Narcotic counts

[CoffeeRTC, BSN, RN]

I know this has been beat to death over the years but I want to know if I'm missing something.

Old fashion way...paper charting...no computers...punch card system. How are you doing it?

Of course it is done by the on coming nurse and off going nurse each and every shift. (unless you are doubling and keeping your cart).

Narc comes into the building from pharmacy.

Verify the count when you sign it it and take it from the delivery driver.

Sign med into the master log in the front of the book.

Complete the count sheet for the med. NOte the page # on the master log.

During count, I like to see the number in the book and the actual pill count.

When the card is done, note it on the master log.

If a resident is dc'd with med, note it on the master log

If med is wasted/dc'd have two nurses waste and sign and note it on the master log.

We've now started counting the # of sheets vs the # of cards each shift.

I've been doing this for 20 or so years, so I'm good with this part.

What is your policy on any discrepancy?? This is what I really would love to know.

[CapeCodMermaid, RN]

Any discrepancy means a call to the supervisor or DON. We always check the math first. Most times it's just a matter of someone forgetting to document.

Remember to have two nurses sign in every narc, two nurses when you change pages, and two nurses sign the new index.

[CoffeeRTC, BSN, RN]

If you find a discrepancy and it isn't due to a math error, then what? What is the general policy? I looked at our pharmacy website and they had a nice educational video on this and included the Ftags etc.

[CapeCodMermaid, RN]

The supervisor or DNS is notified. We take all the cards out of the drawer and check the bottom of the drawer because sometimes the meds fall out. I always investigate if I think it's diversion. Who signed the count as correct? Technically, it's the nurse who signed as correct who is responsible to make sure the narcs are there in the correct numbers. If you suspect diversion, call the pharmacy nurse consultant. Chances are they'll come out and look at the books. They are trained to be able to spot abnormalities. If you can pinpoint one nurse, there is always the tox screen route....

[GLORIAmunchkin72]

Often times discrepancies without med errors happen because because people are not counting the number of doses in one card. For example we get a card of 30 doses but they're half pills so often times the narc paper will say 15 pills (whole)received or sometimes pharmacy will lsend 2 boxes of fentanyl with 5 patches in each but on each box the pharmacy label will say 10patches. It can be really confusing and maddening at times especially for new people.

If you find a discrepancy and it isn't due to a math error, then what? What is the general policy? I looked at our pharmacy website and they had a nice educational video on this and included the Ftags etc.