1
Student ESPN Checklist: NFDN 1002
MEDICATION ADMINISTRATION: Narcotics
Supplies required: Medication cups, medication labels, tray, syringes, needle tips, MAR, physician’s orders, narcotic
count record, a second nurse, narcotic keys, beverage of choice for patient, straw, spoon/apple sauce (if crushing),
medication cards, IM/SC kits
There is room for flexibility in regards to the order of this checklist. As long as safe medication administration is followed,
and the necessary checks are complete PRIOR to medication administration, the order does not have to be exact.
Complete patient assessment (either a focused or full assessment), including a full set of vital signs, pain assessment,
confirm allergies, swallowing assessment, and need for narcotic.
Ensure you have physician orders at the cart.
Maintains Hand hygiene at appropriate times throughout the skill.
FOLLOWING IS AN ESSENTIAL SKILLS PATHWAY NURSING ASSESSMENT
Goal Time: 10-15 for administration of narcotic oral medication.
Confirm in MAR the last dose and time of medication given ☐
Verify all information is present on the physician’s order (date, time, drug, dose, route, reason, and signature)
and confirm the MAR to the physician’s orders to ensure no error in transcription. ☐
Check for documented allergies in chart and MAR. ☐
Get key and unlock the narcotic drawer/cupboard. ☐
Check that the narcotic count was complete and is accurate for the required medication. ☐
First Medication Check of the 5 Foundational rights
☐
Pulls the correct medication from the drawer with correct ordered concentration/dose (1 st check).
Compares narcotic label to the MAR, and confirms the expiry date. ☐
Completes Medication Math at this time. Confirms medication math results with verification nurse. ☐
Request verification nurse to verify and visualize narcotic preparation. ☐
Second Medication Check of the 5 Foundational rights
☐
Pour/prepare the medication
Create and attach label to the narcotic cup/syringe (patient name, drug, dose, your initials, and date).
If taken from a multi-dose bottle/container. ☐
MAKE sure to compare the written medication label against the MAR and medication bottle/container.
Count the remaining narcotics and enter the amount on the narcotic sheet.
co-signature from verification nurse on the Narcotic Sheet/MAR needed at this point if there is no ☐
medication waste.
Third Medication check of the 5 Foundational rights.
If narcotic medication is from a multi-dose bottle/container, complete your check prior to putting the
☐
medication away,
Must compare to the label of the MAR and multi-dose container.
Lock narcotic drawer, and return the key, and gather supplies for medication administration. ☐
At Bedside (This will follow the same method of administration to the Oral Medication checklist
Verify the patient
using 2 patient identifiers (name, DOB, ULI) against the MAR. ☐
If possible, ask patient to verbalize their name as a third identifier.
Compare medication label against the MAR. ☐
NFDN 1002 CHECKLIST: MEDICATION ADMINISTRATION: Narcotics Nov 2023 V.1.23.2
2
Right to Refuse
Right Education
Right Reason ☐
Explain the purpose of each medication to the patient, encouraging patient to ask any questions.
Obtain consent prior to administration.
Assist into sitting position OR a position that is safe and not contraindicated. ☐
Provide patient with beverage of choice to take medications.
Provide patient medications either in cup or in their hand (provide option to patient). ☐
Do not contaminate by touching with bare hands
Stay with patient until medication has been swallowed.
☐
If uncertain if swallowed, ask patient to open mouth.
Right Documentation
☐
Sign the medication administration record after administration.
Dispose of soiled supplies in appropriate receptacle.
Clean working area, if required.
Right Evaluation
Evaluate/Verbalize the patient’s response to the medication at the appropriate onset/peak/duration ☐
and report any adverse effects to prescriber.
END OF ESSENTIAL SKILLS PATHWAY NURSING ASSESSMENT
Must submit documentation and nursing care plan to documentation drop box on Moodle
(based on the Lab Practice Scenario) to be deemed successful in this ESPN
Additional Preparation and Administration Information
If MAR coincides with the physician’s orders, can continue all medication checks against the MAR when preparing
medication. However, must ensure that the verification nurse sees the physician’s orders.
When preparing medication, if pre-packaged in an individual packet, keep in packaging until at the bedside.
If giving multiple medications, ensure narcotics are separated in their own medication cup/container/syringe, and label
appropriately
If a portion or entire narcotic needs to be wasted, ensure that you complete the wastage section on the narcotic count
sheet (ensure you include wastage in DOSE, not VOLUME). Request a co-signature from a second nurse. Discard waste
in sharps container ONLY when it is witnessed, and waste prior to administration. Ensure you do not waste excess
narcotic into sink as this is an environmental hazard.
If using crushed pills, provides support to patient when administering, assessing swallowing with each spoonful.
If any adverse effects, withhold future doses and note on allergy record. Ensure you document on the PRN
Effectiveness on the appropriate documentation.
Complete the remaining 5 rights of medication administration. Complete all additional documentation required.
**** Please ensure you follow the policies at the facilities in which you practice ****
NFDN 1002 CHECKLIST: MEDICATION ADMINISTRATION: Narcotics Nov 2023 V.1.23.2
3
CLPNA & Narcotics:
Narcotics are considered high-alert medications. It is best practice to document
and reconcile the narcotic count sheet with the MAR. If administering a narcotic
on a PRN basis, you must document that it was given, why it was given, and the
patient response into the patient chart. These practices should be followed in
addition to any documentation requirements to ensure best practice and mitigate
drug diversion. For PN Students, it is best practice to have a co-sign for narcotics
orders, this means to obtain an independent double-check.
References:
A prescription for Addiction (No date). https://choices.scholastic.com/issues/2017-18/040118/a-prescription-for-
addiction.html
CLPNA (2021 October): Practice Guidelines: Medication Management.
https://www.clpna.com/wp-content/uploads/2018/06/doc_Practice_Guideline_Medication_Management.pdf
Potter, P., Perry, A. G., Stockert, P., Hall, A. (2024). Canadian fundamentals of nursing (7th ed.). Astle, B. J., & Duggleby,
W. Elsevier Canada, pg. 729 (Box 35-2), 753-756 (Skill 35-1).
NFDN 1002 CHECKLIST: MEDICATION ADMINISTRATION: Narcotics Nov 2023 V.1.23.2
