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

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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.

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Specializes in Geriatrics, Transplant, Education.

I'm not sure I understand. Do all of your residents/patients not have separate numbered bubble cards with their medications in them?

We have a narcotic log book for each med cart. Each time a new order is received, it is entered onto a new page with that patient's name, the drug, order & prescription number and the amount rec'd is listed and signed by two nurses.

When you count, the ongoing nurse & offgoing nurse examine the written count in the book and the actual card of the narcotic, typically with the offgoing nurse reading out the name and amount of med & both nurses confirming "Jane Doe Ativan 0.5 mg, 20, Joe Schmoe OxyContin 10 mg, 67" etc.

I'm a relatively new nurse...thought this was the only way to do narc count in a LTC/med cart setting...I'll be interested to see other replies..

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We do have this system...just how you described it, but now the Adm added another sign in sheet that states the number of items that are in the lock box...they are so confusing at work. But I was just wondering what systems other facilities have that do work? Or possibly some other ideas that I can let our Adm know about.

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Specializes in Geriatrics, Transplant, Education.
We do have this system...just how you described it, but now the Adm added another sign in sheet that states the number of items that are in the lock box...they are so confusing at work. But I was just wondering what systems other facilities have that do work? Or possibly some other ideas that I can let our Adm know about.

Do you mean like an Index of what is actually in the box? Our log book already has that...

Or are you talking about a sign out sheet for an emergency narcotic kit?

Super confused...just trying to figure out what you mean.

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are they documenting the actual number of cards/vial, etc....to prevent theft of whole card etc? this would make sense

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Specializes in Surgical, quality,management.

I have always had to count DA at the beginging of each shift (ie balance checked and correct) and each time we have to give out a S4 or S8 drug (Mr J Blogs 5 mg morphine - 5 discarded) checked out of DA cupboard and checked to the bedside by 2 registered nurses. Is the national poicy in Australia and Ireland (S8 only) bit more lax about temazapam, ativan, diazapam in Ireland. in a country hospital that i worked in where there was only one RN on shift we had to check out with the care worker.

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

The facility I am at now uses the system that the OP is describing, and it does take a few more minutes to do the count but it's not a problem at all. The sheet has columns for offgoing and oncoming shifts, the number of cards you're accepting for your shift, the number of new cards you received during your shift, and how many you used up. Then there is a separate page to log in any new cards you receive (pt name, med, dose, Rx number). The empty cards and sign out sheet are then turned in to the ADON for her to review. This is done (so I'm told) b/c a previous nurse was taking whole cards of Norco when they were delivered.

Honestly, I was initially against the idea of this extra "unnecessary" step, but I've definitely come around. I look at it like another layer of protection for my license and my family against a dishonest individual.

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Yes, that's exactly what I'm talking about. Sorry for being confusing, I confused myself trying to explain it :D Honestly I don't mind doing this extra step, I think it is a good idea. It's just the sheet that the Adm typed up seems confusing to me. He didn't leave enough room for both nurses to sign off. And he typed in times, such as 7a-3p, 3p-11a, 11a-7a. We do 12 hr shifts, what he didn't explain to us is if he wants us to fill out those other times as well, which I would assume he does, but it' just how he set up the sheet it looks confusing. And he didn't make a slot for reason why the count is changed. Meaning if pharmacy delivers 5 new cards, and the count went from 10 to 15. There's no place to explain why. Or if 2 cards were completed, so now the count is 8 instead of 10. So what do your guys sheets look like. Do you have a place for sign off, shift, date, # items on hand, Reason for count change, End count?

Thanks and sorry for the confusion :nurse:

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I think maybe what you are referring to is the number of pills on hand colomn? We have that where we are, I think it is very confusing, and it has resulted in a few errors.

What that is is that instead of just doing a straight-up count, you also have an extra column where you put the number of pills you have "on hand" BEFORE you actually give something. But, that number is already there, in the final count column, so it's a redundancy. And, because now you have TWO columns of numbers that are all one off from the final tally, it can look like you have neglected to give a med if you happen to glance at the wrong column. Hence the potential for error.

But our pharmacy and facility refuse to see it that way, and they make us do the 2-column tally, so the errors will no doubt continue. This is what happens when you have office workers coming up with "good ideas" for those of us in the trenches!

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Oh, sorry, just saw the other posts...You are talking about the number of cards. We mark ours "1 of 5", "2 of 5", etc, to account for all the delivered cards.

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

We work 8 hr shifts, but don't see why the form can't be changed to accomodate for 12hrs. If you took a regular 8 1/2 x 11 page and turned it sideways, our sheet looks something like:

Date, offgoing signature, oncoming signature, # cards accepting, # cards signed in, # cards signed out (repeated 2 more times for the other 2 shifts)

The number of cards signed in and out are for the oncoming nurse's shift.

Ex:

12th, Jnrsmommy, alwayslatenurse, 60, 2, 0, alwayslatenurse, busynurse, 62, 1,1, busynurse, jnrsmommy, 62, 0, 1

13th, Jnrsmommy, alwayslatenurse, 61

(this is actually from my last 2 days, why I remember this, I don't know)

Then the 2nd page is what we use to log in any new narcs (and in our facility, abx).

Date, pt name, drug, strength, Rx number

When a card is used up, the card and the narcotic log that now shows "0" is turned in to the ADON. She reviews these every day, and the number of cards that she has matches up w/ how many were signed out on the 1st page.

So in my example, when she came in today, she has 2 empty cards that correspond w/ 2 having been used up yesterday. And she will see that 3 new cards were logged in, and turn to the 2nd pg and see what 3 they were.

I apologize if this is confusing, getting really tired here.

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