Narcotics (also known as opiates or painkillers) are a classification of pain medications that have the potential to be addictive. Because of their addictive nature and potentially serious side effects if abused or misused, the handling and management of narcotics are highly regulated. Narcotics are classified as Schedule I to Schedule V drugs under the federal Controlled Substances Act. Schedule 1 drugs (such as heroin) have no accepted medical use and have a high potential for abuse. Schedule II through V medications have medical use and range from highly addictive drugs such as oxycodone and morphine (Schedule II) to cough suppressants with a low dose of codeine (Schedule V).
In a medical institution such as hospitals or nursing homes, Schedule II through V medications are subject to many regulations, including the followings:
- The medications must be kept securely locked in a specially constructed cabinet (typically double or special locks designed for extra security) to which only authorized personnel are allowed access. If refrigeration is required, the refrigeration unit must also be securely locked and access-restricted.
- There must be an accounting each time a medication is removed from and returned to the secure cabinet and for each dose administered. The accounting must include the name of the patient receiving the medication, the purpose/reason for administration (i.e., pain), the name of the prescriber, the name of the healthcare provider administering the medication, and the time and manner in which the medication was administered. The system for the accounting can be either manual (written) or computerized (electronic).
- Once removed from the cabinet, the medications should be securely kept until administered. Some medicine carts (used by nurses to hand out medications) have special locking drawers for the purpose of holding narcotics. Most hospitals and many nursing homes use automated drug dispensing systems which are programmed to dispense the right medications to the right patients and also keep automated records.
- Narcotics must be disposed of through an approved method and that disposal must be witnessed and documented.
Despite these statutorily required regulations, mistakes and mishandling still happen.
Human error, including the failure to follow established protocols, is the main reason for narcotic medication errors. Even automated drug dispensing systems are subject to error if there is a mistake with the input data. The simple misplacement of a zero or a period can be the difference between the right dosage and an overdose.
Protocols are only as sound as their implementation and oversight. In one compliance case study, a physician had concerns about the number of Fentanyl patches he was ordering for a nursing facility. An initial audit of the facility’s electronic records revealed no issues. It was only when investigators actually traced the chain of custody of the Fentanyl patches that they discovered the failure in protocol. The nurse who accepted delivery of the medication did not record receipt and reportedly just handed them off to a second nurse who also failed to follow protocol in her documentation. Due to this error, at least one patient was not receiving her Fentanyl patch. These nurses were suspended pending the conclusion of the investigation and the facility’s protocol was changed. The specific storage, handling, and accounting protocols for narcotics are designed for good reason. However, the system is managed by humans, and problems do occur that can negatively impact patient health and safety. If you suspect an issue with how you or a loved one’s narcotic medication is being managed, ask questions about your medical facility’s protocols and how these medications are tracked and administered. If you suspect that your health, or the health of a loved one, has been negatively impacted because of poor narcotic control protocols, contact us.