Narc storage. How are you doing it?

fm_emt

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Our local policy is "biometric safe, or 2 locks." that's it. Someone mentioned putting a tamper proof tag on the narc case after it's restocked but people are complaining saying that they need to physically verify each and every vial at the start of each shift and they won't sign off if they can't see each vial even if the box is security tagged. If it's tagged, it means that a Paramedic & an actual Pharmacist restocked it and tagged it.

Seems like "just hand off narc box keys to whoever is coming on" is not the best security mechanism or has much for accountability.

Any ideas?

Software is probably out of the question due to costs/etc, and the "two padlock" thing barely meets guidelines, but it works. I thought the DEA guidelines changed recently?

There hasn't been a problem but we don't want there to be a problem in the future. People are resisting any change to the current process.

I'm seeking ideas to cover bases, If there's an off the shelf box you've seen that is lockable and provides visibility, I'd love a link.
 

FiremanMike

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My advice is based on my own state's board of pharmacy rules, please double check with yours to verify compliance.

First and foremost, schedule 2 drugs (fentanyl, dilaudid, morphine, etc) are the only meds that need to be double locked. Schedule 3 and 4 drugs like versed, ketamine, etc do not need to be double locked unless your state has different rules or your department requires it.

From there you have a few options. Currently we use the medvault system with a clear container inside which has a tamper tag. Medvault's are expensive, but they track who is accessing the contents. From there, we have a form that we fill out daily and each time that a seal is broken for restock to verify numbers.

Prior to medvaults, I had just a generic safe on each truck with a clear plastic container inside with had a numbered tamper tag on it. The process was the same, but we had keyed lock boxes instead of med vaults.

Whatever you chose, clear plastic containers with a tamper tag seems to be what would meet your requirements. There are a variety out there, we're using ones made by pelican now, but you could honestly just use small clear plastic tackle boxes.
 

NomadicMedic

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I’m actually going through this now.

We are moving to the LogRx tracking system and we keep our narcs in a locked pelican case with tamper resistant seal and tamper resistant labels on each vial.

Tracking the location and status of each med with a cloud based, verified audit trail is most important to me, thus the new software.
 

DesertMedic66

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Ground: we utilize clear pelican micro cases to store our narcotics. Cases are sealed with a red tamper tag. The narcotics either have to be locked up in a locking cabinet in the ambulance or on your person, locking cabinet inside a locked ambulance qualifies as a double lock. 99% of the time I carry them on my person.

Flight: we utilize an off brand of Otterbox that allows a red tamper tag. During shift they are either on one of the clinical crew members or locked up in our Pyxis system. The Pyxis system behind a locked door qualifies as double locked.
 
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fm_emt

fm_emt

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Sounds like smaller clear containers of some sort with tamper proof tags inside of the larger padlocked case is going to be the way to go.
LogRx looks pretty interesting too. I'd love to see us go that direction in the future.
cheers!
 

Ensihoitaja

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We check narcs in/out of a Pyxis at the beginning and end of shifts. Each narc box is a small clear-top Pelican case with a numbered red seal. If the red seal is broken, it gets re-sealed with a blue seal before return. During shift they're locked in a box with a code in the ambulance.

Use and waste gets tracked in ESO.
 

Tigger

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We have a small, clear pelican case that is tagged. We use PSTrax to track the tag number, as well as the lot number of each vial. I do not know why we do this as many of the vials have the same lot number, though we are told this is how we track individual vials.

If the tag is broken and a med is given, we then retag the case and place it back in the safe (Medvault, each ALS provider has a unique code).

For restock, the battalion chief or EMS tag uses PSTrax to log the tag number and then the med, vial number, and expiration date dispensed. The vial is then retagged. This tag number is not logged until someone does a start of shift narc check or another use is documented.

PSTrax is a good system, the way we use it is not.

At my AMR op paramedic gets their own tackle box that is tagged. We have a huge set of combination locked mailboxes at base that you get yours out of at the start of shift, and then they either go on your person or a lockbox (same code on each car). Each medication is individually shrink wrapped along with a use form that get turns in at the end of shift. I am not sure how they track but it is not cloud based.
 

Bullets

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the narcs in the bag are in a clear flambeau case locked in a bankers deposit bag like this. In station theres a Knox box with a keypad. Narcs are counted and recorded on a sheet at the start and end of every shift.
 
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fm_emt

fm_emt

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Are any of you aware of any specific FDA/DEA/etc guidelines on how the vials should be stored on the ambulance? We have "either a biometric safe or behind 2 locks" but that's about it. I'm trying to find specific information about tamper proof seals/tags.
We have employees that are complaining about tags (that weren't being used before) and I'm confused as to why. I'm trying to find information to back up our usage of tamper proof tags. They're referring to our local county protocols, which are quite vague on the subject.
 

Tigger

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Are any of you aware of any specific FDA/DEA/etc guidelines on how the vials should be stored on the ambulance? We have "either a biometric safe or behind 2 locks" but that's about it. I'm trying to find specific information about tamper proof seals/tags.
We have employees that are complaining about tags (that weren't being used before) and I'm confused as to why. I'm trying to find information to back up our usage of tamper proof tags. They're referring to our local county protocols, which are quite vague on the subject.
I have never found anything requiring tags or really anything that requires the tracking of vials.
 

FiremanMike

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Are any of you aware of any specific FDA/DEA/etc guidelines on how the vials should be stored on the ambulance? We have "either a biometric safe or behind 2 locks" but that's about it. I'm trying to find specific information about tamper proof seals/tags.
We have employees that are complaining about tags (that weren't being used before) and I'm confused as to why. I'm trying to find information to back up our usage of tamper proof tags. They're referring to our local county protocols, which are quite vague on the subject.
This will probably be driven by your state board of pharmacy, it is for us. They’re generally pretty cool about answering direct questions “hey this is what I’m going to do, does it comply with your rules?”
 

johnrsemt

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Our drugs (Morphine, Fentanyl, Valium {Phasing out next month}, Versed and Ketamine) are in clear impact resistant boxes, which are tagged with yellow or green numbered tags, then tagged with Red numbered tags when they are broken open, until 1 of the 2 Narcotic people check and restock them.
Then locked in a narcotic cabinet. There are so many syringes and needles in the boxes to make everyone happy that you can't see the individual vials any more.

Military requirement: and everyone seems fairly happy about it
 
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fm_emt

fm_emt

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Our drugs (Morphine, Fentanyl, Valium {Phasing out next month}, Versed and Ketamine) are in clear impact resistant boxes, which are tagged with yellow or green numbered tags, then tagged with Red numbered tags when they are broken open, until 1 of the 2 Narcotic people check and restock them.


Military requirement: and everyone seems fairly happy about it

Ahh.. interesting. Is there a branch specific guideline you are aware of? If there's one you can point me to, that would be awesome! I'm not active duty, I'm a contract human, but there's a military component here as well.
 

johnrsemt

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Try AR 40-3, section 11- pg. 39 - 46......... Make sure you are looking at the newer one, not the one written in 2008. Nothing specifically for EMS.

Fun thing here is we don't have a hospital, we have a clinic: our pharmacist is a RN who is trying to retire (he is 73) but he is the only RN they have right now.
I told him I will take over the pharmacy when he retires or dies, but I want a pay raise
 
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fm_emt

fm_emt

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Try AR 40-3, section 11- pg. 39 - 46......... Make sure you are looking at the newer one, not the one written in 2008. Nothing specifically for EMS.
This is what I noticed as well. I am honestly shocked that there's no such requirement for EMS that I can find anywhere.
 
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