How Do You Sign Your Narcotic Book?

Posted
by flashpoint flashpoint Member Nurse

Has 23 years experience.

You are reading page 2 of How Do You Sign Your Narcotic Book?. If you want to start from the beginning Go to First Page.

Sadala, ADN, RN

Specializes in Med Surg. Has 8 years experience. 356 Posts

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

flashpoint

Has 23 years experience. 1 Article; 1,327 Posts

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

littlespitfire

Has 7 years experience. 33 Posts

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

Specializes in kids. Has 39 years experience. 8 Articles; 4,532 Posts

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

flashpoint

Has 23 years experience. 1 Article; 1,327 Posts

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

txbornnurse

Specializes in QA, ID/DD, Correctional, Education. Has 43 years experience. 32 Posts

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.