L.S. asks: What are the requirements for the biennial narcotic count?
JDJ writes: Federal DEA requirements for all facilities with controlled substances:
Code of Federal Regulations
Section 1304.11 Inventory Requirements
(a) General requirements. Each inventory shall contain a complete and accurate record of all controlled substances on hand on the date the inventory is taken, and shall be maintained in written, typewritten, or printed form at the registered location. An inventory taken by use of an oral recording device must be promptly transcribed. Controlled substances shall be deemed to be “on hand” if they are in the possession of or under the control of the registrant, including substances returned by a customer, ordered by a customer but not yet invoiced, stored in a warehouse on behalf of the registrant, and substances in the possession of employees of the registrant and intended for distribution as complimentary samples. A separate inventory shall be made for each registered location and each independent activity registered, except as provided in paragraph (e)(4) of this section. In the event controlled substances in the possession or under the control of the registrant are stored at a location for which he/she is not registered, the substances shall be included in the inventory of the registered location to which they are subject to control or to which the person possessing the substance is responsible. The inventory may be taken either as of opening of business or as of the close of business on the inventory date and it shall be indicated on the inventory.
(b) Initial inventory date. Every person required to keep records shall take an inventory of all stocks of controlled substances on hand on the date he/she first engages in the manufacture, distribution, or dispensing of controlled substances, in accordance with paragraph (e) of this section as applicable. In the event a person commences business with no controlled substances on hand, he/she shall record this fact as the initial inventory.
(c) Biennial inventory date. After the initial inventory is taken, the registrant shall take a new inventory of all stocks of controlled substances on hand at least every two years. The biennial inventory may be taken on any date which is within two years of the previous biennial inventory date.
CH asks: What medications are effective in treating PONV when the patient has arrived in the PACU?
JDJ: Before administering an antiemetic, other causes of PONV should be ruled out. Once the decision is made to administer an antiemetic, the best-studied agents are the 5-HT3 receptor antagonists i.e. Zofran(ondansetron). It should be noted however, that these drugs are fairly effective for treating vomiting but is less effective for treating nausea. In addition, a drug that has been administered for prophylaxis should not be readministered as treatment in the immediate postoperative period; an agent from a different pharmacologic class should be administered instead.
If your patient received no prophylaxis, therapy with a small-dose 5-HT3 receptor antagonists should be inititated on the first signs of PONV. In general, treatment doses are about a quarter of those used for prophylaxis. (studies have shown no difference in efficacy between 1, 4, and 8mg doses). In patients who received prophylaxis with ondansetron, response rate was significantly higher when promethazine (6.25mg IV) was given than when ondansetron was administered.
Please contact JDJ Consulting if you have any further questions.
Feel free to contact us with any questions related to medication safety, regulatory compliance or drug acquisition.
This section will relay your questions and answers as they relate to medication management in the ambulatory surgery world.
For example:
E.Q. asks: What should we do if there is a narcotic discrepancy at the “end of day” count?
JDJ: Attempt to resolve the discrepancy by reviewing records with Anesthesia and other staff involved. If unresolved, an incident report must be completed listing all staff present that day. Forward the report to your Administrator or Director of Nursing. The Consultant Pharmacist should also be contacted. As per DEA, any theft or loss of a controlled drug substance must be reported by the facility Administrator. Refer to the DEA website below for additional instructions. Contact JDJ Consulting if you have any further questions.