counting narcotics

[ktwlpn, LPN]

No pyxis or anything state of the art here and we still have to count narcs at change of shift.I'm curious-do any of you have a policy stating exactly who should document and who should be actually looking at the drugs? The reason I am asking is a med error occurred one evening after I had worked days.The count was correct when I left and they found a discrepancy at end of their shift.They documented on an incident report that the count was wrong at 3 pm (the nurse that filled out the report was not even there-she was late as usual) AND-the count was correct at 3pm....The 2 nurses involved came up with numerous creative scenarios.We have 2 med carts on the unit and one nurse pulled a residents meds but the other nurse actually took them to the resident.It seems to me like there was alot of room for error.Who knows what happened? But the nurse that counted with me tried to say " O it was noisy and everyone was in a hurry to go home-I stood on the other side of the desk while you went through the meds" and they actually conjectured that I had given a med to the wrong resident "because she was quiet that evening" HELLO-Of course we all would like to leave at the end of our shift-if you all showed up on time we could...and just a reminder-you were standing RIGHT BESIDE ME...It sounds shady to me...Lesson learned-from now on I actually put a little check mark on the card after I pop the med out of the blister and I have always checked my narcs way before change of shift so I know if there was a problem I would have found it.Which I have a history of doing-every single time I have made an error I have immediatly picked up the phone and called my supervisor.How dare professional nurses write such an incident report? My adon made them re-write it...and made them leave my NAME OUT OF IT...2 of us documented that the count was correct at 3pm-I would state my license on it.....Have you ever seen such a mess?

[kcochrane]

According to policy at my facility, once the count is done, the keys are handed over and both people sign, all responsibility goes to the next shift. So it very important that the counter on the next shift counts carefully. One person is supposed to count while the other watches closely. My problem comes when we "pull" for the med pass. If I counted, I pull for myself and then I'm supposed to let the other nurse pull for her med pass. I don't really like having someone else in my narc cabinet if I hold the key. So I pull and give them to the person and they verify they need it. We are lucky in that we work together.

I'm glad your adon made them rewrite the incident report. Sounds like she agrees that once that count was made and agreed upon, it became the next shifts responsibilty.

Maybe that nurse will learn HER lesson and show up on time, and count carefully. That is just so unprofessional.

[NPinWCH]

Our policy is that anytime one of the nurses goes home and/or at change of shift the cart must be counted. At change of shift it must be one oncoming and one outgoing nurse doing the counting. Policy also states that no one can leave until the count is done, that way if there is a problem everyone who had their hand in the cookie jar is still present. IF the count is off, no one is allowed to leave until the problem is found.

I always make sure the count is right before I leave if I am working a half shift or staying over an extra 4 hours or so...that way what happened to you can't happen to me because if 2 people said the count was right when I left it can't be me who messed it up if it's wrong at shift count.

Most of the time it's simply that someone was getting something for an emergency and forgot to sign it out...you simply ask the other nurses, "Hey, did you use any ephedrine today?" That usually reminds them and then problem solved.

[rehab nurse]

oh, i hear you on the "scenarios" people can come up with in a nursing home. anything to avoid laying blame on the correct person. let me tell you, these evil people at my last job are STILL coming up with stuff. i guess i must be THAT exciting to talk about. whatever. i left due to illness (cancer) and still am out of work. but, they have some really interesting rumors going around there that my name is attached to.

when i counted narcs (coming on shift) i was the one LOOKING at the cards of narcs. the going-off nurse would call out the number. i would always LOOK at the number as well, cause I guess a few times the nurse who was diverting KNEW what the correct number SHOULD be, and would call that out. then, when the next shift went to sign, the number was wrong, and the nurse would be none the wiser until she went to count at the end of the next shift, 8 hours later. i hope that makes sense. there are some really awful things going out out there with narcotics. i do feel for the people who are struggling with addiction, but i hated being drug into suspicion due to another's activity. i was always the "suspicious" one due to having chronic pain issues. well, guess what? a year later, there is STILL the same problems going on there. so GLAD i am out of that place. management turns their head.

with those old forms, and ways of counting, one needs to be very careful. especially if there is a "problem" going around. be very careful, cause some people will do anything to avoid being blamed. sad, really.

[TrudyRN]

The oncoming nurse must verify visually the number of narcs she is receiving. She must also be sure the number that is written down is correct, just as Rehab Nurse said.

Be totally certain that the nurse relieving you signs when you guys count because her signature means she accepts what you are turning over to her and that the narc sheet is right.

[nurseofalltrades]

Our policy is that whoever is coming ON duty counts the drugs and has to show the blister pack to the nurse going off duty/writing on MAR. We had several incidences where a missing pill was found a shift later and blamed on previous shift. Now it is overkill but we know our count is correct.

[moomoo111]

Our policy is that the oncoming nurse has to count what's in the drawer while the off going nurse verifies what's on the sheet, the narc book that we sign them out on. Example: I have the book when I am the off going, I start with the first resident and tell her it shows that we have "28", she pulls the card out and says "28" and so on. If that is confusing, I can try to explain it better, it works for us. If that would have been at our facility, everybody would have been drug tested which is what they do at the hospital I work with prn also. I would have been very suspicious of the person who wrote the "incident report". Sounds fishy to me if the DON had them re-write it and take your name out of it. I would be looking at that person and I'd be very careful from now on.

[mhutchins]

As a DON of a small nursing facility, I encourage all of my nurses to take every avenue to ensure their license is protected, especially during shift to shift count. If meds needs to be wasted, including nonschedule drugs (unfortunately these are being diverted as well), my or my ADON's name needs to be on the sheet. That's my way of protecting my nurses' license. I also strongly believe in peers setting the best example. If every other nurse you work with are aware that you take evey precaution to ensure count is correct, and your supervisors are ware as well, the possibility of a diversion will be low.The nurses' you do count with are protected as well for that particular count. We have policies related to shift to shift count, as I'm sure every facility does, but policies are only good as those enforcing it.