Narc Count Disaster

[bluegeegoo2]

There has been a seriously confusing issue with the count on a bottle of narcs over the weekend. I will attempt to outline the issue. Keep in mind that the scheduled dose for this med is TID, 7a-1p-6p. No PRN's have been signed out on this medication.

"Joe" works 6-2 as a med aide. He insists that the count is 104. However, the 2-10 med aide, "Suzie" counts 105 after 2 full counts on the supply. "Joe" becomes flustered and "Suzie" concedes to 104 and accepts the cart. An hour into shift, the count bothers "Suzie" and asks me to count said bottle, and I count 105. We have the weekend supervisor count as well and she comes up with 105. (This count proves that a dose was signed for but not given on the previous shift. "Joe" has recently been written on a med error by omission for not dosing per order.) The count is corrected and shift continues. The resident receives the scheduled dose this shift and count reflects supply at 104.

The 10-6 nurse, "Bill" arrives, counts and verifies the supply at 104. "Bill" and "Joe" count in the morning and "Joe" again gets flustered and insists that the count is 103.

Per the narc count sheet, "Joe" and a 1st shift nurse correct the count at 6 a.m. as 103 and "Bill" concedes as well as signs the new count as correct.

The count is then again corrected to 102 at 9 a.m. with the weekend supervisor. A dose is signed out as given at 1 p.m., which is a scheduled dose and the count is 101. It is unclear if the scheduled 7 a.m. dose was given as the counts were corrected at 6a and 9a and show a dose given as well as corrected. "Suzie" counts the cart with "Joe" at shift change and the count is verified as 101. Scheduled dose is given and signed for on 2-10 to end count at 100. The 10-6 nurse arrives and freaks out because he now sees that it appears a dose is missing on his shift from the previous night. Supervisor is notified who insists that her count earlier in the day is correct from 9a. All doses have been signed out since then and count is correct at this time. (Side note: The resident pays for their own meds, and gets them cheaper on their own than the would from our pharmacy. That's why no blister pack.)

All of that mess out of the way, it now appears that the 10-6 nurse diverted a narc. "Joe" is pointing the finger at "Suzie" for the count issues, and vice versa, but "Bill" seems to be caught in the crossfire.

The moral of the story? Do NOT, under any circumstance, accept a cart that the count is off or if you are the least bit uncomfortable about the count. Count 36 times if that's what's needed to verify the count. I don't care how huffy someone gets over you counting several times or how much time it takes. Have a supervisor (if available. If not, call one) come count with you to verify if you're not satisfied. Someone is likely to lose their job if not their livelihood over the fact that they conceded to a count that they were not comfortable with.

[Alisonisayoshi, LVN]

These aren't nurses are they? They are med aides? Or med techs? That explains a lot oif that's the case. I have been an underpaid med tech and they aren't really trained that throughly. At least not in my experince. They don't really understand the gravity of it. They don't have a license to lose, just a job. One of the ALFs near me had a med tech they fired recently for being drunk on shift.

[duskyjewel]

One of the ALFs near me had a med tech they fired recently for being drunk on shift.

And that's never happened anywhere, ever, with a nurse, right?

Med techs or not, no one should alter a med count. Counts are performed to prevent problems, but also to identify when and with whom they are occurring if they do. And whether a med tech came before him/her or not, any nurse that alters a med count is committing malpractice and risking their license. Such a dumb risk to take.

[bluegeegoo2, LPN]

In my old facility we had some residents that got meds from Walmart....except narcotics. All narcotics came from our pharmacy and that was a non negotiable item. If a resident brought meds from home we used them...except narcotics. Some feathers were ruffled over the expense of the narcotics from our pharmacy but if you have a policy in place then it prevents the above scenario.

Our pharmacist happened to be on my unit when I came on and I suggested this option for all of the reasons stated. Too much time and energy are wasted on counting bottles. Not to mention the drama that surrounds them. We actually have an automated medication packaging system right there in our building. Unless the narcotic ordered is uncommon or a not often used dose and must come in a blister pack, there's no need to count at all. The person paying for the very common narc in question is who insisted we use their supply and not our own.

[Alisonisayoshi, LVN]

And that's never happened anywhere, ever, with a nurse, right?

Med techs or not, no one should alter a med count. Counts are performed to prevent problems, but also to identify when and with whom they are occurring if they do. And whether a med tech came before him/her or not, any nurse that alters a med count is committing malpractice and risking their license. Such a dumb risk to take.

The difference is a med tech doesn't have a license to lose. They are just an employee, and a low paid one at that. Thus, the risk of them making a dangerous error, or working in an unsafe manner is probably (I'm just postulating based on anecdotal experience) higher than someone who has a license or career on the line. I hope that makes my point more clear.

[BoyNamedSue]

Sorry, I didn't read all of the original post, but I can relate. I had a similar situation where there was a missing narc. Not signed out, just gone. I told the off-going nurse I would not sign, and then called my DON. They worked it out ... someway; but I still never signed. I believe the DON ended up signing.

[bluegeegoo2, LPN]

Follow up: The dust has settled and all involved are still employed. The only change is that 2 nurses must count the bottles of narcs, while the med aides are still allowed to count blister packs.

[duskyjewel]

The only change is that 2 nurses must count the bottles of narcs

This is a change? At my workplace, the oncoming and outgoing nurses must always do the count together. I thought that was just standard but apparently I was wrong. That's a good change though, it protects everyone.

[bluegeegoo2, LPN]

This is a change? At my workplace, the oncoming and outgoing nurses must always do the count together. I thought that was just standard but apparently I was wrong. That's a good change though, it protects everyone.

Agreed, but who counts what is based on facility policy. I worked in a facility that med aides were not allowed to give any narcotics. Those were on the nurses cart. In another state, med aides were allowed to give meds via PEG tube. I haven't seen that in Texas.

[ktwlpn, LPN]

It has always been my policy to take my time through the narc count,visualize both the med and the the narc sheet.I don't give a fig how much of a hurry my co-worker is in to get out of there.Not flexible when it comes to the narc count.

[NurseQT]

I've always learned that two LICENSED nurses had to do the count at change of shift. Med techs and nurse techs ate not licensed and there fore cannot sign off on a count at shift change. The nurse working the hall/floor is ultimately responsible and is supposed to do the counts with the oncoming nurse. I would NEVER accept the keys if the count is wrong. I'm not going to put my license or job on the line for something like that.

[Ruby Vee, BSN]

I've always learned that two LICENSED nurses had to do the count at change of shift. Med techs and nurse techs ate not licensed and there fore cannot sign off on a count at shift change. The nurse working the hall/floor is ultimately responsible and is supposed to do the counts with the oncoming nurse. I would NEVER accept the keys if the count is wrong. I'm not going to put my license or job on the line for something like that.

If Med techs can get into the narcotics to give pain medication, why would they not be able to count those narcotics? Just asking . . . I work in an ICU and the ONLY people who get into the narcotics are nurses and the pharmacy techs who stock the Pyxis.

[NutmeggeRN, BSN]

Small LTC but the count is done together, oncoming and off going, either nurse or MNA. The oncoming counts and the off going verifies while the oncoming nurse looks to affirm the count. If there is an issue, it is settled right then and there.