Intermittent Pain Meds
Miscellaneous
ADC (Omnicell)
IV Analgesia Infusions
High Risk Behaviors
Controlled Dangerous Substances
100
The most appropriate time to remove PRN pain medication from the ADC is...
What is AFTER a pain assessment has been performed?
100
The partial dose waste of a PRN pain medication should take place when?
What is as soon as possible? and definitely before the end of shift
100
It takes this many nurses to complete the Omnicell Cycle Count.
What is 2?
(and they must be PHYSICALLY PRESENT at the Omnicell)
100
Your fentanyl infusion bag has run dry. Prior to (or simultaneously to) removing the new bag you must..
What is waste the completed bag?
100
You can make an anonymous report of suspected, potential, or actual drug diversion using this forum.
What is the Corporate Compliance Hotline or Origami?
100
You have completed the yellow Controlled Substance Administration Record with a second RN. This should be done with the completed form.
What is send to the pharmacy?
200
You walk into your patient's room to administer 10mg of Oxycodone. You trip and drop both pills on the floor. You must..
What is waste the original "dirty" pills with a witness prior to removing new ones?
200
A term utilized to indicate that the user(s) are not aware of the correct number of designated medications when verifying inventory in an ACD.
What is a blind cycle count?
200
A witness must confirm this before signing off on a return of a controlled substance.
What is correct medication and dose?
200
Nurse A is covering Nurse B for lunch. Nurse B's patient is on a Fentanyl infusion. The patient's fentanyl drip runs dry so Nurse A hangs a new one but there was no scanner available. Later in the shift, Nurse B recognizes there was no MAR actions for the Fentanyl infusion on their shift. Name the failed patient right.
What is right documentation?
200
Constricted pupils, sweating, chills, anorexia, itching, scratching, n/v/d, wearing long sleeves in the Summer are physical signs of this..
What is Opiod Use Disorder?
200
A nurse removes oxycodone from the Omnicell, upon entering the patient’s room the patient changes their mind and requests Tylenol for pain instead. The nurse did not open the oxycodone package. What should the nurse do with the Oxycodone?
What is return the intact oxycodone to the Omnicell external return bin with a witness?
300
Your patient has 5mg of Oxycodone ordered for moderate pain (4-6) and 10mg of Oxycodone ordered for severe pain (8-10). Your patient states their pain is a 5/10 but they've "always just taken the 10mg". You should...
What is administer the 5mg Oxycodone dose? AND educate your patient on the pain medication dosing via the 0-10 scale
300
Repeated discrepancies under one user’s login may trigger this.
What is a fair warning investigation?
300
If you find an open or expired package during a cycle count you should...
What is notify pharmacy to remove?
(Do not waste on your own)
300
Patient is transitioned from active treatment to comfort care. The order for the hydromorphone drip remains active.
The indication on the order reads for a goal CPOT less than 3. The nurse documents RDOS and makes a change to the infusing dose. Name the error.
What is practicing outside of clinical scope of practice?
300
One of your peers routinely asks you to witness wastes for IV narcotics that they state were already deposited in the Rx Destroyer. This is an example of what behavior?
What is Waste Diversion?
300
You remove a vial of a CDS from the ADC, remove the cap, but do NOT administer any of the medication, what should you do?
What is waste the entire vial?
400
You are caring for 2 post-operative patients. Patient A reports 7/10 pain and requests pain medication. Overhearing this request, Patient B states their pain is 5/10 and they also would like pain medication. You walk to the ADC and your next step is to...
What is remove meds for ONE patient at a time?
400
You are performing a cycle count and you notice a sheet of paper in a pocket of the ADC with the last number of a CDS listed. What should you do?
What is discard the sheet of paper and perform your own cycle count?
400
This is the process for resolving discrepancies.
What is immediately address and resolve the discrepancy in real time?
AND Notify unit leadership of any outstanding discrepancies that require resolution or investigation
400
A continuous fentanyl infusion is ordered on an intubated patient. The Fentanyl is currently running at 25mcg/hr.
The order reads: Titrate by 25 mcg/hour every 30 minutes to goal CPOT score less than 3.
The nurse increases the fentanyl drip by 25mcg and documented CPOT score is 0. Name the failed patient right.
What is right dose?
400
Nurses who steal injectable controlled substances for their own use, put patients at risk for this.
What is risk of blood borne pathogen transmission?
400
Your patient reports 7/10 back pain. You bring 10mg of oxycodone in a medicine cup. The patient states he is going to wait for his breakfast tray to arrive because taking it on an empty stomach makes him nauseous. What should you do?
What is educate your patient that you cannot leave CDS at the bedside?
You need to witness them take it or it needs to be wasted.
500
Nurse A has been taking care of patient X for the last two shifts and on both days he reported 7/10 pain at 1000. His pain was treated with a PRN order for a CDS. Since Nurse A knows patient X, she pulls the CDS at from the ADC at 0800 since she anticipates that he will need it with the rest of his 1000 meds. What is the correct policy for removing CDS from the ADC and administering?
What is the CDS must be given without delay once removed from the ADC?
500
A patient arrived to your unit with a Fentanyl Patch from home. What is the appropriate process?
What is a document patch site, obtain order for a new patch then remove the old patch and waste in the Omnicell with a witness, and apply the new patch to a new site?
500
The RN is removing Suboxone from the Omnicell. She counts 8 tabs and receives this message... The RNs next action should be to..
What is recount the drawer to confirm?
(Making sure to include any meds they may have in their hand)
500
Patient expires at 18:57. Off going Nurse A informs oncoming Nurse B of the patient's family saying their final goodbyes. A discrepancy notification is sent to the manager. There is 88mg of outstanding Morphine that was not wasted. Nurse A did not document the stopped medication in the MAR and Nurse B stopped all continuous infusions upon the discharge. Both nurses are written up for a missing narcotic and improper disposal of medication. Name the preventative measure to avoid this scenario.
What is hand bedside report/handoff?
500
Nurse A and B are doing bedside shift report. At handoff, both team members note that the bag of Hydromorphone has 37mL left. Nurse A diverted 10mL of Hydromorphone during her shift. What did Nurse A do to ensure the drug volume matched during handoff?
What is substituted with 10mL of saline?
500
You are administering a PRN narcotic that is not stocked on your unit. What do you need to document on the yellow Controlled Substance Administration Record?
What is the administration and waste?