Approximate Narc. count?

  1. A resident has an order for Roxanol TID,.25ML, about 3 drops SL. The drug came up in a 30ml bottle, I give a dose at 1100, when I count at 1500 there is no way to know exactly how much is in the bottle, after all how do you distinguish in the bottle that .25ml was given from a 30ml bottle, how can you tell how much is really in that bottle,also when I count at 0700 I really dont know how much is in the bottle, the Night nurse gave .25ml, and also Eve. gives .25ml ,so we dont know what the real count is, so we are really only counting approximately, we should have pre-filled syringes of the drug but the pharmacy wont send it and I've talked with 2 supervisors who arent concerned.
    Is OK to have an "approximate" Narc. count? If not what should be done?
    Thanks
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    About garciadiego

    Joined: Feb '06; Posts: 207; Likes: 29
    from HI , US

    15 Comments

  3. by   SouthernLPN2RN
    I wouldn't feel comfortable with this. You could pour it out into cups to measure, but you'd lose some from sticking to the cups and possibly risk a spill. I'd push for prefilled syringes or a better marked bottle. If 0.25ml is being given each time, I don't quite get why they're dispensing a bottle so large. Good luck!
  4. by   Antikigirl
    When we would get our narc elixers, we nurses would take a sharpie and mark the top line of the medications..because some bottles mark above a line or below a bit...and also depends on if the dropper is full or empty (that moves the line!).

    We also put in a rule that you must count with the dropper OUT and empty for a more accurate count. But you can't be perfect really (unless you do the whole med cup thingie which we have had spills and miscounts on too), so you do the best you can..and if things seem odd you act on that!

    My mindset...is someone really going to steal 0.25 or even 0.5 of this med? Where will they put it, why that little, not worth the risk..and so on.

    Some of the nurses mark lines with each pass, but those small bottles you can't tell since a line is about equal to a dose! LOL!

    Best approximation, if it seems odd..investigate.

    I too agree with the prefilled syringes per single dose!
  5. by   garciadiego
    Thanks for thoses replies
    I come from the place that narc counts are not approximate measurements but it seems I'm learning otherwise, not everything learned in school is correct, oh well.
  6. by   LilRedRN1973
    Ours comes in little sealed cups, much like our Milk of Mag and potassium (liquid form) does. Single dose, no measuring required. The only exception is Roxicet, which pharmacy sends up in prefilled syringes. All other nars (hydrocodone elixir for example) is in the little, single dose cups.

    Melanie = )
  7. by   miko014
    We have morphine and ativan in the dropper bottles, and we also have some prefilled syringes. I don't know why we have both, but whatever. Anyway, when we take anything out of the bottle, we have to take the whole ml and waste the rest. I usually take an ml, put it in a med cup, and draw up what I need with a tb syringe. It's more accurate that way than trying to figure out those tiny doses with a cup or dropper. As for the count in the bottle, there are lines on ours every 2 ml, and when you first get it out of the pyxis it says, "beginning count: 12 ml. Is this correct?" If it's not, you type what's really there. I guess I never thought about someone stealing it, but I'm sure they look for patterns, and I know they keep an eye on what we're doing in there. If one person kept consistently changing the count, they'd follow up. Once I chose the wrong pill to return...dilaudid and oxycodone were next to each other, and I must have picked the wrong one. Anyway my manager was like "was there oxycodone in teh dilaudid drawer??" and I had to be like "oops, no, I suck, sorry!" So at least where I work, big brother is watching us
  8. by   P_RN
    You said resident and not patient. Is this perhaps a hospice or long term care facility?

    I like the prefilled syringe idea, but the pharmacy supplying the med may not agree to do it.

    I'm also cautious about nurses filling injection syringes with oral medication. Just think of all the problems if someone were to inject a patient with something intended to be given orally. I believe that would also be dispensing rather than administering. Dispensing is not within a nurses scope of practice.

    Go up the company's food chain and find out if you can have the pharmacy dispense in a more easily countable container.
  9. by   Cheez-It!
    If it's like the bottles we have at work, the drug itself is clear. We had a hospice pt that had it ordered, and the hospice nurse actually put a drop of food coloring in it so we could count it better. It beat holding a flashlight on the other side of the bottle trying to count. But, you also have to remember that's going to add another drop to your count.
  10. by   miko014
    Quote from P_RN
    I'm also cautious about nurses filling injection syringes with oral medication.
    There's no needle (or any kind of adapter) on it. It's just a 1 ml syringe. If you draw it up and give it yourself, I don't see a problem with it. I'm not going to get halfway to the room and forget what I'm supposed to do with the med (and even if I did, I'd have a hard time injecting with no needle or cannula on it). If you only have one person's meds at a time (our policy and one I strongly believe in), it shouldn't be an issue.
  11. by   Indy
    I really like the idea of drawing up the whole ml, giving whatever you can measure in a tb syringe (sans needle) because it's what, a drop? and waste the rest. Just have to be careful with the little bitty syringe not to accidentally push that little drop out other than where you intend to put it.

    However, we aren't regularly using roxanol at work, or much else with a dropper. We had one hospice patient on my unit there for respite care, and it was her own med we used; I think the patient's family might have been miffed if we threw out half her bottle of roxanol just to keep an accurate narc count. But the method might certainly work for our purposes if our patients start having it dispensed from our hospital pharmacy.
  12. by   rjflyn
    Another option could be to go by the weight of the bottle. There are highly acurate digital scales one could use to weigh the bottle and its contents. With the big push by joint commission on pt saftey one should not be using a large multidose container anyway. RJ
  13. by   P_RN
    What I posted about the syringe was right after I read that an RN had injected 7.5 ml of liquid tylenol (she had prepared herself) into her patients central line. I was thinking what would happen if there were (multiple) pre-filled syringes.

    Last edit by P_RN on Nov 11, '06
  14. by   Smokey9283
    If the OP is working in a nursing home, then they are not held to the standard of the JC.

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