Narc Count - page 3

by bdbrdb | 4,188 Views | 27 Comments

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... Read More


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    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.
  2. 0
    Quote from jnrsmommy
    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.
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    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.
  4. 0
    Quote from nursenow
    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.
  5. 0
    "I personaly think it is impossible to steal a card of narcotics without getting caught."

    For a properly-run place, that is true. Without saying exactly where I work, I can tell you it is IMPOSSIBLE to do without being caught. It may take a few days, but if you do, you WILL be caught. Even if you didn't take them for personal reasons, just lost them, it would be so inept, you wouldn't be able to defend it.
    You get a delivery of say, 120 pills. The patient takes, maybe, 30 of them. All documented by the nurse. So, you would have 90 left for that patient. And, when you are the oncoming nurse, you HAVE to count that crap, so you'd KNOW how many you should have. And how many were given by the previous nurse. It should all be there, folks. I don't understand how there can be such a problem.
    All a particular nurse is doing is making sure the count is OK from one shift to the next. As for deliveries, there SHOULD be a record of EVERYTHING sent by pharmacy, since these patients are being BILLED for these meds!
  6. 0
    Quote from jnrsmommy
    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.
    The pharmacy has the half of the pharmacy slip we sign so even if you throw out our half it doesnt matter. Trust me; There is no way any pharmacy is going to deliver narcotics without being able to prove without a doubt they delivered them. Otherwise what is going to keep the delivery person from just keeping them and saying they gave them to you? It doesnt happen. It doesnt matter how organized my facility is, the pharmacy IS covering their behind!

    There are actually laws the pharmacy has to follow. That is why when you try to order a narcotic one day early they wont send it until the predetermined day that was set by the doctors order back when it was originaly ordered. if they send you a thirty day supply, they will not refill it three days early. The computer is counting the days and knows when it is due for refill. Try ordering 30 days of narcotics a week after they were already orderd the first time and you wont be able to. It is not about what is happening at the facility because the pharmacy tracks it.

    Most narcotic cards have a sticker that says reorder when you have a certain amount left, but they still dont just send out more because you tell them you never recieved a card.
    Last edit by nursenow on Sep 15, '09
  7. 0
    Ours is similar to what you are describing. First we do the actual pill count, matching up to the page number in the log book. Then we count the actual cards/bottles.

    The line in the sign off book looks something like this:

    Date Shift Departing Nurse Oncoming shift Total number Additions Subtractions Discrepencies

    9/15/09 AM/PM Nancy Nurse, RN Lucy Nurse LPM 22 +2 (p. 118,119) 0 0



    Subtractions typically are because it's the end of the card, so we'll add which pages were subtracted for verificication. Or it can be because they were destroyed by Pharmacy was in house and destroyed some of the narcs d/t discharge, d/c'd meds, or death of the resident.




    Quote from bdbrdb
    Ugh, I hit the tab button and posted my thread before I was done...So I made a table and typed the following in the rows...I wish I knew how to post a link to the table, would be a lot easier to see.

    Shift Nurse Sign On Nurse Sign Off #Items on Hand #Items Removed Reason Removed End Count


    Do you think this sheet would work? Reason they are counting the # of items in the lock box is because narcs came up missing. So I guess they are trying to figure out a way to keep better track of narcs.
  8. 0
    The interesting thing is those sheets we count with and sign as we give meds are for in house use/audit by state... The pharmacy know what you have recieved and when you are supposed to get more, even if you tell them you need more they dont go by our count they go by their count.


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