Open Forum

Good morning,

Our nursing protocols state that nurses can complete pill count for patients that are on narcotics.  We do not have a SOP or SOW.  Some nurses have questioned them counting narcotics.  Can any of you share your current practices at your clinics?  If completed nurse will need to have another nurse as their witness.  However, is it legal for a nurse outside of a Pain Management Clinic to count narcotics?

------------------------------
Isabel Foote RN
TVHS VA
Cleveland TN
------------------------------

Hello,

At the facility I work, which is a cancer center, the ambulatory care RNs are responsible to do daily Narc checks. On the floors it is every shift. They do not have to be pain management nurses. I believe different states may have different requirements and even some facilities may have different ones, but it is usually two licensed professionals counting the narcotics and they do not have to work in pain management. 

I hope that helps

------------------------------
Tamara Duck BSN, RN, OCN, AMB-BC
Fox Chase Cancer Center

------------------------------

Good morning,

Thank you.  I was referring to outpatient medications.  We fortunately do not have narcotics at our clinic.

------------------------------
Isabel Foote RN
TVHS VA
Cleveland TN
------------------------------

Original Message:
Sent: 05-07-2025 09:30
From: Tamara Duck
Subject: Narcotic Pill Count by Nursing in a Primary Care Outpatient Setting

Hello,

At the facility I work, which is a cancer center, the ambulatory care RNs are responsible to do daily Narc checks. On the floors it is every shift. They do not have to be pain management nurses. I believe different states may have different requirements and even some facilities may have different ones, but it is usually two licensed professionals counting the narcotics and they do not have to work in pain management. 

I hope that helps

------------------------------
Tamara Duck BSN, RN, OCN, AMB-BC
Fox Chase Cancer Center

------------------------------

Hi,

I think you are referring to patients who are being monitored correct?  We (RN's) stopped doing pill counts a few years ago when our FQHC clinics dramatically decreased our narcotic prescriptions.  Pt's being monitored now are engaged with our behavioral health/SUD team.  Nurses no longer do the pill counts or urine testing.

------------------------------
Rebekah Sherman
La Clinica de Valle
Medford OR
(541) 221-3040
------------------------------

Yes, this is for patients on opioids prescribed by PCP (Primary Care Provider).  I reviewed the VA/DOD guidelines for opioids and it mostly mentions performing urine drug screen testing as a monitoring tool.  It also states that evidence is lacking for most mitigation strategies like pill counts, limited pills per prescription.  Our new nursing protocols were created to cover 5 different facilities in 2 different states.  Most of our patients that may need higher doses are being referred to pain clinic as  Primary Care will only prescribe up to 90mg daily of morphine or it's equivalent.  

------------------------------
Isabel Foote RN
TVHS VA
Cleveland TN
------------------------------

Original Message:
Sent: 05-08-2025 15:33
From: Rebekah Sherman
Subject: Narcotic Pill Count by Nursing in a Primary Care Outpatient Setting

Hi,

I think you are referring to patients who are being monitored correct?  We (RN's) stopped doing pill counts a few years ago when our FQHC clinics dramatically decreased our narcotic prescriptions.  Pt's being monitored now are engaged with our behavioral health/SUD team.  Nurses no longer do the pill counts or urine testing.

------------------------------
Rebekah Sherman
La Clinica de Valle
Medford OR
(541) 221-3040
------------------------------