How does your agency handle narcotic counts?

[Loodlow]

We have had missing valium and ambien. We werent doing counts every shift. That would involve the mom, a sitter, and various nurses. It seems pointless, but this puts us all at risk of accusations. If you do perform counts every shift, do you measure the liquid meds with a syringe?

Thanks!

[SDALPN]

We have had missing valium and ambien. We werent doing counts every shift. That would involve the mom, a sitter, and various nurses. It seems pointless, but this puts us all at risk of accusations. If you do perform counts every shift, do you measure the liquid meds with a syringe?

Thanks!

Every agency I've worked for has their own narcotic sheet. I've personally never seen any problems unless a nurse would give the med and forget to document it on the narc sheet. But when the family has access to meds and the nurse isn't there, there is no real way to say who took the meds if they went missing.

I did notice a problem with one med when we were counting it by drawing it up with a syringe. Turns out that little bit in the tip of the syringe that was getting tossed twice a day added up since the dose was .6mL. We figured out that had to be the cause. So we started doing a count based on what the sheet said should be in the bottle and what the markings on the bottle said. The agency said to only report it if a large amount went missing.

But so far, so good. Don't forget if narcotics are left over to have the Dr discontinue the order. That way if its a pain med and the family chooses to give a dose to the pt, it won't effect the nurses.

I see some nurses really get worked up over narcotics. I don't see it as a big deal unless the count is way off considering human error does happen. To me, a pill off is probably a mistake unless it happens regularly. Same with liquid..an mL or 2 off could be meds on the outside if the syringe a few times plus whatever is left in the tip of the syringe.

I've seen a few nurses get mad at the family for not documenting when they give meds. But the family is at home and they aren't nurses. I think that is asking too much of most parents. Although its a plus if they do document.

Hope that helps.

[Elle23]

They don't.

We drew the meds from the bottle for each dose. There wasn't a log sheet or anything, except the MAR.

[PerfectlyPlump, ADN, RN]

No, families do not record on the MAR, and controlled meds have not been counted, as far as I have seen. They were not locked up either, and there were plenty of family members around. Of course, it is up to the pharmacy to limit how often the script can be refilled. Seems like there is plenty of room for a nurse to be accused.

Now that you bring this up, I think if I ever find myself in a setting like that on a regular basis, I will have a talk with the supervisor about the legal issues involved.

[SDALPN]

That's a common situation in this job. Its best to document and leave it alone. If anything comes up I'd offer to take a drug test on the spot to prove you aren't taking the meds. They would still have to prove you took the meds. From what I've seen, the nurses that cause a big fuss over it don't last. There is no way for the nurses to keep track of the meds 24/7 and you can't be responsible for what happens in someones home when a nurse isn't present in the home.

I had one family, who didn't trust the nurses, keep the meds in a safe and we had to ask for the meds. If the pt hurt when the family wasn't there, the pt had to wait in pain until the family came home. We still documented the count. But it made things uncomfortable since we couldn't be trusted. The pt was A&O x3 and capable of telling the family if anything was wrong.

[systoly]

we count at the beginning and at the end of the shift

we count liquids by the markings on the bottle so it isn't completely accurate

but we can't pour liquids back into the original container as in my state it

is considered filling medication

often times, there is no one to co sign, but the goal is to have at least one

co signature per shift

families are not allowed to use our paperwork so they cannot sign for

what they give

some nurses document "mother gave valium"

i have a big problem with that, because they really don't know it happened

some nurses document "mother states gave valium"

i just document the count on the controlled substance record

every great once in a while, someone will drop a pill - no big deal

i have worked on a case where, yes, valium started coming up missing

at first, 1-2 pills a week, then 3-5 a week, then, after i was off for three days

the count was 10 pills short

when i first reported it, my employer said "well, we really don't have any control over that"

when i reported the 10 pills missing, every nurse on the case had to take a drug test

one nurse refused and was dismissed

my problem with missing controlled meds is two fold

first, i want to make sure the patient is receiving the correct dose

i document teaching the family about medication

this is also the reason why i immediately contact my employer if

a narcotic is missing, because it could be in my patient

second, if it is indeed diversion, i do not want to be part of it

so, if the count is off, i insist on getting a signature from a family member

that doesn't get me on the most popular list, but my license has

never been renewed on the basis of popularity and in the end, most

people realize it's the right thing to do

ps families can co sign on our narc sheets

[SDALPN]

we count at the beginning and at the end of the shift

we count liquids by the markings on the bottle so it isn't completely accurate

but we can't pour liquids back into the original container as in my state it

is considered filling medication

often times, there is no one to co sign, but the goal is to have at least one

co signature per shift

families are not allowed to use our paperwork so they cannot sign for

what they give

some nurses document "mother gave valium"

i have a big problem with that, because they really don't know it happened

some nurses document "mother states gave valium"

i just document the count on the controlled substance record

every great once in a while, someone will drop a pill - no big deal

i have worked on a case where, yes, valium started coming up missing

at first, 1-2 pills a week, then 3-5 a week, then, after i was off for three days

the count was 10 pills short

when i first reported it, my employer said "well, we really don't have any control over that"

when i reported the 10 pills missing, every nurse on the case had to take a drug test

one nurse refused and was dismissed

my problem with missing controlled meds is two fold

first, i want to make sure the patient is receiving the correct dose

i document teaching the family about medication

this is also the reason why i immediately contact my employer if

a narcotic is missing, because it could be in my patient

second, if it is indeed diversion, i do not want to be part of it

so, if the count is off, i insist on getting a signature from a family member

that doesn't get me on the most popular list, but my license has

never been renewed on the basis of popularity and in the end, most

people realize it's the right thing to do

ps families can co sign on our narc sheets

Writing "mom gave valium" is ok if we witness it drawn up. But I won't document the amount because most parents would be offended if we checked behind them. I will also document it as "mom stated" if that is the case. But I never document something I didn't see. I see lots of nurses do that. What's worse is if I leave a blank in the mar by accident and a nurse comes in and fills it with "f"for family. Then it looks like I saw it on my shift like that.

I guess I don't worry too much because my drug test will come clean at any time. And if it doesn't, its because I have a prescription. I refuse to take narcotics while working, so if I'm that bad off I'll be home anyway. So I think a nurses actions also say a lot, making it easier to figure out who may be guilty.

[Adele_Michal7, ASN, RN]

That's awful that the patient had to wait in pain because of the parents!

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[systoly]

That's awful that the patient had to wait in pain because of the parents!

Sent from my iPhone using allnurses.com

It makes no sense.

Why in the world would you leave your child in the care of someone

you don't trust.

I briefly worked on a couple of cases like that

one of them was just plain micro management

i left the case because i was not given the opportunity to do my job

on the other case the mother thought the nurses were just giving

pain meds to make the pt. stop cry and moan -

even the pediatrician educated on the need for pain control

and that early intervention usually equals less meds

[sarigamp]

Narcs in the home are narcs in the home. They have an owner which is not

the Agency, hospital or State. They are owned by the patient and the patient is

responsibe for them. If a large amount is missing then it needs to be addressed

like any other missing med. Stop badgering your fellow nurses and start using common

sense. This type of nurse persecution is why we are at the bottom of the pole fighting

over scraps while MDs cont to earn six figures. Ever heard an MD bad mouth a peer?

Lets help each other. Do something good for a nurse behind her back.

[OrganizedChaos, LVN]

When I worked PDN & there were any narcs there would be a count sheet that we would have to document on. It was kinda scary cause I had to count them by myself so if there is a discrepancy, my heart would pound. Thankfully the last cases I work there weren't any.

[JustBeachyNurse, LPN]

There is a specific P&P in both agencies I work for in how to count alone and account for meds dispensed by parent/family per parental report (we do NOT document unwitnessed med admin on the MAR only in narrative. Though certain nurses have taken to placing a check mark for meds due/given by family before our shifts start. The MAR & narc sheets are a mess and I'm just waiting for the flaming messages sure to come when last month's MAR & narc sheets are audited this month.

One nurse was pouring the (calibrated per pharmacy standards) prescription bottle of liquid narcs into a not necessarily clean glass baby bottle with estimated measurements!!! And spilling a decent amount along the way! Not as much as the discrepancy but this child NEEDED the narc d/t an acute injury and class 2 narcs can only be filled so often so child was losing potential doses !