i'm don of a small long term care facility in tennessee. if the narcotic count is not correct at shift change, the oncoming nurse should not take responsibility
for someone's else's error and it should be corrected before the offgoing nurse leaves. our nurses pass medications to 43 residents and it is policy of our pharmacy (pharmerica) that the narcotics administered must be documented on the narcotic sheet upon removal from the cart, documented on the front of the mar (they're usually given prn) and
on the back of the mar with explanation of the reason it was given and the effectiveness. how you're getting away with signing them out at the end of the shift of beyond me. this is asking for trouble not to mention increasing the risk for errors! recently 8 of our state surveyors went into a facility on a complaint, 2 of them each went to the 4 medication carts and said, "excuse me, we'd like to do a narcotic count."
they, too, did not sign out their narcs until the end of the shift. needless to say, they were slapped with a violation. our pharmacy consultant comes once a month and does an extremely thorough mars audit, which i do randomly throughout the month. if i were the oncoming nurse, i'd refuse to accept narc keys or take report until the count was correct. has she not been investigated for this repeat occurance? maybe a random med pass observation by the don is indicated!