Missing Narc.....but for how long?

Specialties Geriatric

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I found the missing narc thread but the last post was in 2008, so here is my issue.....

Last night when doing the narcotic count, we were missing an ativan. You can visualize a card of 30......12 were punched out of the card and all documented, but the on coming nurse noticed #6 was missing. There was a tiny hole in the back of the card and a tiny dent in the front, as if maybe the card had gotten crammed in the drawer too many times, but the oncoming nurse was adamant that it was punched out, and "not that I don't trust you , but....." Shift after shift after shift did we all sign off that the count was correct. No one noticed it missing until last night, so now I am the automatic suspect, I guess. What happens in a situation like this? I've never been accused of stealing, least of all narcs, and my count has never been off until last night......or maybe last night just happened to be the night we noticed #6 missing. It wasn't in the bottom of the drawer. I did forget to point out last night that the lady came to our side of the building from the other side, and didn't think to search the other narc box for the missing pill. So we called the DON and I wrote a statement out. She left work earlier today and didn't call, so I suppose that they just corrected the count. Any one dealt with this before? And how else should I handle this? From now on I will take all cards out and look at the back, too, to make sure none are missing!

Specializes in LTC/Skilled Care/Rehab.

Our liquid morphine never measures up to what it should be. It always measures up as more. I don't know why the bottle are measured by 5 ml when we are only giving 0.25-0.5ml at a time.

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Specializes in Gerontology, Med surg, Home Health.
Why are Ativan pills in your narcotic count? Just curious.

Ativan requires a script and is a countable drug. It is used recreationally and must be counted. Ultram (tramadol) is not a narcotic, but it is stolen frequently so we count that, too.

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Specializes in LTC.
Our liquid morphine never measures up to what it should be. It always measures up as more. I don't know why the bottle are measured by 5 ml when we are only giving 0.25-0.5ml at a time.

Ours is too. Liquid ativan does the same. Its always about 3-5mL's over. And I know I give the correct amount and its still over. I think it starts over when we receive it from the pharmacy.

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At the facility that I WORKED at (long story there...I had to get out of that place)...We had a bottle of Roxanol that was about 4 mLs UNDER..yes UNDER. I couldn't believe it. I was the supervisor that night (rare occasion I was the supervisor w/o a floor assignment) and the LPN called me over to verify. The DON just happened to be there....I took the bottle and the Narc sheet right to her and her words were "How do you know it is under, the numbers on the bottle are never the real amount anyways..." Ummm yeah you are right but 9 times out of 10 the amount is over by up to 1 or 1.5 mLs at best, not under the count...and if it is under, it is very little.

UGH...that place still gives me the twitches when I think about it.

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Specializes in LTC.
At the facility that I WORKED at (long story there...I had to get out of that place)...We had a bottle of Roxanol that was about 4 mLs UNDER..yes UNDER. I couldn't believe it. I was the supervisor that night (rare occasion I was the supervisor w/o a floor assignment) and the LPN called me over to verify. The DON just happened to be there....I took the bottle and the Narc sheet right to her and her words were "How do you know it is under, the numbers on the bottle are never the real amount anyways..." Ummm yeah you are right but 9 times out of 10 the amount is over by up to 1 or 1.5 mLs at best, not under the count...and if it is under, it is very little.

UGH...that place still gives me the twitches when I think about it.

I had a similar story. Back in the summer our DON for some reason avoided taking DC'd narcotics off the floor and we would have them and have to count them until she did. (The pile grew faster than weeds). There was a dc'd roxanol and I dropped it on the floor(plastic bottle). Thought nothing of it. Picked it up put it back in the cabinet. I go to count with the on-coming nurse and its short about 3mls. Mind you the resident that had received this had been dead for a month. It was short 3mls because it spilled out of the bottle for some reason as there was blue-green gook on the inside of the box. (I swear I didn't lick it lol)

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Ours is too. Liquid ativan does the same. Its always about 3-5mL's over. And I know I give the correct amount and its still over. I think it starts over when we receive it from the pharmacy.

and here's what drives me crazy. A nurse self reported herself to the board for diversion, she had been taking the liquid morphine and methadone, then adding water. We never noticed because the count was correct.

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Specializes in LTC.
and here's what drives me crazy. A nurse self reported herself to the board for diversion, she had been taking the liquid morphine and methadone, then adding water. We never noticed because the count was correct.

At least she had the guts to turn herself in.. I don't see how you could be able to tell if its just water during counting. Although if you look at the liquid in the the bottle.. the drug is a little more thicker than water.

I could never do that. Deprive a dying person of their pain medicine.

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Specializes in Gerontology, Med surg, Home Health.

Our liquid Morphine used to be tinted an orangey pink color with a very distinctive odor. For some reason, the manufacturer stopped tinting and making it smell so now it looks just like water, except for the viscosity. Let's just make it easier to divert, shall we?!?

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Specializes in LTC, Hospice, Case Management.
and here's what drives me crazy. A nurse self reported herself to the board for diversion, she had been taking the liquid morphine and methadone, then adding water. We never noticed because the count was correct.

Isn't that the truth. They put all these systems in place to prevent diversion which is really just a pain in the orifice to all of us who would never dream of stealing a medication anyways...but the real crooks can easily work the system. You could lay all this stuff right out in front of me, swear to me I'd never get caught and I have absolutely zero interest in taking any of it (for my personal use or to sell). But...I guess I'm just preaching to the choir.

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All depends where you work. I'm currently at CVS pharmacy and losing a narc isn't the END of the world. It all comes down to trust. Shouldn't hire someone you wouldn't genuinely trust.

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At the facility that I WORKED at (long story there...I had to get out of that place)...We had a bottle of Roxanol that was about 4 mLs UNDER..yes UNDER. I couldn't believe it. I was the supervisor that night (rare occasion I was the supervisor w/o a floor assignment) and the LPN called me over to verify. The DON just happened to be there....I took the bottle and the Narc sheet right to her and her words were "How do you know it is under, the numbers on the bottle are never the real amount anyways..." Ummm yeah you are right but 9 times out of 10 the amount is over by up to 1 or 1.5 mLs at best, not under the count...and if it is under, it is very little.

UGH...that place still gives me the twitches when I think about it.

Impossible to be accurate with this- the stuff needs to come in premeasured doses in glass vials. Those plastic bottle and droppers get nasty anyway- I've seen nurses put them into a patients mouth and make contact.

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Impossible to be accurate with this- the stuff needs to come in premeasured doses in glass vials. Those plastic bottle and droppers get nasty anyway- I've seen nurses put them into a patients mouth and make contact.

ewwww

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