My narc count was over!

[August10]

When I started my shift we counted narcs, I read off the physical amount of pills while the nurse leaving checked the paper, she agreed with all my counts. When I went to give one the paperwork was off. I had an extra pill so obviously one was signed out but not given. It's my fault because I didn't look at the paperwork as I counted, right? I reported it as soon as I found the error and the director was really mad about it. I guess at least I was over and not short. I am a new nurse and I have been really stressing about this. Is there anything I should have done differently, what can I expect to happen over this? Any experiences like this?

[NotFlo]

This is my first rn job and I was given no real training, just following other nurses around for a couple of days. Yes, I read the physical amount of pills and the outgoing nurse checked the paperwork. So you are saying I should have the number from the paperwork read to me as I check the physical amount of pills? None of the nurses there do this including the director, I need to protect myself obviously!

Always. The nurse withe paperwork should be reading off the number from the sheet, and you should be verifying that the number is correct with the physical count. NEVER have I seen or heard of it being done any other way.

[RNKPCE]

As a previous poster said in pyxis you have to say how many you physically see then pyxis tells you if you are correct, that way there are no preconceived ideas about how many drugs there should be. Years before pyxis would say : expected 21 and you would have to enter how many you have. They switched to the blind method now. In my other job we don't have a pyxis and I count the drugs and the one with narc log verifies if I am correct. No preconceived ideas about how many are there.

[Meriwhen, ASN, BSN, MSN, RN]

Better that you have extra than being short :)

That being said...

1. Don't let anyone rush you when counting on or off. Don't let anyone interrupt you either.

2. Pay attention when counting; don't try to do anything else at the same time.

3. Count every single pill, capsule, vial, etc. Don't assume a count is correct unless you count it yourself (exception: if the box of narcs is still factory-sealed, assuring that no one has been in it, then there's no need to open it and count).

4. Get into the habit of checking your narc count after you give out any of them. For example, if you started the shift with 19 Percocet and dole one out, you should instinctively check that the count and the paperwork are now both at 18.

5. Do not accept a count that is off for any reason--demand that the off-going nurse rectify the matter (i.e., recount the meds, recheck the MARs, notify the supervisor, file a discrepancy report, etc.) before accepting. If they refuse to do it, then YOU notify the supervisor and let them know what's going on and that you won't accept responsibility for the narcs before it's been addressed. Remember, once you accept the count is correct and assume responsibility for the narcs, any discrepancy found is now on YOU even if it happened on another shift.

6. Likewise, if you're the one with the discrepancy on your hands, resolve it ASAP before signing off to the next nurse.

7. Never give anyone else the narc keys/book while it's in your name. Likewise, make sure narcs are always locked up if you are going to leave the medication room or cart for any length of time.

8. And last, remember that when you accept the narc keys/book/etc. YOU are the one who is liable and it's your job and/or license on the line. So do whatever it takes to protect it!

[morte, LPN, LVN]

always check subtraction///

[CompleteUnknown]

always check subtraction///

This is always the first thing I do if the count is off in any way. Sometimes you find a simple error that somehow hasn't been noticed - everyone is just seeing what they expect to see.

[belle005]

I had something similar happen. I had counted with another nurse. I looked at the cards and the other nurse followed in the book saying "yep, yep, yep" as I read off the cards. At the end of my shift, I was two short on one card. It was a card I had not used at all during my shift, so I knew it wasn't me. I let my supervisor know immediately and told her I counted with the previous nurse and supposedly the count matched. Turned out the other nurse forgot to sign out the narcotics she had given on the previous shift, and maybe she just wasn't paying attention during the count or heard me incorrectly. Who knows. She signed the narcs out the next day and that was that. No biggie. That stuff is going to happen once in a while.