-Extra- Narcs?

[SaraO'Hara]

I'm orienting on night shift. Yesterday morning, we found that we had one more dose of injectable morphine than was indicated on the count sheet. The RN with whom I am orienting and the day nurse wasted the extra dose, making the count even.

Coming on to nights again yesterday, we had the same problem - should have had seven doses (three unopened vials and one half-full), but had eight (four totally unopened vials).

How does this kind of thing happen? O_o

[icyounurse, BSN, RN]

I am not sure how it works with your narc counting system, but the system we use right now if it comes up with too many vials, its usually because someone doesn't notice that they are giving a dose that requires 2 vials and only takes one.

For example, we have dilaudid 1 mg's in our pyxis, and if your dose is 2 mg the machine charges you for 2 of those vials but if you aren't paying attention you may make a mistake and only take 1 while being charged for 2. Which makes you have an extra vial.

[SaraO'Hara]

The patient in question has an order for morphine, 5mg, sub-Q q 8 hours prn severe pain. Each dose is half of one 10mg/ml vial... the only thing I can think of is that somebody signed it out but didn't give it, two days in a row! The patient is not one to call for a pain shot, then refuse it (she watches the clock).

Our narcs are kept in a locked drawer within the locked med cart. Accounting is done with forms printed with numbered spaces - the number of the next blank space should match the number of doses / pills (pills are in blister cards).

[BelleKat, BSN, RN]

The patient in question has an order for morphine, 5mg, sub-Q q 8 hours prn severe pain. Each dose is half of one 10mg/ml vial... the only thing I can think of is that somebody signed it out but didn't give it, two days in a row! The patient is not one to call for a pain shot, then refuse it (she watches the clock).

Our narcs are kept in a locked drawer within the locked med cart. Accounting is done with forms printed with numbered spaces - the number of the next blank space should match the number of doses / pills (pills are in blister cards).

Perhaps the nurse is hanging onto the 10mg dose and giving 2 5mg doses from the same tubex without getting another out. That's how we used to do it. I don't know why she'd sign two out though.

[RNsRWe, ASN, RN]

We use a pyxis now, but when we had handwritten narc sheets and this would happen, the unit manager would be notified and pharmacy would be notified. Nothing would be wasted to 'make it work out': we just recorded what we found, discrepancy and all.

Could be a repeating med error, and one not likely to be caught if you don't say something to someone who cares.

[SaraO'Hara]

Perhaps the nurse is hanging onto the 10mg dose and giving 2 5mg doses from the same tubex without getting another out. That's how we used to do it. I don't know why she'd sign two out though.

No tubexes... they are rubber-topped vials. We give two doses from each vial. Our problem was that we'd end up with an extra dose.

[medsurgrnco, BSN, RN]

I wouldn't be comfortable doing a narc count with half a vial - how do you know the med is actually in there? That half vial should be wasted with a witness.

I have discovered numerous times that the person writing down the count on the sheets wrote down the wrong number, and the person doing the count claimed they said the correct number. Every time I've seen this situation we've been able to figure out what is wrong and correct the count. Suggest you watch your back with paper count records and be sure there is a second signature any time you deal with wasting narcs or correcting a count.

[SaraO'Hara]

Well, yes, of course. Also, as an orientee, I'm not permitted to waste any narcs. I am very careful about counting -everything-... some people skip counting the Fentanyl patches, for instance, and only count the PO meds. I'm too new to take any liberties with correct practice