How Do You Sign Your Narcotic Book?

[flashpoint]

Currently, my facility has one page for each bubble pack. When we give a narcotic, we sign our name, date, time, the current number of tablets (patches, vials, etc.), the number we are taking, and the number remaining. At shift change we sign one for saying that we counted all of the controlled substances and that the count is correct. In the few months I have been there, there has not been a discrepancy. Policy states that if there is a discrepancy, we don't sign, notify the DON, and she investigates. In the six years that she has been the DON, she has always found a logical explanation for each discrepancy.

Our nurse consultant wants us to sign each individual page at every shift change to verify that the count is correct. We would also need to write in the date, time, and correct number of tablets or whatever. I tried it today and it took over 20 minutes. When they are concerned about overtime and the system we are currently using works, making a lot of changes doesn't seem to make sense.

How do you do it?

[Sadala, ADN, RN]

Where are you working that you have a cart and paper MAR. Is this Rehab or LTC or?

Oh, rrrrrrrrrrright. I just looked at the header and noticed which section I'm in. (being lost is typical)

[flashpoint]

We don't have a paper MAR, just a paper narcotic sign-out and count book. The last place I worked had us sign each page at the end of the shift. We were supposed to do it with the oncoming nurse and both of us sign as we counted. It didn't work because it took more than forty minutes and that was on a good day. I really hope the DON stands up to the consultant and we keep doing what we are doing. I think she will. It is frustrating that we deal with a problem or potential problem by taking extreme measures. It reminds me of the meme where someone burns down a house to kill a spider. :-)

[littlespitfire]

We have 2 nurses count at report.. Incoming reads the cards off and outgoing reads the sheets off, then both sign the shift change sheet. Our narc sheets are the standard name date time dose given doses remaining sheets... My whole report takes about an hour. 2 day nurses, 2 carts and 20 patients.

[NutmeggeRN, BSN]

Unfortunately we do it the second way you describe. Each time we give a med, we have to write in the starting count, the dosage given, dosage wasted, end count, and our signature.

At shift change, same thing, one page for each med.

Signing narc count takes 20-30 minutes of my shift.

We do that each time the med is removed, we have been instructed NOT to be doing it at shift change.

Date

Time

# on hand

# removed-route

# left on hand

Signature

[flashpoint]

We do that each time the med is removed, we have been instructed NOT to be doing it at shift change.

Date

Time

# on hand

# removed-route

# left on hand

Signature

We do the

Date

Time

# on hand

# removed-route

# left on hand

Signature

thing every time a med is removed. That isn't what I am talking about.

Our consultant wants us to do

Date

Time

# left on hand

Signature / SIgnature

at the end of every shift to verify count. Both nurses will have to sign to verify that the count is correct. I have done this in another facility and it takes so much time. I would like to see an actual regulation or evidence based practice that says this is the best way to do it.

[txbornnurse]

I do not know what state you are in OP but in my state there is NO pharmacy or SNF/Medicare reg regarding anything about each shift signing each individual sign out sheet in place of a separate shift to shift count sheet. I do know DEA regulations regarding controlled substances require what I noted in my earlier posting. Nothing more is needed. Your nurse consultant needs to provide the specific regulation requiring her recommended additional step to show justification for her recommendation.

The reason for having a separate shift to shift count/sign off sheet is that this can be (and must be actually) kept in a file for review by a surveyor or anyone else authorized to review narcotic accountability at your facility. These shift to shift count sheets do not contain individual patient identifiers so they can be stored together. Using the individual sign out sheets for their intended purpose plus shift to shift counts means the facility would need to store them together for review instead of in the individual patient folders where they are required to be kept. Those shift to shift records have to be done and have to be kept for review per federal regulations. Co mingling paperwork of different patients together is not a wise practice.

If your nurse consultant is recommending shift to shift counting on the individual sign out sheets PLUS a separate shift to shift count sheet IMO she needs to fully explain why because I cannot fathom any sensible or evidence based or regulatory requirement to do the duplicate documentation. Doing it that way instead of a separate shift to shift shift is actually not in compliance with federal regulations for the storage and documentation of controlled substances.