care areas. "One of the big issues we've seen is recovery room nurses
not auditing opioid transactions," says Ms. New. "A number of cases
have involved PACU nurses pulling 2 pills, but giving only 1. Nobody
was auditing the actual administration records, so no one knew. The
issue went unnoticed until things spiraled out of control."
2. Secure storage
Automated locking carts are the Rolls-Royce of opioid security. "It's the
most secure and accountable way of managing controlled substances,"
says Ms. New. "You have an automated trail, so you know who's gained
access to what."
Absent automation, a manually locking storage cart is the next best
thing, says Ms. New. But don't lull yourself into thinking a strong lock
is all you need. "I strongly recommend facilities focus a video camera
on the cart that's storing controlled drugs," she adds. "And keep the
key stored in a separate location, like a wall-mounted lock box, to
prevent widespread access to the stored drugs."
Ms. New says it's convenient to have one central storage location for
controlled substances. She's also seen some facilities that have manual
locking storage cabinets pack other expensive supplies into the cabinet
with controlled drugs. That's a medication security no-no. "Designated
storage carts should contain only controlled drugs," she says.
"Remember, you want to reduce the number of times staff members
need to gain access to that location."
3. Accurate counts
Perform a count of controlled drugs at both the beginning and end of
every shift or day of surgery. "If you have any discrepancies or issues,
you'll be able to recognize them as quickly as possible," says Ms. New.
Ms. New also stresses that 2 staff members should perform end-of-
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