Is there a state rule on how to count narcotics?

suzanne4, RN · Sep 29, 2007

Each Board of Pharmacy for each state sets the requirements for that state. All states require that two licensed personnel count the narcotics.

If you are still counting manually and using the ledger method, the one that is coming on is taking responsibility that the pills are actually there, I would want to verify both places for each. And as far as my opinion is on it, the nurse counting should call out the number, not the other way around.

Have seen too many issues that way that have jumped up later on.

caliotter3 · Sep 29, 2007

Several times I have had co-workers hold the ledger book at an angle away from my line of sight so that I couldn't see what was actually written. I've insisted on checking both what is on the card versus what is written on the ledger and refuse to sign until I am satisfied. More than one nurse has become irritated with me when I caught them trying to get one over on me. Another trick is to go so fast, trying to make you miss where the "discrepancy" is, that they want to pass on to your responsibility. And always, always, count every pill or tab in any bottle and check the level of liquid meds. Two nurses were reprimanded when someone removed a seldom used med from a bottle that had been taped shut with a count, date, and initials on the tape. The tape was just reapplied, and no one really checked. Bottles should not be taped like this, for this very reason. The other nurse may show her/his bad attitude toward you if you are meticulous, but I can bet a paycheck that they will be the same person laughing at you if you are the one who is caught with the error; particularly if you get fired for it and they come out smelling like the proverbial rose.

CapeCodMermaid, RN · Sep 30, 2007

We have always had the oncoming nurse look at the meds and the outgoing look at the book. Regardless of who does what, TWO nurses should look at the book and the med. I always either showed the nurse with the card of narcs the book or if I was the one with the card, I would look at the book to make sure everything matched.

Sabby_NC · Sep 30, 2007

When I worked in the hospital it was two checking. The previous shift with the oncoming shift. Both meds and book were looked at by both RN's. No med container was taped, every thing was counted out.

marjoriemac, LPN · Oct 1, 2007

We have always had 2 nurses counting and verifying the amount of controlled drugs. Then both sign the book to agree.

sonjawin66 · Apr 28, 2008

when a liquid narc was obtained from an outside pharmacy a sheet was not started However a nurse took out 5cc 's at 2000 another nurse removed another 5cc's at 0600 the dose scheduled.then again at 1300 never signing out. That left 105cc's The next nurse noticed that there was 90cc's remaining So the supevisor started a sheet for 90cc 's and started the count from that amt. THE 7-3 LPN refused to take the med cart WAS she right in doing so? She did not show up for work the next day due unsafe practice acts

CapeCodMermaid, RN · Apr 28, 2008

I suppose technically that meant there were 30ccs unaccounted for. YIKES. The nurse who used the med without entering it into the narc book should be counseled as should all the other nurses who used the medication without documenting.

The supervisor's practice is also at question. Who would do that? I don't blame the nurse for not showing up, although if it were me, I would have called and asked to speak to the DON to let her know what transpired.

marjoriemac, LPN · Apr 30, 2008

I'd say whilst both trained staff are present at handover, both shold count drugs and check the amount is correct.

Caffeine_IV · Apr 30, 2008

At my facility, the oncoming nurse handle the cards and the leaving nurse looks in the book. When I'm coming in I look at both and pull all the cards out of the cart, flip them over and check for tears.