Questions about being a Narcotics Control Officer

[UnkiEMT]

So, I was just handed the duties of Narcotics Control Officer for the small service I work for...and I only have a general idea about what my duties and responsibilities are. The previous NCO is unavailable for me to talk to until Monday, and, oh yeah, I originally had a pharmacist audit scheduled for Monday, (Though that's supposed to have been rescheduled for next week to give me a bit of breathing room.)

I haven't had a chance to dig into it yet, but I'm relatively sure that our inventory counts are accurate, on the other hand, I'm willing to bet significant amounts of money that our paperwork is out of whack, at least for the last couple of years. I just don't know how badly. I've raided the file room, and come up with I think every piece of paper we have going back about 10 years, so when I'm not running calls this weekend, reconciling that pile will be my life.

Come Monday, I'm going to talk some with our last NCO and contact both the state pharmacy board and the EMS bureau, and of course I've spent some quality time with google, and have read the appropriate legislation, and the narcotics policies of a few services around the country that have posted them online.

What I'm posting here to look for though are any tips or tricks I may be able to garner, copies of more services' narcotics policies or really anything else helpful, especially as pertains to New Mexico.

Thanks.

 

[mycrofft]

Can you refuse? Do so if possible. Not a fair deal.

Being ignorant of your specific situation, there's one basic procedure most agencies often get wrong: the count.

If you do a manual count between two people (oncoming and off going staff), the oncoming staffer uses the book and does not share it with the other person until you both sign at the same time, and the off going staffer counts the actual drugs out loud to the oncoming staffer. Example: a service uses twenty-dose blister packs, and each has a serial number. The off going person picks them up, says "Seconal, 30mg capsules. Full counters: #01,12,33, 44 and 45 of twenty each. #56 has fifteen". Or some such.

Do not "count in" (oncoming)with the book open together unless you ALSO count the actual drugs as well. Never have the off-going counter use the book alone, he'll say "good count" no matter what.

Never "restock" a dose once it has left the counter. Waste it and both on and off shift counters sign. If it is unrecognizable (dissolved but all there), the off going supervisor and the oncoming supervisors need to step in. No taping it back into the counter or whatever. Barfed up drugs don't count, just destroy them.

Never accept a bad book count no matter how big or small. As you come on with this new duty, insist oon a complete stock count of whatever you are responsible for, and that your supervisor and you both inspect the books and the stock count. DO NOT accept any irregularities, no matter how your predecessor cries or moans that he inherited it too. Stop it with your shift. Call the commander if the supervisor doesn't fix it (by reporting it to the commander).

 

[UnkiEMT]

Sadly I can't really refuse it, I thought about that.

As far as the general count goes, as I said, I'm pretty sure that's accurate, that being said, before I leave base on monday, I am going to go through all of it, and if I can't account for every single dose going back for 3 years (which is before the previous NCO took the duties), then I'm going to make him deal with it.

As far as the hand off counts goes, our current policy is that each narc box is opaque and has a numbered seal on it, if you pop the box, it's your responsibility to restock and update the inventory in the book, then reseal it with a new number. I don't like this policy since if I pop a box and find that the count is inaccurate, it's up to me to prove that it was they guy before me who screwed up.

As I said, though, we're a small service, we have a total of 4 people who can carry narcs, what I'd like to do, and I'm not sure if this is legal (Though I can't imagine why it wouldn't be...except that pharma laws are arcane), is assign everyone their own box, inventory it with them and then seal it. Any time they pop the seal, I'd restock them, inventory with a witness, then reseal it. Each person gets their own storage area (read drawer in a filing cabinet with a hasp and padlock) that only they (and I) have access to. That way there's no liability being passed on to anyone else.

 

[unleashedfury]

Sadly I can't really refuse it, I thought about that.

As far as the general count goes, as I said, I'm pretty sure that's accurate, that being said, before I leave base on monday, I am going to go through all of it, and if I can't account for every single dose going back for 3 years (which is before the previous NCO took the duties), then I'm going to make him deal with it.

As far as the hand off counts goes, our current policy is that each narc box is opaque and has a numbered seal on it, if you pop the box, it's your responsibility to restock and update the inventory in the book, then reseal it with a new number. I don't like this policy since if I pop a box and find that the count is inaccurate, it's up to me to prove that it was they guy before me who screwed up.

As I said, though, we're a small service, we have a total of 4 people who can carry narcs, what I'd like to do, and I'm not sure if this is legal (Though I can't imagine why it wouldn't be...except that pharma laws are arcane), is assign everyone their own box, inventory it with them and then seal it. Any time they pop the seal, I'd restock them, inventory with a witness, then reseal it. Each person gets their own storage area (read drawer in a filing cabinet with a hasp and padlock) that only they (and I) have access to. That way there's no liability being passed on to anyone else.

If everyone had their own box, and it has limited access, I.E. the 4 people who have the ability to use Narcs have access to it. I don't see how it would be illegal. However cost effectiveness and accuracy? Sealing the box after each use and placing under lock and key can be beneficial unless of course the sealing person's count is messed up. Lets say I use 5mg of MS and never restock it. Place the seal on the box and call it good. Now 4 days go by before the box is used again, Now you need MS and its not there? Yes I will have some explaining to do but now your patient who may have needed that medication has to suffer and wait..

ETA - I see that you stated that you will restock after each run. I get the idea of that. but are you going to come out a 2AM to restock and inventory my medications or be there 7 days a week at shift change? I think you need to find a reasonable route that won't hamper your personal life.

 

[UnkiEMT]

Well, we really don't use many narcs, I'm hands down the most active narc user (Which is why I got volunteered), and I think the most I've done is three different pushes in a 72 hour shift, so 1) more of out narcs expire than get used, so I'm not really worried about the expense and 2) I can keep the boxes stocked with a pessimistic week's supply pretty easily, and I work 3 on/4 off, so they really shouldn't be able to blow through the box's supply, though I may set up a shared box they can grab if they do manage to empty their box.

As far as the restocking issue goes, that's a legitimate problem, and is the problem I have with our current method, but if I'm the one doing the restocks and seals, I'm basically trusting myself not to screw it up, especially if I have someone checking me and countersigning.

 

[mycrofft]

Sadly I can't really refuse it, I thought about that.

As far as the general count goes, as I said, I'm pretty sure that's accurate, that being said, before I leave base on monday, I am going to go through all of it, and if I can't account for every single dose going back for 3 years (which is before the previous NCO took the duties), then I'm going to make him deal with it.

As far as the hand off counts goes, our current policy is that each narc box is opaque and has a numbered seal on it, if you pop the box, it's your responsibility to restock and update the inventory in the book, then reseal it with a new number. I don't like this policy since if I pop a box and find that the count is inaccurate, it's up to me to prove that it was they guy before me who screwed up.

As I said, though, we're a small service, we have a total of 4 people who can carry narcs, what I'd like to do, and I'm not sure if this is legal (Though I can't imagine why it wouldn't be...except that pharma laws are arcane), is assign everyone their own box, inventory it with them and then seal it. Any time they pop the seal, I'd restock them, inventory with a witness, then reseal it. Each person gets their own storage area (read drawer in a filing cabinet with a hasp and padlock) that only they (and I) have access to. That way there's no liability being passed on to anyone else.

So how can you control that?

Protest and request relief in writing, then throw your self on the inspectors' mercy, ask their input and opinion. If that won't do the trick, then at least it is on record that you think this is not a workable setup.
=====================
We got called up for DESERT STORM to an active duty hospital. They didn't know what to do with one of our majors, our admin OIC/commander (as opposed to the medical commander). So they assigned her to the so-called "busy work" of "count the narcs".

Little did they know she was, in civilian life, an IRS regional manager. Out came the drugs, all the drugs, from the safe. Out came the books. Out came the registered journal of "who was in charge when" of the drugs. Active duty folk were not so smug when they were called to account for massive miscounts accrued at least since twenty years before. I think the pharmacy OIC was replaced.

 

[UnkiEMT]

So how can you control that?

You can't, of course.

So far in the year and a half I've been working for this company, it hasn't bitten me on the arse as a provider, when I get through the reconciliation we're going to find out if it's gonna bite the previous NCOs, but it surely isn't going to bite me.

One way or another, that method of securing the narcs is done for with me being given charge. If I can't get away with personal boxes, then there's going to be some way of doing at least a visual inventory without breaking the seal.


So, I realized that I asked the wrong question here, I mean, I'd still love if it were answered, but the question I should have been asking is "What narcs policies have you had that you loved or hated, or maybe never had but always thought would be a really good policy?

 

[mycrofft]

You asked a good question, I muddied the waters.

I started a thread a few years ago about narcotics procedures and some people not only were operating under horrendously irresponsible procedures (no chain of custody, not under double lock) but became testy when it was suggested they could face trouble if the DES drops around.