Missing Narc.....but for how long?

[SE_BSN_RN]

I found the missing narc thread but the last post was in 2008, so here is my issue.....

Last night when doing the narcotic count, we were missing an ativan. You can visualize a card of 30......12 were punched out of the card and all documented, but the on coming nurse noticed #6 was missing. There was a tiny hole in the back of the card and a tiny dent in the front, as if maybe the card had gotten crammed in the drawer too many times, but the oncoming nurse was adamant that it was punched out, and "not that I don't trust you , but....." Shift after shift after shift did we all sign off that the count was correct. No one noticed it missing until last night, so now I am the automatic suspect, I guess. What happens in a situation like this? I've never been accused of stealing, least of all narcs, and my count has never been off until last night......or maybe last night just happened to be the night we noticed #6 missing. It wasn't in the bottom of the drawer. I did forget to point out last night that the lady came to our side of the building from the other side, and didn't think to search the other narc box for the missing pill. So we called the DON and I wrote a statement out. She left work earlier today and didn't call, so I suppose that they just corrected the count. Any one dealt with this before? And how else should I handle this? From now on I will take all cards out and look at the back, too, to make sure none are missing!

[AngelRN27]

One simple "trick" I use during narc count if the bingo card has tiny pills (such as Ativan) is I shake the card. This way, all the little pills move in their bubbles. Nine times out of ten, your eyes will instantly catch if one of the bubbles that should be full doesn't have a little pill hopping around inside like the rest of them do.

[stardust80916]

The protocol was to "make the MAR reflect the medicine on hand"

I've never heard of that practice and I've been working in ALFs for 5 years. We documented missing pills in the narc sheet. Never in the MAR. Now I have seen people refer to the MAR as well as the narc sheet to make sure all pills were double accounted for. If the situation did ever arise, we were to call our RSD for further instruction. Usually we'd be told to document the missing pill on the narc sheet with explanation as well as write an incident report. Both QMAPs would have to sign the narc sheet.

[stardust80916]

One time we had an almost full bottle of roxinol that was found in the fridge and the bottle was broken. There was roxinol EVERYWHERE! Talk about a huge fiasco.