learned an important lesson last night - re: narc count

Nurses General Nursing

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Specializes in Psych, OB-GYN.

I work my PRN job pretty infrequently - and usually stick to the same unit when do. I was called in yesterday to work a unit I haven't been on in over a year - since I oriented actually. I had never even met the med nurse that I followed. That should have been my first red flag.

My facility does not use any kind of pixis machine for our narcs - they are in a locked drawer that only the med nurse on shift has a key - and we sign them out by hand each time one is given.

In my one year there, I've never had an issue. Last night started out the same. Showed up, did the count with the off-going nurse - ran through the 50+ drugs and went out about my business.

Then shift change came this morning - started the narc count and ran into a problem when we came to valium. The count was 5 when I came on. All 5 packets had been separated and like usual, had been lightly tapped together on the back, so that they didn't get lost in the drawer. Nothing out of the ordinary, so during my count, I didn't make much of it.

Well, the on coming nurse did. She took them apart and we discovered that one of the blister packets had actually been opened, and taped back up. The pill inside was actually broken. Of course, she refused the count (and was making a HUGE deal about it on the unit while notifying the off-going supervisor) I felt like crap (she had already been 45m late for the shift!!) I was mostly just po'd that I had missed it. But I came on at 11 - called in late due to a nurse not showing up - so just whizzed though the count.

The supervisor came up and told us to just waste the med. That she would do it and sign. The oncoming nurse protested - continuing to state that she wasn't going to waste a med that she didn't believe was actually valium (Super never told her to wasted it - she hadn't accepted the count!) She kept stating that who knows what went on last night - clearing insinuating that I should be tested for the drug - WTH?? She told the super over and over that she had been gone for a week - making a huge deal about it. Yah, it was an opened pack (and the super agreed w/ me that it looked like all the other valiums) She finally told the nurse to leave the med room since she hadn't take control of the narc drawer. When she did, she apologized for that nurse's behavior and told me to relax - that she had no reason not to believe me and didn't for one minute suspect a diversion. She told me that she would not be requiring me to complete a drug test - just an incidence report (I felt like crying just at that though!) She gave me a heart to heart and told me that if I was going to RN school this fall, I just learned a HUGE lesson - go over the narc drawer like it was my bank statement. Scrutinize ever single drug that I pick up before I sign off on the sheet.

I felt like crap by the time I left - and that nurse was still at the nurse's station carrying on and on about the opened pill pack that didn't look like a valium.

The worst part - this nurse was my preceptor last spring when I was hired :mad::down::devil::mad:

So, that's the story of my first Narc count issue.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

great lesson. thanks for sharing!

i learned a great lesson years ago. if the blister pack is broken, you really don't know what's in there. when i worked on an oncology floor, the patients kept complaining that their morphine wasn't helping anymore. the docs would up the dose, and it still wouldn't help. if they'd switch to another drug, suddenly the patient would have excellent pain control. so they started investigating the nursing staff. after months of being investigated over and over, having our neighbors questioned, etc., the investigation was concluded. someone in pharmacy was sucking the morphine out of the carpujects and replacing it with ns. it wasn't the nursing staff after all. but he was pretty clever -- just took the morphine from our unit -- probably because we used the most.

Something similar happened to me. A big to do was made about something that had clearly happened at another time with another nurse, not me, but not a word, not a peep, not a whisper, until I took over responsibility. How stupid do they think you are that you can't figure out that they were intending to hang the discrepancy on the first fool who happened upon it that is not in their circle of friends? But, you better never make a mention of anything you find or you will be crucified as not taking care of the other nurse. I learned my lesson. I'm her/his friend when they make a mistake, but I'm on my own if I am foolish enough or in too much of a hurry to realize someone else's mistake (or deliberate act) is being pawned off on me. It happens every day.

Specializes in Gerontology.

While I do feel sorry for your problems and agree that this is a good lesson to all, I do have 1 issue with your post.

You stated that you had never met the med nurse you first counted with before and this should have been your first red flag. Why? Just because you haven't met her she must be in the wrong? How do you know it wasn't some other nurse on a prior shift. That broken valium could have been sitting there for days before someone noticed it. You are upset that you are being accussed of something, yet are very quick to do the same to someone else.

Specializes in NICU, Post-partum.
I work my PRN job pretty infrequently - and usually stick to the same unit when do. I was called in yesterday to work a unit I haven't been on in over a year - since I oriented actually. I had never even met the med nurse that I followed. That should have been my first red flag.

My facility does not use any kind of pixis machine for our narcs - they are in a locked drawer that only the med nurse on shift has a key - and we sign them out by hand each time one is given.

In my one year there, I've never had an issue. Last night started out the same. Showed up, did the count with the off-going nurse - ran through the 50+ drugs and went out about my business.

Then shift change came this morning - started the narc count and ran into a problem when we came to valium. The count was 5 when I came on. All 5 packets had been separated and like usual, had been lightly tapped together on the back, so that they didn't get lost in the drawer. Nothing out of the ordinary, so during my count, I didn't make much of it.

Well, the on coming nurse did. She took them apart and we discovered that one of the blister packets had actually been opened, and taped back up. The pill inside was actually broken. Of course, she refused the count (and was making a HUGE deal about it on the unit while notifying the off-going supervisor) I felt like crap (she had already been 45m late for the shift!!) I was mostly just po'd that I had missed it. But I came on at 11 - called in late due to a nurse not showing up - so just whizzed though the count.

The supervisor came up and told us to just waste the med. That she would do it and sign. The oncoming nurse protested - continuing to state that she wasn't going to waste a med that she didn't believe was actually valium (Super never told her to wasted it - she hadn't accepted the count!) She kept stating that who knows what went on last night - clearing insinuating that I should be tested for the drug - WTH?? She told the super over and over that she had been gone for a week - making a huge deal about it. Yah, it was an opened pack (and the super agreed w/ me that it looked like all the other valiums) She finally told the nurse to leave the med room since she hadn't take control of the narc drawer. When she did, she apologized for that nurse's behavior and told me to relax - that she had no reason not to believe me and didn't for one minute suspect a diversion. She told me that she would not be requiring me to complete a drug test - just an incidence report (I felt like crying just at that though!) She gave me a heart to heart and told me that if I was going to RN school this fall, I just learned a HUGE lesson - go over the narc drawer like it was my bank statement. Scrutinize ever single drug that I pick up before I sign off on the sheet.

I felt like crap by the time I left - and that nurse was still at the nurse's station carrying on and on about the opened pill pack that didn't look like a valium.

The worst part - this nurse was my preceptor last spring when I was hired :mad::down::devil::mad:

So, that's the story of my first Narc count issue.

..she is freaking out as if the pill could not be accurately identified.

I would have opened up A KNOWN valium and compared it to the one that broke then wasted both of them (with a third witness) once that nit realized that they were the same thing.

Also...you may not have "missed it"...someone may have opened it and taped it back up on your shift.

Specializes in Psych, OB-GYN.

No, I missed it. Only 2 people have a key during the shift. I had one, the supervisor the other.

And I didn't mean my comment about the other nurse and meaning that I suspected. I wa unclear there. She was new and I should have been more attentive during our count. It could easily have been that she. had a pt refuse and taped it back up. My not knowing her doesn't make her more likely to divert - did't mean to imply that at all!!!

Specializes in Certified Med/Surg tele, and other stuff.

I would have told her to call pharmacy for an ID of the pill (not that you need one to look at a pill. A drug book would do that) and a urine cup. Bring it on sista!

Sorry you had to worry about all of this mess, but it was a lessoned learned. I really look over our packets. Some of them have no pills, and another might have two. It's the weirdest thing.

Specializes in Psych, OB-GYN.
I would have told her to call pharmacy for an ID of the pill (not that you need one to look at a pill. A drug book would do that) and a urine cup. Bring it on sista!

Sorry you had to worry about all of this mess, but it was a lessoned learned. I really look over our packets. Some of them have no pills, and another might have two. It's the weirdest thing.

I volunteered - nothing to hide!!

Specializes in Hospice / Psych / RNAC.

In the old days we use to put them back and tape it up/put it back in the slot or whatever when taking out a narc and then it was refused. I think that's probably what happened. You can't do that these days you need to waste it instead of trying to save it.

Why would you say it was a red flag just because you didn't know the nurse?

Specializes in SICU.

My CI (excellent excellent critical care Nurse) used to tell us:

1. Love many, trust No one when it comes to Narcotics.

2. Dont even trust your Momma with the Narcs Keys.

We used to laugh... but its really true... plus You NEVER know who the closet diverter is. People are sneaky and they WILL throw you under the bus.

My first Semester of NS on a small Telemetry unit, some Narcotics were stolen/ the count was short. Of course they blamed the NS's. even though... we had no access to the Med Bin and as 1st semester students, the strongest med we passed was Digoxin :D

Needless to say the Nurse who had pilfered the drugs was caught when they did a unit wide drug test....

To the OP, it may be wise to insist on a drug test just to clear your name incase this comes back to haunt you at a later date....

Specializes in PACU, OR.
I would have told her to call pharmacy for an ID of the pill (not that you need one to look at a pill. A drug book would do that) and a urine cup. Bring it on sista!

Sorry you had to worry about all of this mess, but it was a lessoned learned. I really look over our packets. Some of them have no pills, and another might have two. It's the weirdest thing.

Yeah, I'd have challenged her there and then. Best practice is really to leave drugs in their original packaging with the security seal still intact, but I suppose it's not always feasible to do that, especially if you have limited storage space.

Specializes in Electrophysiology, Medical-Surgical ICU.

Maybe that nurse took it when she was last there and was trying to cover her tracks by blaming on which ever was nurse was there before her next shift! J/k ;-)

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