Miscounting Meds

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I have been in my new grad program here in NYC for about 3 months (since April). During my time in the program, on 2 occasions miscounted controlled substances (ativan and PO norco) on the Pyxsis causing discrepancies. These were both quickly alleviated (within 10 min) when I informed my charge or preceptor of the miscount and they quickly did an inventory on the pyxsis and the discrepancy went away once the actual count was made. No meds were lost and all meds were accounted for quickly. My manager has been on me each time these incidences occurred telling me im on probation and these occurrences wil look really bad on my evaluation. Also, each time I had to write an incident report as to why the discrepancy was made. These were honest miscounts. I know I should slow down, but I get really anxious at times when i'm in the med room and 3-4 nurses are waiting for me so they can get on the pyxsis. Now i'm recounting all the meds at least 3 times to make sure I get the right count. However, I am really worried about what my manager told me regarding my evaluation. I really don't know how I can redeem myself to my manager for making these mistakes.

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I think you know the answer to this question, slow down when you are counting. The only way management will "get over" errors such as these is for you to not make them in the future. Review how you do things, compare them with how others do them, ask your preceptor etc, and come up with your own plan for remediation.

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Specializes in Psych (25 years), Medical (15 years).
I think you know the answer to this question, slow down when you are counting.

The genius of your reply is in its simplicity, CharleeFoxtrot!

And believe me, I have to keep reminding myself of this, especially since I've gotten older: "Slow down and focus on the task at hand, Dave!" my little voice tells me.

Good luck to you and welcome to AN.com, WickerRN!

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Specializes in critical care, ER,ICU, CVSURG, CCU.

Charlie fox said it best!

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Specializes in Critical Care and ED.

Here's a little advice, and please take this in the spirit it is being given. If there's one thing you should be very, VERY careful about, it's narc counts. Every time you take out a narc or controlled substance, pay attention to what you're doing, and triple check before you take the med. Never put it in your pocket, never put it down anywhere, and never forget to waste a residual. Make it your priority because your hospital has made it theirs. No matter if you "meant" to do it or not...they are watching. If you foul up you will be flagged and you may be fired because they don't even need a reason. They do not want any kind of scandal at their facility and so if you're making it a habit of making mistakes with narcs, they will get rid of you. Do yourself a favor and move on, and in the future be very careful.

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I do a double or sometimes triple count, mindfully, every time. Doing this isn't a "new grad" thing and it doesn't speak negatively to your skill/competence.

What you need to realize is that there's no shame in being meticulous with this. Your coworkers aren't really breathing down your neck, although it may feel like it - they just have no where else to go right at the moment. So everything's okay and feel free to slow down. Actually, I like the term mindfulness. Over time, you will learn to be mindful while not being inordinately slow. It's an excellent habit to get into, and it's more than just not being Chatty Cathy while doing important tasks - it's about being purposeful with your own thoughts and actually mentally focusing on the task at hand.

If you sense that this issue has put a target on your back and may affect the outcome of your probationary period, you could go casually talk to your manager and say you've taken steps to make it a habit of being meticulous with this.

Good luck ~

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Well......my free advice is "Don't worry, be happy.".

Seriously the more anxious you become the more you will miscount, take too long, etc.

You do know how to count, you do know how to use the pyxsis.

Give your pyxsis a name. Petunia Pyxsis. Say good morning to Petunia at the start of your shift. Give her a kiss and hug and tell Petunia you know you're going to have a very good day.

Anything you can think of to help you relax!

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It will be on your evaluation? Incident reports?? That's seems pretty ridiculous, to me. Your manager has too much free time. Just reading this makes me a little angry.

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Specializes in Critical care, Trauma.

I'm a little confused. My facility uses a Pyxis and if you miscount the narcs, it will come up saying something like "Are you sure?" to make sure you didn't miscount, hit the wrong number, etc. You then put in the real number and there is no discrepancy if the second number is the expected one. Does your Pyxis not have this safety net? I can see a potential for error if it only gives you one chance but when you get that flag and it asks you again, it's a pretty good notice to focus and re-count. But I've only ever used a Pyxis as this hospital so I don't know if others are somehow different.

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The amount of discrepancies for my unit's Accudose (Pyxis like dispenser) dropped by 75%, when we made our med room a "Distraction Free Zone". Our med room is a quiet place,with no talking allowed other than conversations needed for wasting narcotics or other medication relation topics. The call light bell was disabled in the room as well as the phone was taken out. Maybe you could do a little bit off research on this subject, put together a proposal for your manager and pitch this idea. Maybe it will show them that you are being proactive and identifying areas for process improvement.

Like you said, just slow down a little, and maybe ask one of the other nurses waiting behind you to help watch you count.

Good luck!!

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Specializes in Psych ICU, addictions.

You know both the cause of and the solution to your problem...in fact, you said it yourself:

I know I should slow down, but I get really anxious at times when i'm in the med room and 3-4 nurses are waiting for me so they can get on the pyxsis. Now i'm recounting all the meds at least 3 times to make sure I get the right count.

When it comes time to count, that's all your should be doing: slow down and focus on the count. Unless a bona-fide code is going on, those 3-4 nurses can wait the extra 15-30 seconds it will take you to carefully count.

As far as counting multiple times...almost every Pyxis I've ever used will warn you if you enter an incorrect count. It's only when you enter a second incorrect count that a discrepancy is created. While I don't blame you for counting multiple times right after this, the fact is that provided you slow down and focus on counting, you should really only need to count once. If the Pyxis warns you that the count is incorrect, then count again.

Also, be sure that you are entering the correct count number in. That touch screen can be fickle at times and can misread your touch (happens to me on occasion: 26 will read as 6 because the Pyxis didn't register the 2, or it could read as 266 because it registered the 6 twice). So before you submit the count, eyeball the screen to make sure the number you entered is the actual number you meant to enter.

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Specializes in Pedi.

Does everywhere not require 2 nurses to count narcotics? When I worked in the hospital, 2 nurses always counted every time a controlled substance was being pulled.

We always had a lot of discrepancies with liquid meds because if, say, your kid was ordered for 1 mg of morphine and liquid morphine is 2mg/mL, the pyxis wants you to take out 1 mL to waste 0.5 mL but most people just drew up 0.5 mL to not waste anything. These discrepancies were easily fixed though, we just went in and said "overage d/t not wasting liquid meds."

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