Narc Count

Nurses General Nursing

Published

Hello,

I was wondering how other LTC facility deal with Narc Sign On/ Sign off Sheets? Recently our Adm came up with a Sheet for Narcs where we count the number of items that are in the lock box, but to me and the other nurse's the sheet doesn't seem as though it'll work out. I thought about coming up with an idea of a sheet of my own. Basically the same idea as the Adm. but mine seems less confusing...

Shift Nurse Sign On

I think they make things a lot more complex than they have to be...The way I see it is this, you start out with 100 pills, you give 2, you better have 98 left. Regardless of the number of cards, etc, you have to have 98 pills left. Why is this so hard?

Specializes in LTC/Rehab,Med/Surg, OB/GYN, Ortho, Neuro.

That's true, but I guess it's because there have been instances of nurses stealing the whole card and getting rid of the sign out sheet as well.

We use a basic form that comes with each narcotic when it arrives from pharm. when we administer a narcotic we fill the date/time/qty given/qty remaining and sign. when we change shift we review the count with the oncoming nurse and they assume responsibility for the count. If it comes up wrong it is the current nurses responsibility to figure it out or pay the price. a very simple and reliable method that works well and honestly I have never seen any other method used, except for electronic accountability. The forms used come from the pharmacy and are not made by the facility.

That's true, but I guess it's because there have been instances of nurses stealing the whole card and getting rid of the sign out sheet as well.

I guess thats possible but how do they hide the entire MAR? They have to sign there also for any meds, vitamins... do they steal a whole page listing many meds also? You dont just sign the Narcitc sheet you also have to sign the MAR.

Specializes in LTC/Rehab,Med/Surg, OB/GYN, Ortho, Neuro.
I guess thats possible but how do they hide the entire MAR? They have to sign there also for any meds, vitamins... do they steal a whole page listing many meds also? You dont just sign the Narcitc sheet you also have to sign the MAR.

I'm referring to someone getting a new delivery from pharmacy (either new med or refill) and just taking it.

actually this wouldnt stop a person from stealing what was delivered during their shift, they would just not log it in.....eventually they would get caught if someone were monitoring the drugs well...did catch someone doing this once.... acutally the nurse i was working with caught it....but i was supping......a nurse ordered a med that my fellow nurse knew didnt need to be ordered and when she went to put it away the older card with 25/30 left was gone....the order sheet for the new card was gone....the sign out sheet for the old card was gone....the culprit wasnt counting on M. to remember what was in her narc drawer, big mistake, lol!

That's true, but I guess it's because there have been instances of nurses stealing the whole card and getting rid of the sign out sheet as well.

This ^^

You can only account for individual pills on a card or patches in a box if their count page is still in the book.

I know of FOUR SNFs in my town that have had to implement a separate 'item count' sheet last fall due to entire cards of drugs and their corresponding page going missing.

It can take weeks or even months for something like that to get caught, if ever.

They were able to narrow down a time frame when the thefts occured based because my state requires sequentially numbered pages in a bound book. Because of the staffing situations in those facilities at the time, the fact it was a 'new' issue at each facility and the consistent nature of the thefts it is being attributed to an agency nurse but because it took so long to discover the thefts no action can be taken. But word gets around in a not-so-small-town, our SNF Administrators and DoNs are a close knit bunch.

We use a basic form that comes with each narcotic when it arrives from pharm. when we administer a narcotic we fill the date/time/qty given/qty remaining and sign. when we change shift we review the count with the oncoming nurse and they assume responsibility for the count. If it comes up wrong it is the current nurses responsibility to figure it out or pay the price. a very simple and reliable method that works well and honestly I have never seen any other method used, except for electronic accountability. The forms used come from the pharmacy and are not made by the facility.

Oregon allows that system and I hate it.

It just makes it that much easier for someone to steal the card and the page.

The sequentially numbered pages in a bound book is supposed to remove that possibility but the truth is that no one 'bothers' to count correctly. Part of the count is both nurses looking at each page to verify no pages are missing, so often finished pages are banded/clipped/stapled together and people only look at the pages they have cards for.

Where I work, when the meds come in, there is a sheet that lists all of them, and the amounts. So, regardless of the info on individual cards, there is a record of what was sent. I don't understand how anyone could get away with stealing an entire card of meds, especially narcs, which are very carefully accounted for in most places.

Our narc count is really simple. Each card has it's own count sheet which is pre-numbered all we do is sign. The sheets are 90 tab sheets but when the meds arrive we write in at the top how many were received and circle that number so we know where to begin signing them out. Ghe blanks are labeled as date, time, number, signature. The backside of the sheet is used to count liquid narcs like phenobarb and is not numbered, it has a blank for the date, time, dosage, current amt remaining and signature.

We also have a general sheet we sign when we count the meds in, and then count the meds out to demonstrate it was done but offgoing and oncoming nurse.

That's all we do. I don't understand the purpose of keeping track of how many items removed per shift, unless they are monitoring how many narcs are being given by a particular nurse, but that could be figured easily other ways.

I say keep it simple. less room for errors.

oh just an interesting tidbit. One facility I worked at had several cards of narcs just disappear, everyone tested clean on urine or had scripts to cover them. We wound up having a 3 nurse count. It was a pain in the rear but now if I work with a nurse who consistantly comes up screwy at narc count, I ask for a 3rd nurse to witness the count. Gotta save your own butt ya know.

I'm referring to someone getting a new delivery from pharmacy (either new med or refill) and just taking it.

We order narcotics, they are delivered, a nurse signs for them and puts them in the cart. If I come on shift and Mr. so and sos, meds are missing the first thing I would do is asked the off going nurse "where are they?" We all know what meds Mr. so and so recieves and they also are listed on the MAR, as well as in the physicians orders of the chart. We also have to list any PRN med given when we give report to oncoming nurses.

If the meds are never put into the cart, the pharmacy would provide a copy of the form the nurse signed when recieving the meds. If no one new they had been delivered because a nurse stole them, they would get caught the first time someone tried to reorder them because the pharmacy would refuse to refill them order too soon. They are computerized and track that stuff. I personaly think it is impossible to steal a card of narcotics without getting caught. Maybe you can steal a couple off a card but even then you have to get another nurse to co-sign when you waste them. The nurse you co-sign with is going to ask what happened to them also. A nurse might let you slide the first time but not time after time.

Specializes in Haematology, stroke.

We have one signlist per drug (narcotic) which has the following columns:

1. Date, 2. number of pills/vials added, 3. number of pills/vials taken out, 4. patient's surname, 5. number of pills/vials left, 6. balance (+/-), and 7. nurse's signature.

Specializes in LTC/Rehab,Med/Surg, OB/GYN, Ortho, Neuro.
We order narcotics, they are delivered, a nurse signs for them and puts them in the cart. If I come on shift and Mr. so and sos, meds are missing the first thing I would do is asked the off going nurse "where are they?" We all know what meds Mr. so and so recieves and they also are listed on the MAR, as well as in the physicians orders of the chart. We also have to list any PRN med given when we give report to oncoming nurses.

If the meds are never put into the cart, the pharmacy would provide a copy of the form the nurse signed when recieving the meds. If no one new they had been delivered because a nurse stole them, they would get caught the first time someone tried to reorder them because the pharmacy would refuse to refill them order too soon. They are computerized and track that stuff. I personaly think it is impossible to steal a card of narcotics without getting caught. Maybe you can steal a couple off a card but even then you have to get another nurse to co-sign when you waste them. The nurse you co-sign with is going to ask what happened to them also. A nurse might let you slide the first time but not time after time.

While that may be true, I work night shift, I get to file all the misc paperwork that gets left on the desk. You would not believe the number of pharmacy slips I have found that do not have any signatures on them. We have these extra steps in place because a nurse before I started working there was stealing whole cards of narcs for months. From what I'm told, it was a big finger pointing session btwn the nurses and the pharmacy until she was finally caught. As evidenced by the signature-less receipts I find, no system is perfect, and I'm all for doing a little bit extra if that means I get to protect my license/my way of life from someone else.

+ Add a Comment