there ever is a problem, I figure it will help cover my butt too.


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## Ridryder911 (Sep 20, 2008)

Most states only require a pharmacist if purchasing direct, under a physician license. I have worked where we ordered narcotics directly alike all other medications, one has order under the physician DEA number. 

Shame to have to "test" this assumes that there is a problem, as well as waste in front of them. What happens if it is late at night or have multiple calls, etc? 

R/r 911


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## boingo (Sep 21, 2008)

I'm not sure how well the test thing would work here, I draw up and admin or waste narcs all the time.  We don't return anything once its been drawn, we waste it and both medics sign for it.  If the drug has expired, then we will return it to the pharmacy, otherwise once we have it we use it.


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## firemedic7982 (Sep 22, 2008)

Pharmacists, Pyxis machines... Wow some services are rediculous in their practices. As Rid said it doesnt have to be anywhere near that complicated. And as far as a pharmacyst testing the wastage to see if it's really the narc??? I'm sorry but I would take offense to that. HUGE offense. If you don't trust me to waste the proper narc, then you probably shouldn't hire me because I'm obviously not trustworthy!

As far as my system goes, The narcs are kept under lock and key in the truck. They never leave the truck. The incharge is the only one with a key to the box. They are logged at the beginning, and end of each shift change. When they are administered they are documented on a separate form with time, date, run #, amt admin., and amt wasted (if any). If wastage occurs, both crew members must sign. When we need to replace narcs, we contact the on duty field sup. He/She comes and brings us more. 

We carry Fentanyl, Morphine, Valium, Versed, Succs, Etomidate, Vec.


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## boingo (Sep 22, 2008)

They never leave your truck?  Don't you carry the drugs with you to the patient?  If you don't have a pharmacy or PYXIS machine to retrieve your drugs from, where do you restock?  And where do they restock?  Just curious.


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## So. IL Medic (Sep 24, 2008)

Ridryder911 said:


> Most states only require a pharmacist if purchasing direct, under a physician license. I have worked where we ordered narcotics directly alike all other medications, one has order under the physician DEA number.
> 
> Shame to have to "test" this assumes that there is a problem, as well as waste in front of them. What happens if it is late at night or have multiple calls, etc?
> 
> R/r 911



We get all our meds from our resource hospital and have the bonus of being able to switchout  any meds near expiration date without charge. One of those things where it has always been done that way...

As for multiple calls, we carry enough for three or four back to back calls without replacement. Two extra stocked drug boxes and narc boxes are kept locked up at the resource hospital if needed.

Long time ago, we used to do the waste in front of partner or nurse and sign a wastage sheet but new PMD and new head pharmacist changed the system a couple years ago. Again, no problem that I know of, they just wanted more accountability.


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