Accounting for Narcotics

[phyrngn]

Hello...how do y'all account for your narcotics? What do you use for paperwork and logs? Do you do it on a daily/weekly/monthly basis? I'm especially interested in volunteer services that don't necessarily have shifts or even a call every day. Thank you.

[SPFTMEDIC]

Well my department is career but we check the narcs on the rescues evrey am at shift change. Our stock of narcs is kept in a locked cabinet that only chiefs have access to. As far as usage we have a controlled substance use/waste form. If you are interested in a copy let me know.

[Weruj1]

We are a POC department that carries and replaces our own narcotics.
They cabinet is double locked attached to a wall in the locked supply room.

How do we maintain them ? Here is what works for us:
The drugbox/medbox tags are recorded daily as we have "on duty" personnel from 0800-1600 7 days a week.

The boxes are checked through bi-monthly on the 15 and 30th/31st.

All medics get color coded tags and are assigned 10 tags at a time and they can only be issued by an EMS Officer and are written down and signed by both parties. So that way we can track through both color and #.

Here is where we get our seals from (http://www.healthcarelogistics.com/mall/more.asp?fmmore=7906R)

And here is what we use for a drug box (http://www.pacsafety.com/products/ems_a500d.htm)

Hope this helps.

[LeuitEFDems]

Carrer here, but for us it's as follows:
Continuous medic truck (one that is a medic unit 24/7, not put on reserve or used as BLS/ILS), the narcs are locked in the overstock cabinet under the tech seat. We use Peilcan-like hard cases with a keyed padlock and numerical tag. The extra narc kits and key sets are locked in our "expensive" cabinet (extra monitors, drug boxes, etc) which the supervisors have keys to the door. The tag number is recorded everytime a truck changes hands. We put down the amounts of the drugs that were listed prior, the tag number, signature, and that the box/tag is sealed and intact. If we use any we have to write down what we used, attach a copy of the PCR and a narc usage form signed by med-con. the log is then double signed with the new dosages left in the box and the new lock number. The boxes are checked and refilled accordingly bi-monthly.

[RyanEMVFD]

The 24s here keep them locked in a cabinet in the truck. The peak load units take them off when out of service and keep them locked in their locker. Each day the drugs are signed in and out by the medic.

The drugs accounted for are: Nubain, Valium, Succs, Versed and Vec.

[Ridryder911]

I hope they just keep them "either on person or double locked"... more than once had to deal with DEA, because I recognized a inappropiate count.

Not fun..............

R/r 911

[specialized26]

We have ours locked in a Pixis or Omni-Cell, or what you call it where we keep all our meds. Everyone has access to the meds except the narcs which are locked is spedial drawers that only the medics have access to. We switch ours after the kit is opened. We have a seperate card with the kit that logs who used, who witnessed the waste and what pt it was used on as well as the doc signature. Then we have log books for each truck, that say the kit/seal number that get checked every shift. The narcs are in a locked bag which is locked in a cabinate in the rigs. The keys are carried on the medic. We are also a hospital based survice.

[specialized26]

and by survice i meant service.

[mitllesmertz1]

Counting narcs?
1 for me, 1 for the pt...
1 for me, 1 for the pt...

[ffmedic2112]

We are staffed from 0600 to 1800. Out narcs are locked in two seperate boxes. One in out medic kit that holds all our other meds and one in a lock box that is secured in the rig. Medics are the only ones that have access to the narcs. We have a "roving" medic for the county that has access to each rig's narc boxes. When we use a narc on a run we have to fill out paperwork that lists pt name, run number, narc used and how much. There is also a seal on each kit and that is recorded also. The medic signs his name and also a witness signs to any wasted or if left overs are left at hospital a nurse or Dr will sign. This paper is turned into our EMS chief for a new kit.

[taidan]

Haha mittle i should suggest that to my medical director, wonder what he will think...

[N2DFire]

O.K. - it all seemed so simple till I started explaining it now it sounds really screwie. We are a volunteer service supplemented by a small career staff.

We have a standardized regional Med Kit with all our drugs in it. These are numbered & sealed (the seal also has a serial number). The boxes (or kit's if you prefer) are stored in a locked compartment on each vehicle. Since all levels can work out of the same box, then the locks are most often a combination lock of some type. For any still using a keyed lock there is a key hidden somewhere on the truck.

Daily inspection
Exact procedure varies with agency but the couple I'm familiar with do a nightly inspection that logs the box number, expiration date, seal #, and signature of the person inspecting the box (one also adds unit mileage :confused: )

Box Usage / Exchange
Any time we "crack a box" we have to list the meds used on the PCR, then the box is exchanged at the ER.
When it is exchanged there are actually 2 records made.
1) On the PCR we have a record of the box turned in, the box given out, and a signature of the exchanging nurse indicating that all the narcotics were accounted for (a copy of the PCR goes in the box before the nurse puts a temporary seal on it).

2) A log book that list box # in, box # out, Pt. name, Date, Technician Name, and the exchanging nurses name.

Each hospital pharmacy will restock any used / expiring meds and the box is returned to the ER to be put back in the exchange rotation.
Also we record narcotics accounted for & box exchange info on the PCR and again the nurse signs.

To further complicate matters we have 3 trucks that are staffed by career personnel from 05:30 to 18:00 M-F. By "royal decree" of our OMD - it was taking too long to get boxes exchanged for *simple* drugs since everything is in the same sealed kit, so now the 3 career trucks carry a small med bag containing ASA, nitro tabs, D-50, and Albuterol. These are restocked PRN by the ER.

[emt3shields]

Volly here!

We Have them locked in our truck's adn a lock box in the supply room. More or less you need a fab key than a narc key and a combo. Everytime you sign in on the truck too pull duty you have a 800 to do ( NYS MOH). You also have sheets than you have to sign. Everything is done every 12/h being a busy volly company (1200 +/y). Everything in our base is based is on a key fab system. I like it because everytime you use it it records the time you opened it. So if narcs are missing they can see who was in it last also theres cameras everwhere. We can also lock anyone out at anytime with the click of a mouse.

[emtJon]

We are a volunteer and paid department down here. Our narcs are actually kept in a Knox-Box. When needed, a tone is set off from dispatch that releases the key, which we then use to unlock the Box. There are papers inside that must get filled out each time a narc is used, not if the box is opened. For example, if we are taking a cardiac transport, we can have the key released just in case we need access once we're out of radio range.

Extra stock is kept in a double-locked box in the chief's office.