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Narcotic Education

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by

Jenelle Jackson

on 18 April 2014

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Transcript of Narcotic Education

Research Conducted:
The Idea:
First Meeting
Data:

Teaching Presentation
Can I get a witness?
narcotic Wasting and handling policy
QI Project:
Can I get a witness?
Narcotic policy and procedure adherence

Pre-teaching survey:
GOAL:
Increase compliance of witnessing removal and wasting of narcotics
I understand the PKV narcotics policy:

YES (25)
NO (2)
Do you always watch your fellow nurse waste narcotics?

YES (17)
NO (10)
I know of a nurse that has in the past or currently does not dispose of waste narcotics properly or has taken them home (purposely or accidently)

YES (3)
NO (24)
Jenelle Jackson, IPPNS
Michelle Johnson, IPPNS

Opinion of narcotic wasting/accountability?

a. waste of time, I trust my co-workers (1)
b. it is needed to cosign and witness, I work with a bunch of druggies (4)
c. neutral, I do what I'm told (13)
d. other opinion (10)
Purpose:
To provide the staff of 5 surgical a refresher course on Parkview’s narcotic policy, as well as show supporting evidence as to why the policies are necessary, not only for patient safety, but also serve as protection for the nursing staff and the hospital as an organization.

I work:
Days (11)
Nights (15)
Other (1)
it's the law, I do trust my co-workers but it is important to me to protect my license.
I feel it is needed to cosign and witness, but not because I work with druggies (4)
I do it to follow policy
it's stupid to have a witness. You do not see them waste, you only witness to pull the drug!
cover yourself.
do it! It's policy!
It is important to watch wasting of narcotics.
Other thoughts:
There needs to be more nurses available to waste narcotics!
There is often no one around!
Pre-survey
&
Post-survey
Any questions?

PKV has narcotic policies in place to comply with federal law.
These policies serve to protect the patient, the hospital and you the nurses.
Compliance is hard due to work environment.
New tools can increase compliance in policy, as well as increase patient safety.

Conclusion

This sign will be posted in Med rooms to remind you of policies and need of a witness

Can I get a witness? Can I get a witness?
Am I pulling a narcotic?
Am I wasting a narcotic?
Am I documenting an error?
Am I emptying Pyxis Returns?
If you can answer YES to any of the above ask…
Can I get a witness? Can I get a witness?

Implementation of Change

Keep a record or tally of the number of times each pod witnessed a narcotic removal or wasting of medication. The Pyxis does not prompt for a witness for all narcotics, nor do you have to chart the witnessing of wasting. This could help increase compliance and serve as motivation for your pod to have the highest tally marks at the end of shift.

Ideas for change

Utilize a “Buddy System”: two nurses on the pod could “buddy up.” This allows the nurse to know who they are responsible to witness for and get a witness from.
Add “witnessing and wasting” to shift report… give new nurse a heads up on how often she potentially will need a witness.


Ideas for change

To ensure patient safety.
To ensure policy and laws are being complied with.
To ensure nursing license is protected.
To ensure co-workers licenses are protected.

(Thompson, 2013) (http://www.state.in.us/legislative/ic/code/title25/ar1/ch9.htm)

Why change???


Increased responsibility for education of patients on medication safety, side effects and proper handling of controlled substances.

Must always use two patient identifies when giving medications.

Double check right patient, dose and medication prior to administration for patient safety and protection of your license.

Make it a priority to follow witnessing policies. Share the love… witness for others so they will witness for you.


(Nazarko, 2007) (www.jointcommission.org/assets/1/6/2014_HAP_NPSG_E.pdf)

What does this mean for you?

Required by law to staff a “Controlled Substance Compliance Officer.”
Job description: To oversee all narcotic policies as well as ensure Pkv is adhering to all state and federal narcotic laws.
Your Rep: Amber Coleman



(Thompson, 2013) (Parkview Regional Medical Center HR department)

What does this mean for the hospital

What does this mean for the patient?

The Big Picture

Nursing boards across the Unites states report substance abuse as the number 1 disciplinary action that takes place each year.
In Indiana, if you are found guilty of a narcotic violation you can face fines, suspensions and termination of license and possible jail time depending on the offense.



(http://www.juns.nursing.arizona.edu/articles/Fall%202002/hrobak.htm) (http://www.state.in.us/legislative/ic/code/title25/ar1/ch9.html)

Who Knew?

Physician from 1970-1998
Middle class citizen
Husband and father of 4
Known drug addict (almost lost his medical license until completed rehab and was considered “cured”)
Serial killer Murdered between 215 and 260 patients with IV narcotics
Caused “Shipman Inquires” which in 2007 resulted in stricter drug policies and consequences not only for medical staff but hospitals as well.

(Thompson, 2013) (www.biography.com/people/harold-shipman-17169712 )

Harold Shipman

To promote proper management of controlled substances.
To have controlled and organized clinical systems.
To reduce criminal activity.
To promote patient safety.

(Thompson, 2013)

But Why witness?

According to the PKV education power point by Amber Coleman and Elizabeth Shultz:

Removing of a narcotic (controlled substance) from Pyxis

Wasting of controlled substances

Weekly controlled substance audit

Documentation of discrepancies

Emptying of Pyxis return bins


When exactly witnessing is required at PKV?

According to PKV policy, when should witnessing occur?
A. Emptying Pyxis returns
B. When documenting a med error
C. When pulling all medications
D. All of the above
E. A, B only

Let’s test our memory…

It’s stupid to have a witness. You do not see them waste you only witness to pull the drug!

Cover yourself.

Do it! It's policy!

It is important to watch wasting of narcotics




Some of your “other” choices

Do you always watch your fellow nurse waste narcotics?

Yes – 17 No – 10

I know a nurse that has in the past or currently does not dispose of waste narcotics properly or has taken them home (on purpose or by accident).

Yes - 3 No - 24

Your thoughts continued…

Your opinion on narcotic wasting/accountability…

A. It is a waste of my time to cosign. I trust my co-workers – 1

B. I feel it is a needed thing to cosign and watch wasting of narcotics. I work with a bunch of druggies – 4

C. Neutral on the subject… I just do what I'm told – 13

D. Other opinion - 10

Your thoughts continued…

Survey results

I work…
Days – 11, Nights – 15, Other – 1

I understand the PKV narcotics policy…

Yes – 25 No – 2






Before we begin… what are your thoughts on this subject?

Increase compliance of witnessing removal and wasting of narcotics.


Goal

Clark, C., & Farnsworth, J. (2006). Research for practice. Program for recovering nurses: an evaluation. MEDSURG Nursing, 15(4), 223-230.
Coleman, A., Shultz, E. 2013. Nursing and Controlled Substance Accountability. Parkview Education PowerPoint. Accessed 3/13/14.
Medication safety. (2010). Journal of Pharmacy Practice & Research, 40(3), 224-228.
Morriss Jr., F., Abramowitz, P., Nelson, S., Milavetz, G., Michael, S., & Gordon, S. (2011). Risk of adverse drug events in neonates treated with opioids and the effect of a bar-code-assisted medication administration system. American Journal Of Health-System Pharmacy, 68(1), 57-62. doi:10.2146/ajhp090561
Nazarko, L. (2007). Managing controlled drugs: regulation changes. Nursing & Residential Care, 9(6), 278-280.
Parkview Regional Medical Center HR phone interview. 4/8/14.
Thompson, A. (2013). Overview on the safe management of controlled drugs. Nurse Prescribing, 11(8), 401-406.
www.biography.com/people/harold-shipman-17169712 
http://www.in.gov/pla/2497.htm. Accessed 4/8/14.
www.images.searches.yahoo.lightbuld. Accessed 3/14/14
www.images.searches.yahoo.narcatics. Accessed 3/20/14
www.images.searches.yahoo.nurseandpatient. Accessed 3/31/14
www.images.searches.yahoo.nurses. Accesses 3/14/14
www.jointcommission.org/assets/1/6/2014_HAP_NPSG_E.pdf. Accessed 3/31/14
http://www.juns.nursing.arizona.edu/articles/Fall%202002/hrobak.htm. Accessed 3/31/14
http://www.state.in.us/legislative/ic/code/title25/ar1/ch9.html. Accessed 3/31/14

References

This sign will also be hung in med rooms with a dry erase marker. This will serve as a reminder as well as encourage some friendly pod competition.

Witnessed Wasting
IIIIIIIII

Witnessed Removal
IIIII

When new patient is admitted: review MAR to see how many times in the shift a witness may be required. This allows for proper time management of other daily task, as well, for both nurse and her “buddy.”
Waste in Med room. This will serve a few purposes… first, it will save time of both nurses because the witness can chart the removal of the med, as well as the wasting of the med at the same time. Secondly, wasting in the med room gives the nurse a full light source, which will increase proper measurements. Often, patient’s rooms are dark. This can pose a risk for improper wasting because of poor lighting. Wasting in the med room will avoid possible confrontations from patients over why wasting is occurring.


Ideas for change

Bar codes systems : reduces harm caused to patients by medication errors.
Thumb print system for witnessing and withdrawing of some narcotics. (Requires compliance of policy)
Required before and after pill count upon removal of narcotics. (Detours theft and medication errors)

(Morris, et al, 2011)

For you protection…

New at home policies require patients or family members to show ID for drop off and pick up of narcotics.
Stricter policies on narcotic at home prescriptions require office visits for refills, as well as no more than a 28-30 day supply of narcotic prescribed.

(Nazarko, 2007).

Stricter policies on handling of narcotics increases patient safety by fewer medication errors.
Patients will receive specific education regarding narcotics (i.e. use, side effects, addictive tendencies, etc.)

(Nazarko, 2007)



What does this mean for the patient?

1 in 7 nurses battle drug or alcohol abuse at some time in their career.
Nurses are more likely to be addicted to opioids and often get drugs from their place of employment.
Most nurse addicts remain anonymous and undetected.
6-8% of nurses are currently battling addiction and their addiction affects their job performance and put patient safety at risk.

(Clark, et al, 2006).

Who Knew?

How do you know?

Package labeled with a marking:
CII – Morphine, Dilaudid, Percocet
CIII - Norco
CIV - Ambien
CV – Codeine


(PKV PowerPoint)


What is considered a narcotic?

Need to have more nurses available to waste narcotics!

Often no one around!

Your added thoughts….

It is the law, I do trust my coworkers, but it is important to me to protect my license.

I feel it is a needed thing to cosign and watch wasting but not because my coworkers are druggies – 4 people answered this.

I do it to follow policy


Some of your “other” choices

Jenelle Jackson, IPPNS jackjr02@students.ipfw.edu
Michelle Johnson, IPPNS johnma07@students.ipfw.edu



Contact information

To provide the staff of 5 surgical a refresher course on Parkview’s narcotic policy, as well as show supporting evidence as to why the policies are necessary, not only for patient safety, but also serve as protection for the nursing staff and the hospital as an organization.

Purpose

Goal: To provide the nursing staff ways to comply with current procedures which will improve patient safety, as well maximizing time management and allow the nursing staff continue provision of excellent care.

Ideas for change

Health care facilities are now required to strictly monitor controlled substances because of Harold Shipman.


(Thompson, 2013)

Did you know…

By: Jenelle Jackson, IPPNS
Michelle Johnson, IPPNS

The importance of proper narcotic handling

Can I get a witness?

Post-Teaching Results
I work:

Days - 10
Nights - 3
student - 6
Now that the presentation is over, do you think prior to the presentation you really fully understood the narcotic policy of Parkview?


YES - 12

NO - 7
What is your opinion on narcotic wasting/ accountability NOW after the presentation?
A. It is a waste of my time to cosign. I trust my co-workers! (0)
B. I feel it is a needed thing to cosign and watch wasting of narcotics. I work with a bunch of druggies. (5; 3 crossed out druggies portion)
C. Neutral on the subject… I just do what I am told. (11)
D. Other opinion (3)

Will you now ALWAYS watch your fellow nurse waste narcotics?
YES - 18

NO - 1
Will you utilize the new Med room posters and attempt to have a “buddy for the day”
YES - 17

NO - 1
Contact with floor manager
a. I was introduced to floor manager on first day
b. Contacted her after that via email or her cell phone due to use of PTO for personal reasons.
c. Suggested the topic of narcotic control on their unit
i. PKV’s policies
ii. What we observe as weaknesses on unit
iii. How to improve handling and wasting of narcotics

Michelle’s first meeting was the February 1st
Upon my first meeting Kristen advised I should ask their new floor manager what our teaching topic should be.
I notified Jenelle of what my preceptor told me
Jenelle’s first meeting was Feb. 12th
I brought up the suggested teaching topic with Wendy, who agreed it was a good idea

Emails were made to head of PKV pharmacy and controlled substance officer
Received PKV’s training PPT for reference.
Did inquiries on CINAHL
Made inquiries to HR

Thank you!

Questions?
It's important for accountability
I think its very important
It's policy now, we have to do it
1 no response
Full transcript