Missing Narc.....but for how long?

mozella · Feb 28, 2011

that happened at our facility once. 4 percocets were missing from the e-box. all nurses on all shifts had to take a drug test. the police were called too. the nurses that tested positive had to be escorted to the hospital for blood tests. then they had to show prescriptions for what they tested positive for. they never found out what happened and all nurses in question still have their jobs.

SE_BSN_RN, BSN · Feb 28, 2011

Hmmm, well I'm not sure how long benzo's stay in the system but I can guarantee I'll come up clean. No one's had to take a drug test yet.

MHSA LPN · Feb 28, 2011

Although this is not funny, I can't help but laugh. At the ALF where I worked very briefly it was no big deal if a narc was missing. (I couldn't believe it.) The protocol was to "make the MAR reflect the medicine on hand".... despite the fact that an ex-employee was caught stealing about 30 or 60 percocets and filling the resident's bottle with white pills. I'm convinced that place is a bootleg ALF.

Forever Sunshine, ASN, RN · Feb 28, 2011

I had a scare once with those ativan cards. Ativans are sneaky little things. Our pharmacy cards aren't sealed very strongly on the edges so my luck it came apart and I noticed before counting with the oncoming nurse that two were missing from the bottom but the card was unpunched. *Start heart attack here*. So I retrace all my steps, look all over the floor, I open up the narcotic box in the med cart and theres two little tiny ativans sitting in the corner. *End heart attack*

Be careful with your nails too, they can punch tiny holes .. even if your carrying a pen or another card hits it. Carry narcotics with two hands. Don't smush them in your arms while trying to carry 20 cards of narcotics and the narcotic book.

CapeCodMermaid, RN · Mar 1, 2011

First off , you can't really 'fix' the count. If the pill is missing an investigation has to be done. I've been in buildings where the count was pretty much a joke and the nurses wouldn't even really look to make sure count was correct.

We had 10 oxycodones disappear one day. I had to question everyone, get statements, check every drawer, nook and cranny. I reported it to the DEA. They didn't even come out to do their own investigation. I guess in the big scheme of things, 10 oxycodones aren't that big a deal.

Chin up · Mar 1, 2011

You need to be more careful, check the front and back of the card during count. Look at both the narcotic book and make sure the card matches page, exactly... You now know and should be glad it was not a stronger narcotic, such as percocet, morphine, a schedule 2 drug....having said that, being an Ativan, your DON may have had mercy and "fixed" the problem. Those things happen all the time. A drawer that is too full, a fingernail, can cause soft back cards to lose pills. Sometimes you find them in the draw, sometimes they fall under the med draw etc. If this were to happen again, you may be held accountable. Be thankful this time, but please take narcotic count seriously. Don't let anyone interrupt your count and look,look,look at everything. Ask the person who reads the count to slow down if needed. When taking the keys, you are now responsible for every narcotic in that draw. Peace!

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Mar 1, 2011

Don't sweat a single missing Ativan. Seems like a similar event occurs to every nurse at some point. A little paperwork and this too shall pass. Serious drug diversion is a big issue, and the bad guys will always find ingenious ways to get away with it right up to the point that they get sloppy and are caught. They ALWAYS get caught eventually.

Music in My Heart · Mar 1, 2011

I reported it to the DEA. They didn't even come out to do their own investigation. I guess in the big scheme of things, 10 oxycodones aren't that big a deal.

...unless it happens repeatedly.

vampiregirl, BSN, RN · Mar 1, 2011

Where I work we occasionally get a card with a sealed bubble, but no pill. We mark the front of the bubble with a sharpie and error-correct the number received in the narc book. It then must be initialed by 2 nurses. Sometimes it really hard to see if some of the smaller half pills are in the bubbles. I know it's easy to rush through narc counting, but if I'm the one taking responsibility for the cart, I'm going to make sure everything is reconciled before I take the keys:)

JenniferSews · Mar 1, 2011

I only have 1 yr experience. But on the very rare occasion we've had a narc count off we have been fortunate that there was a solid explanation. From listening to the nurses with more experience, it was never just ONE Ativan missing that indicated a problem. Most often it was a pattern of patients in pain who were given something (ie Tylenol) but not their narcotic. From my own experience I can see where someone could sign out an ativan for a confused and anxious patient without actually giving it. To punch one random pill and HOPE no one notices isn't the usual pattern of diverters.

On the other hand I would take this as a learning experience. Not so long ago I carefully emptied and entire bottle of liquid morphine into a tiny little med cup because the nurse wasn't comfortable with the labeling on the side of the bottle. The count said 14.5 ml and the bottle looked more like 18. I emptied it, sweating the whole time that I might spill a whole bottle of morphine, and it really was 14.5. The bottle wasn't labeled for a real narc count and you couldn't visualize the meniscus. Of course she had experienced being agency and someone trying to count off who was clearly intoxicated and the count was off.

No one on our staff held it against her in the least for refusing the count. Visualize the entire card and don't feel pressed to worry about time. We all understand not wanting to take a count we don't feel 100%

Ginger80 · Mar 1, 2011

Why are Ativan pills in your narcotic count? Just curious.