What to do with narcotics after use?
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Onceamedic
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Very important to CYA with the narcotics. We document the amount given to the patient (as with every drug) and then procure a signature from the RN at the receiving (oops - amost wrote deceiving 
) facility for WITNESSED wastage. DO NOT get a witnessed wastage from your partner.
Some people bring in the empty vial too.
Get with a training officer or senior medic and make sure you understand the procedure at your agency. Do not slip up with the handling of narcs.
) facility for WITNESSED wastage. DO NOT get a witnessed wastage from your partner. Some people bring in the empty vial too.
Get with a training officer or senior medic and make sure you understand the procedure at your agency. Do not slip up with the handling of narcs.
Medic744
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For my particular situation there are 3 forms of documentation needed and one of them has to be witnessed by the person watching you waste the medication. We carry Morphine and Valium and it is strictly monitored. Most of the time we are alone in the back when we admin the med but it is rare that we use the whole amt and our partner has to be present when we waste it. The empty tube with serial numbers, 2 sign off forms, and a copy of our run report all get turned into our director so that we can recieve a replacement.
MasterIntubator
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You need to go to your medical director/manager/Chief/Pharmacy or who ever is in charge and will give you a straight and final answer.
Do not try to fish for information any other way with sensitive stuff like narcotics, someone will always leave something out.... and that is not cool.
Each department and juristiction have thier own rules, mine or others may not be the same proceedures.
Many medics have lost licenses due to improper documentation/disposal/etc.
Do not try to fish for information any other way with sensitive stuff like narcotics, someone will always leave something out.... and that is not cool.
Each department and juristiction have thier own rules, mine or others may not be the same proceedures.
Many medics have lost licenses due to improper documentation/disposal/etc.
MSDeltaFlt
RRT/NRP
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Zen,
In most services, I hope all but I'm covering myself by keeping this statement open, there are 2 separate books one must be completely familiar with: 1. the protocol book, and 2. the policy and procedure book. The policy and procedure book (or equivilant) should tell you how to do those things not directly involved with patient care; on the job training, injury, how/when to certs/licenses up to date, disciplinary actions, and narcotic storage/disposal/replenish, etc.
That's where I would look first.
In most services, I hope all but I'm covering myself by keeping this statement open, there are 2 separate books one must be completely familiar with: 1. the protocol book, and 2. the policy and procedure book. The policy and procedure book (or equivilant) should tell you how to do those things not directly involved with patient care; on the job training, injury, how/when to certs/licenses up to date, disciplinary actions, and narcotic storage/disposal/replenish, etc.
That's where I would look first.
Your protocols/policies/procedures will also be linked to how and where you get your medications. Services tend to have an agreement with a hospital pharmacy (often one where you deliver patients often). Ask your supervisors if you should expect to restock at base (and they replenish the restock supply), or at the hospital when you deliver the patient. Strive, when wasting medications, to have a charge nurse witness-- it provides additional validity to the statement of waste.
DV_EMT
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get a witness... period. just so long as its a witness who can legally handle the medication. IE. Nurse, Doctor, Other medic, or even pharmacy. and have them date and initial if its a paper document. then shoot the medication into a blue bin.... or biohazard one if a blue bin isnt present B)
I have no idea how other places deal with there drugs. We carry two drug boxes on ALS unit and one on a BLS unit.
We have a drug box that has a seal on it. If you open the box then you must check it in when you get to the ER and check out the new one before you leave. The RN that checks in the box has a check list of drugs that she checks if they were opened or not. The stuff that opened gets put on a scale to record the weight. If you have drawn something up that was not used it goes back into the bottle it came out of for weight. If the weights and what was used on your report match then all open bottles go into a large metal container for disposal. If the weight is off they will draw it up.
When you’re done the RN signs the check in form and you get a copy for your records. Once you’re box is checked in you can check out a new box at any time.
The only time I run into issues is if I run a call with 2 PT that both need drugs. If I open 2 boxes I’ll grab something out of the wrong box for the wrong PT; if I open one box then there is extra paperwork to be filled out.
Our primary 2 hospitals are good about taking care of our drug boxes but we go to 2 hospitals once in a blue moon that have a different system. When we run a call to one of them we put a lock on the box with our reports inside the box and trade it in at one of our primary hospital the next time were there.
We have a drug box that has a seal on it. If you open the box then you must check it in when you get to the ER and check out the new one before you leave. The RN that checks in the box has a check list of drugs that she checks if they were opened or not. The stuff that opened gets put on a scale to record the weight. If you have drawn something up that was not used it goes back into the bottle it came out of for weight. If the weights and what was used on your report match then all open bottles go into a large metal container for disposal. If the weight is off they will draw it up.
When you’re done the RN signs the check in form and you get a copy for your records. Once you’re box is checked in you can check out a new box at any time.
The only time I run into issues is if I run a call with 2 PT that both need drugs. If I open 2 boxes I’ll grab something out of the wrong box for the wrong PT; if I open one box then there is extra paperwork to be filled out.
Our primary 2 hospitals are good about taking care of our drug boxes but we go to 2 hospitals once in a blue moon that have a different system. When we run a call to one of them we put a lock on the box with our reports inside the box and trade it in at one of our primary hospital the next time were there.
Medic744
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Every agency is different in what to do. We keep strict records and if anything goes missing there is all kinds of red tape to go through. I learned what all has to happen when something isnt accounted for. A couple of wks ago while checking off the trucks a valium was missing and 3 hrs later and 6 stacks of paperwork gone through it came out that somebody just never replaced an expired one. I am super vigilant about keeping up with my records because I worked where the narcs werent locked up and things kept "disappearing"
How much does that hold you up at the ED? Seems kinda arcahic...
The procedure here is both partners have a drug box key, takes both keys to open the box. Most of the time full vials are drawn into a syringe, waste is usually down a sink witnessed by both partners and logged onto a narc count sheet. Sheets are faxed at the end of each month to HQ.
Just about everything comes in one use bottles that come boxed so it’s not bad. Our drug boxes are medium sized tackle boxes and everything they pull out and check is on 2 of the pull out shelves. It was well thought out…
If you take your drug box in and sit down to finish out your paperwork they will have finished there inventory before I can finish my report. There have been times that ER is backed up and you do have to weight in line. Most of the time there are 20 pulse full drug boxes ready to be checked out.
Each unit has a locked cabinet that the drug box(s) are in. The combination is biased on the unit number. When the drug boxes are filled they put a numbered tag on the box that cuts off. Just check every sift that you’re drug boxes have not been tampered with.
If you take your drug box in and sit down to finish out your paperwork they will have finished there inventory before I can finish my report. There have been times that ER is backed up and you do have to weight in line. Most of the time there are 20 pulse full drug boxes ready to be checked out.
Each unit has a locked cabinet that the drug box(s) are in. The combination is biased on the unit number. When the drug boxes are filled they put a numbered tag on the box that cuts off. Just check every sift that you’re drug boxes have not been tampered with.
DT4EMS
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***Yup******* Using this method is safer in my opinion. The reason...... there is not the same perceived relationship between you and the receiving RN as there is between you and your partner.
Follow your local SOP of course......... but in nearly 20 years in EMS (18 as a medic) I never had that way questioned.
old areas to be that we had paperwork that the nurse signed, after witnessing us wasting the drug into the sharps container.
our drugs at the FD were in locking canvas/kevlar bank bags, inside a locked metal box that was mounted to the truck (the keys for both were usually hanging on the box so they didn't get lost.
drugs at Private service were locked in box, that we hid somewhere on the truck
new area: waste it at the hospital, do the paperwork back on base. lots of paperwork with the army.
our narcs here are carried in a small plastic parts box, that is plastic tabs shut.
our drugs at the FD were in locking canvas/kevlar bank bags, inside a locked metal box that was mounted to the truck (the keys for both were usually hanging on the box so they didn't get lost.
drugs at Private service were locked in box, that we hid somewhere on the truck
new area: waste it at the hospital, do the paperwork back on base. lots of paperwork with the army.
our narcs here are carried in a small plastic parts box, that is plastic tabs shut.
thegreypilgrim
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Usually you just waste whatever you didn't give the patient at the receiving facility and have the RN sign as a witness. Or bring the empty vial/ampule/whatever if you used all of it. Photocopy your run report and send it in with the rest of your paperwork. That's how I would imagine most jurisdictions handle this, but check your policy/procedure manual to see if yours does anything different.
firecoins
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I inject any left over morphine into my veins. I find its the most painless way of disposing of narcs.
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Unfortunately, I think preventing that is the point of this whole discussion. It would be an efficient use of the medication, though! Waste not, want not.