Questions about Missing Narcs

[medsurgrnco]

Wondering how other facilities deal with narcs missing at the end of the shift. We do not have a pyxxis machine, use blister packs kept in a locked area, several nurses get meds out during the shift, and have 2 nurses do narc count at the end of the shift.

Also wondering if travel nurses have been involved at a higher rate in taking narcs at facilities. I have nothing against travel or agency nurses, but in our situation we had recently hired a travel nurse and the other nurses that worked that shift had been employed with the company for quite some time.

[SuesquatchRN, BSN, RN]

It knows! That's kind of creepy!

It's interesting that they don't operate by dispensing the item requested rather than opening the whole drawer. It seems to me that this would narrow it down to one person rather than two.

Rgds,

Kenny B.

Mine only dispense the specific pill requested, but in whatever quantity is in there.

[RN1121]

When I worked agency and came on/off shift, I was extremely thorough with counting the narcs. I looked at the book AND the actual meds on hand to make sure they matched. I wasn't ever one to take chances. If the count was off when I came on shift, the supervisor was called to sort it out. Agency nurses are frequently the ones who were blamed for everything. I made sure there was never a reason to blame me.

We even started to look at the duragesic patches on the actual resident each shift to make sure it was still there on their skin, properly dated.

One can't ever be too careful.

[Crystal2dish]

An addendum for the thread... every LTC I have worked has the narcs in the same blister card as the regular med drawer. Many times the cards are so tightly packed into the drawers that pills will break through the foil backing and either be found rolling around on the bottom of the drawer, stuck somewhere among the cards, or magically disappear. It is another reason why I check the back of the card when counting narcs. If I can see that the backing has been cut/slit or otherwise corrupted, I will call a supervisor to co-initial and either confirm that the tablet in the blister is correct or someone's substitute tablet. It may be a pain for the nurse I am counting with, but I have learned narc count is not something to flash through just so everyone can go home.

So more advice for nurses working in LTC's that use med card blister packs in drawers, it pays to be careful when pulling them and returning them to their assigned order. Your careful efforts will be less lost or missing pills. This is critical with narcs and things like coumadin, antibiotics, and qod meds. Plus your cart will be neater for the next nurse who follows you.

[RN1121]

An addendum for the thread... every LTC I have worked has the narcs in the same blister card as the regular med drawer. Many times the cards are so tightly packed into the drawers that pills will break through the foil backing and either be found rolling around on the bottom of the drawer, stuck somewhere among the cards, or magically disappear. It is another reason why I check the back of the card when counting narcs. If I can see that the backing has been cut/slit or otherwise corrupted, I will call a supervisor to co-initial and either confirm that the tablet in the blister is correct or someone's substitute tablet. It may be a pain for the nurse I am counting with, but I have learned narc count is not something to flash through just so everyone can go home.

So more advice for nurses working in LTC's that use med card blister packs in drawers, it pays to be careful when pulling them and returning them to their assigned order. Your careful efforts will be less lost or missing pills. This is critical with narcs and things like coumadin, antibiotics, and qod meds. Plus your cart will be neater for the next nurse who follows you.

That's a great idea to check the backs of the blister packs. I've heard stories about nurses cutting open the foil, taking out the narc and placing a vitamin c back in the blister pack.

CYA

[medsurgrnco, BSN, RN]

Thanks so much for all the information that has been posted on my thread. I have been more careful with the narc situation at work since this situation happened and as a result of the info I learned here. Does anyone know of any way to find out if a nurse has ever been caught using or diverting narcs? I know how to look up online license verifications to check for complaints or actions against a license, but I do not know how to investigate problems with narcs. Thanks in advance for any suggestions anyone can give me!

[shouldhavebeenanunRN]

Worked as charge in a LTC one night. A travel RN & Permanent RN counted and all was good @ end of shift. Travel RN comes on next day and says narcs missing since her last shift. Permanent RN said never counted particular narcs w/ travel nurse; and count was good until Travel RNs shift next day. Enter new DON .. who destroys wrong narcs w/ permanent nurse during shift (had access lets say and possibly destroyed narcs? but not case). I was on another unit that day thank god! No access.. DON gone for day too; and a full 80mg blister of oxycontins GONE! NARC sheet gone! SO, perm. RN did not recall any such narc on cart as she was forced to administer a prn 5mg prior to end of shift for same pt., claiming no knowledge of higher dose in narc box/count. MY role in the procedure as charge RN was to report to Administrator, ADON, DON and police if so directed by adminstrator. As I assumed/concluded permanent nurse was innocent/clueless of missing narcs as they were not incl. in count & fact she did sign out a 5mg prn before end of shift for same pt. Traveling nurse who reported narcs missing was my #1 suspect as she had direct knowledge of narc dosage & count and behaved suspiciously after I suggested a UA for everyone on the spot to administrator. Her eyes bulged for sure.. LOL! Anyway, could have been the new DON too.. but left before finding out how it all ended. I do know perm. RN was allowed to come back to work and DON still there, so I assume it was the travel nurse who was suspect in the end. I also know it is a federally reportable/investigatable offense and heads will roll. Glad I wasn't on shift with any of them... and I can only recommend if you have blisters... count every single pill/don't rush and compare to narc sheet #. If it is off, stop & report immediately. CYA!!

[medsurgrnco, BSN, RN]

I'll divulge a little more info - it gets really hard to try to stay anonymous on this forum sometimes! I'm pretty new at this job, and I've always previously used pyxis machines so it was very limited to the number of nurses who could have been involved in any narc discrepancies and those discrepancies were always easily resolved in the past (altho I heard one nurse got caught diverting pt meds and some nurses seemed quite offended when I actually wanted to witness them wasting narcs). I was shocked at the lax style of dealing with narc counts and narc keys when I started work at my current job. But this is a very small facility where I work with a small number of nurses and was told they don't have problems with narc counts - which has been the case. But soon after this traveler nurse started, the narc count was off and could not be accounted for by forgetting to chart giving a narc, giving the wrong narc, a narc falling out of those fragile blister packs, etc, etc. I've worked with the other regular nurses on enough shifts to feel very comfortable with them and that includes the nurses who worked that shift. This traveler nurse is "strange" in many ways and also acts suspicious regarding the narc count in ways other regular nurses that worked the shift in question do not. Any suggestions would be greatly appreciated on how to deal with this situation. I am VERY careful with this traveller nurse when we work together. Again, any advice will be greatly appreciated!