Securing Controlled Meds

[Handsome Robb]

They're inside a key-locked box which is inside of a cabinet which is locked with a 6 digit combination. Each medic is issued a combination when they clear their FTO time.

We used to use Pyxis to check out, in or restock narcotics but I believe we switched to a different system. Not sure though.

 

[Angel]

wall safe, each medic has a # they can use to open, and a seal/tag on the actual med box

I don't like the idea of carrying narcs on my person.

 

[rmabrey]

Inside a cheap plano box with a numbered tag. We each have our own that we are responsible for. They stay locked in our individual mailbox when not on shift. Each medic has their own narcs.

 

[TransportJockey]

Medic holds keys for the locked cabinet. Inside each box is locked as well. Every Monday the ongoing and offgoing medic counts and signs for drugs. Only two medics have access to the drugs on each truck, A-shift and B-shift.

 

[usalsfyre]

I don't like the idea of carrying narcs on my person.

Why? If they'll kill you for the narcs they'll kill you for the keys.

 

[mycrofft]

Because any discrepancy or accident means you just lost the DEA Musical Chairs routine.
And seeing the meds on you could trigger an impulse grab whereas seeing a bunch of keys wouldn't.

 

[Hockey]

I just don't get what the big thing is about whats in the box. Okay, Fentanyl and Morphine. Maybe get some Versed too. That little high for a few minutes isn't worth losing my job, or my license over. Ever. I never will understand why some folks have done it.

 

[chaz90]

I just don't get what the big thing is about whats in the box. Okay, Fentanyl and Morphine. Maybe get some Versed too. That little high for a few minutes isn't worth losing my job, or my license over. Ever. I never will understand why some folks have done it.

That would be the addiction component. As non-addicts, we can't understand the reasoning (or lack thereof) of an addict.

 

[Handsome Robb]

I don't like the idea of carrying narcs on my person.

Why not?

Besides zofran, narcotics are the medications I most commonly administer at the bedside prior to moving the patient at all? Makes things overly complicated if you have to run out to the truck to get your narcs every time you want to administer them.

If anyone ever challenges me for my narcotics with a weapon I'll gladly hand them over. I'd do the same with my keys and digilock code. I was thinking that they should put something into the digilocks so if you input your code backwards it'll still open the safe but will trigger a silent 10-78 alarm in dispatch. I read somewhere that ATMs do that. If you put your PIN in backwards it'll give you money and call the cops. Not sure if that's true or not though.

 

[UnkiEMT]

If anyone ever challenges me for my narcotics with a weapon I'll gladly hand them over. I'd do the same with my keys and digilock code. I was thinking that they should put something into the digilocks so if you input your code backwards it'll still open the safe but will trigger a silent 10-78 alarm in dispatch. I read somewhere that ATMs do that. If you put your PIN in backwards it'll give you money and call the cops. Not sure if that's true or not though.

It's not true, moreover, it would be a bad thing if it were, then the guy holding you at weapon point would have incentive to make sure you were using the real code, not the alert code.

 

[mycrofft]

I wonder how many such stickup occur?
Anyway, if you're the carrier and something's short or funny, here's your next corporate stop:

 

[usalsfyre]

I wonder how many such stickup occur?
Anyway, if you're the carrier and something's short or funny, here's your next corporate stop:

And you're entrusted with the responsibility when they're signed out to make sure they come back in the same condition or have a good explanation of why they didn't. It's accountability. I'm accountable to the medical director and the DEA that the narcs are taken care. My field providers, in-turn, are accountable to me. Why is this a reprehensible concept? It's no different than inspecting the $100,000 ambulance you're entrusted with prior to the start of the shift for damage. If you don't, and it comes back nungered, it's on you.

It makes no difference if they were in the lockbox or on you. If they come up missing and there's not a good explanation why, it's your ***.

 

[mycrofft]

And you're entrusted with the responsibility when they're signed out to make sure they come back in the same condition or have a good explanation of why they didn't. It's accountability. I'm accountable to the medical director and the DEA that the narcs are taken care. My field providers, in-turn, are accountable to me. Why is this a reprehensible concept? It's no different than inspecting the $100,000 ambulance you're entrusted with prior to the start of the shift for damage. If you don't, and it comes back nungered, it's on you.

It makes no difference if they were in the lockbox or on you. If they come up missing and there's not a good explanation why, it's your ***.

I'm failing to find the word "reprehensible" in my reply….

And one definition of "under the bus" is "It's your ***". I've seen a couple co-workers blown out then exonerated when they wouldn't lie still after wrongful termination (no investigation). The winning plaintiffs are required to sign a non-disclosure agreement about settlements, but neither of them were dumb enough to come back and apparently didn't need to.

I had to sit by as a staff nurse during a DEA audit. They don't use the phrase "it's your ***", they systematically ask questions and examine evidence following the whole chain of custody. Any weakness from any aspect is winkled out. Staff training about procedures is tested. Accounting for keys or changing of combinations is examined.

It's good to be careful about firing people or other changes until after the audit is over, also.

The gist of my reply was if you receive controlled drugs or anything, inspect it, count it, and do NOT accept it until you are happy with it; if there's something wrong, before you sign, get the boss.

 

[Angel]

Why? If they'll kill you for the narcs they'll kill you for the keys.

well i wasnt thinking KILL, lol they can have them before it comes to that
i just think its easier to steal (or threaten/assault and take) and/or misplace. also there are no keys, its a wall safe and each medic clicks their own number to open it. any medic on any rig can put in their number and access it.

Why not?

Besides zofran, narcotics are the medications I most commonly administer at the bedside prior to moving the patient at all? Makes things overly complicated if you have to run out to the truck to get your narcs every time you want to administer them.

If anyone ever challenges me for my narcotics with a weapon I'll gladly hand them over. I'd do the same with my keys and digilock code. I was thinking that they should put something into the digilocks so if you input your code backwards it'll still open the safe but will trigger a silent 10-78 alarm in dispatch. I read somewhere that ATMs do that. If you put your PIN in backwards it'll give you money and call the cops. Not sure if that's true or not though.

that would the exception. if i had to for pain mgmt or active seizing ( since thats all we get: morphine, fentanyl soon, and versed)
but i guess im just overly cautious/paranoid.

 

[TransportJockey]

Why not?

Besides zofran, narcotics are the medications I most commonly administer at the bedside prior to moving the patient at all? Makes things overly complicated if you have to run out to the truck to get your narcs every time you want to administer them.

If anyone ever challenges me for my narcotics with a weapon I'll gladly hand them over. I'd do the same with my keys and digilock code. I was thinking that they should put something into the digilocks so if you input your code backwards it'll still open the safe but will trigger a silent 10-78 alarm in dispatch. I read somewhere that ATMs do that. If you put your PIN in backwards it'll give you money and call the cops. Not sure if that's true or not though.

I wish I had pockets big enough for my narc boxes. Lol it does suck to have to send someone to the rig for one of them.

 

[usalsfyre]

I'm failing to find the word "reprehensible" in my reply….

And one definition of "under the bus" is "It's your ***". I've seen a couple co-workers blown out then exonerated when they wouldn't lie still after wrongful termination (no investigation). The winning plaintiffs are required to sign a non-disclosure agreement about settlements, but neither of them were dumb enough to come back and apparently didn't need to.

I had to sit by as a staff nurse during a DEA audit. They don't use the phrase "it's your ***", they systematically ask questions and examine evidence following the whole chain of custody. Any weakness from any aspect is winkled out. Staff training about procedures is tested. Accounting for keys or changing of combinations is examined.

It's good to be careful about firing people or other changes until after the audit is over, also.

The gist of my reply was if you receive controlled drugs or anything, inspect it, count it, and do NOT accept it until you are happy with it; if there's something wrong, before you sign, get the boss.

I've been the guy in charge of the controlled substances program during a DEA Audit. It's even less fun.

"Under the bus" to me implies you're being unfairly blamed for system/others failures.

You're last sentence shows we're on exactly the same page. If there's an issue with controlled substances I want to know about it right away, not several days later. Anyone with a controlled substance issue is told to contact their supervisor, and if they don't get told to go OOS till it's resolved, call me directly.

 

[Bearamedic]

We are required to keep them on our body.

At my place, that is expressly forbidden. The reason being that It makes us a target.

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Locked cabinet near the airway seat, clear number sealed container that allows us to examine at the start and end of each shift, 2 signatures verify intactness at that time.

Upon usage, sig of wasted amount, management deals with the extras or storage with triple locks.

 

[Household6]

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!

That's our setup. Then counted and signed for every shift change. Single use vials where the dose is recorded and the rest must be squirted into a wastebasket in front of your partner.

 

[Clare]

Controlled drugs (morphine, fentanyl, ketamine) are stored in the drug safe which is locked, then stored inside the stores room which is also locked.

They are carried in a belt pouch on the person of somebody who has authority to possess them.

Personally I do not understand the logic in having them (double) locked in the ambulance; what a waste of time having to go back to get them or take them out on every job; you never know when you are going to need them/

 

[jwk]

It's a comparable problem anywhere controlled substances are kept.

In general, according to DEA, they are supposed to be kept behind two locks, even in the hospital. So if the pharmacy is locked, and they're kept in a locked cabinet, that satisfies the requirement. If a pharmacist is present, then the first lock requirement is obviously unnecessary. But if the pharmacist leaves the pharmacy, and this happens both in the hospital as well as retail stores, the pharmacy is supposed to be closed off and locked. If your rig is locked, and the narcs are in a locked cabinet, the requirement should be satisfied as well.

Carrying them around might be a different issue. If you're taking them out with the intent to use them on a given patient, you should be fine. If you take them out to carry them around just in case, that might be more problematic. I can't check out controlled drugs in the hospital "just in case". They have to be for a specific patient. It didn't used to be that way, but it's much more controlled nowadays than it used to be. I think you're much more at risk for accidental loss or broken amps/vials/pre-loads by carrying them around, and of course a broken vial is supposed to be documented as a narcotic discrepancy.

Don't know how it is with EMS, but any time we start accumulating discrepancies in the hospital, regardless of the reason, it will raise eyebrows. I will show the broken vials to the pharmacist and have them document, or, I will tape broken pieces of the vial, with the label, to the narcotic discrepancy form. Too many discrepancies in too short a period of time, and we get to go pee in a bottle with a witness - refuse and you're fired - it's that simple.