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Narc Count Disaster

Posted

Specializes in LTC. Has 11 years experience.

There has been a seriously confusing issue with the count on a bottle of narcs over the weekend. I will attempt to outline the issue. Keep in mind that the scheduled dose for this med is TID, 7a-1p-6p. No PRN's have been signed out on this medication.

"Joe" works 6-2 as a med aide. He insists that the count is 104. However, the 2-10 med aide, "Suzie" counts 105 after 2 full counts on the supply. "Joe" becomes flustered and "Suzie" concedes to 104 and accepts the cart. An hour into shift, the count bothers "Suzie" and asks me to count said bottle, and I count 105. We have the weekend supervisor count as well and she comes up with 105. (This count proves that a dose was signed for but not given on the previous shift. "Joe" has recently been written on a med error by omission for not dosing per order.) The count is corrected and shift continues. The resident receives the scheduled dose this shift and count reflects supply at 104.

The 10-6 nurse, "Bill" arrives, counts and verifies the supply at 104. "Bill" and "Joe" count in the morning and "Joe" again gets flustered and insists that the count is 103.

Per the narc count sheet, "Joe" and a 1st shift nurse correct the count at 6 a.m. as 103 and "Bill" concedes as well as signs the new count as correct.

The count is then again corrected to 102 at 9 a.m. with the weekend supervisor. A dose is signed out as given at 1 p.m., which is a scheduled dose and the count is 101. It is unclear if the scheduled 7 a.m. dose was given as the counts were corrected at 6a and 9a and show a dose given as well as corrected. "Suzie" counts the cart with "Joe" at shift change and the count is verified as 101. Scheduled dose is given and signed for on 2-10 to end count at 100. The 10-6 nurse arrives and freaks out because he now sees that it appears a dose is missing on his shift from the previous night. Supervisor is notified who insists that her count earlier in the day is correct from 9a. All doses have been signed out since then and count is correct at this time. (Side note: The resident pays for their own meds, and gets them cheaper on their own than the would from our pharmacy. That's why no blister pack.)

All of that mess out of the way, it now appears that the 10-6 nurse diverted a narc. "Joe" is pointing the finger at "Suzie" for the count issues, and vice versa, but "Bill" seems to be caught in the crossfire.

The moral of the story? Do NOT, under any circumstance, accept a cart that the count is off or if you are the least bit uncomfortable about the count. Count 36 times if that's what's needed to verify the count. I don't care how huffy someone gets over you counting several times or how much time it takes. Have a supervisor (if available. If not, call one) come count with you to verify if you're not satisfied. Someone is likely to lose their job if not their livelihood over the fact that they conceded to a count that they were not comfortable with.

Edited by Joe V

duskyjewel

Specializes in hospice.

Why are these nurses allowing themselves to be talked into altering the count? Don't they know better? Especially on a narc....are they nuts?

LadyFree28, BSN, RN

Specializes in Pediatrics, Rehab, Trauma. Has 10 years experience.

:eek:

WHY are they conceding into that count, and why isn't the nursing supervisor counting the ENTIRE bottle before accepting a corrected dose?

Seems like there is plenty of blame, as well as rightful suspicion to be placed all around.

SWM2009

Specializes in LTC. Has 2 years experience.

My co-worker got all huffy when I insisted on calling the DON at home on a Sunday afternoon because 2 pills of a narc were missing. She and the overnight nurse had done the altering the count thing on the sign off sheet and I would not agree to do the same.

I will not mess with narcs. If the count is off, I refuse to accept the cart and DON gets notified pronto.

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

Paragraphs please!

Seems like blame all around -- and I'd be suspicious of all.

Why is Joe always flustered and insisting on changing the count? Joe would be the one I would investigate.

Forever Sunshine, ASN, RN

Specializes in LTC. Has 7 years experience.

See this is when I would take a couple sheets of paper and write out each number and put a pill at each number. 1, 2, 3, 4, 5 etc If the count is then off then call a supervisor and take it from there. Never take the keys if the count is off.

motherof3sons

Specializes in LTC. Has 22 years experience.

I would never take keys if the count was off.....never let someone pressure you into signing off just so they can leave. Call the DON immediately if count is off. We had a nurse whose count was off in a pattern but unable to prove she was taking the meds and she didn't have the chance to stay long.

Edited by motherof3sons
spelling

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

Cheaper or not, it's ridiculous for nurses to have to count ANYTHING that comes from a bottle. We have enough to do without all this.

Sounds like a potential diversion. I've worked in places where the supervisor would 'fix' the count. I come along and refuse to fix anything without a thorough investigation. I hear nurses say "I'm going to lose my license' for this or that minor thing. They don't understand that the narcotic count is one of the most important tasks they have and doing it correctly every time might save their license.

motherof3sons

Specializes in LTC. Has 22 years experience.

In my old facility we had some residents that got meds from Walmart....except narcotics. All narcotics came from our pharmacy and that was a non negotiable item. If a resident brought meds from home we used them...except narcotics. Some feathers were ruffled over the expense of the narcotics from our pharmacy but if you have a policy in place then it prevents the above scenario.

xoemmylouox, ASN, RN

Has 13 years experience.

What a mess! Never accept a cart if the count is off.

ktwlpn, LPN, RN

Specializes in Med Surg, Homecare, Hospice.

Cheaper or not, it's ridiculous for nurses to have to count ANYTHING that comes from a bottle. We have enough to do without all this.

QUOTE]

Exactly! We have a policy prohibiting this -it was put in place after we suffered through that baloney some years back with a resident who came in for respite care , the family pitched a fit when they picked the gal up after their respite cruise and felt there should have been a few more pills in the bottles (I'm talking whopping big bottles of Tylenol,aspirin,colace,vitamins-they were not concerned about the b/p meds....) The entire two weeks we fought with those bottles-trying to pour out the right number of pills without touching or spilling them,invariably spilling them any way,taking up an entire drawer in the cart..what a pain.The DON walked on the floor during a med pass and observed that mess and a policy was born.

Alisonisayoshi, LVN

Specializes in LTC.

These aren't nurses are they? They are med aides? Or med techs? That explains a lot oif that's the case. I have been an underpaid med tech and they aren't really trained that throughly. At least not in my experince. They don't really understand the gravity of it. They don't have a license to lose, just a job. One of the ALFs near me had a med tech they fired recently for being drunk on shift.

duskyjewel

Specializes in hospice.

One of the ALFs near me had a med tech they fired recently for being drunk on shift.

And that's never happened anywhere, ever, with a nurse, right? :rolleyes:

Med techs or not, no one should alter a med count. Counts are performed to prevent problems, but also to identify when and with whom they are occurring if they do. And whether a med tech came before him/her or not, any nurse that alters a med count is committing malpractice and risking their license. Such a dumb risk to take.

bluegeegoo2, LPN

Specializes in LTC. Has 11 years experience.

In my old facility we had some residents that got meds from Walmart....except narcotics. All narcotics came from our pharmacy and that was a non negotiable item. If a resident brought meds from home we used them...except narcotics. Some feathers were ruffled over the expense of the narcotics from our pharmacy but if you have a policy in place then it prevents the above scenario.

Our pharmacist happened to be on my unit when I came on and I suggested this option for all of the reasons stated. Too much time and energy are wasted on counting bottles. Not to mention the drama that surrounds them. We actually have an automated medication packaging system right there in our building. Unless the narcotic ordered is uncommon or a not often used dose and must come in a blister pack, there's no need to count at all. The person paying for the very common narc in question is who insisted we use their supply and not our own.

Alisonisayoshi, LVN

Specializes in LTC.

And that's never happened anywhere, ever, with a nurse, right? :rolleyes:

Med techs or not, no one should alter a med count. Counts are performed to prevent problems, but also to identify when and with whom they are occurring if they do. And whether a med tech came before him/her or not, any nurse that alters a med count is committing malpractice and risking their license. Such a dumb risk to take.

The difference is a med tech doesn't have a license to lose. They are just an employee, and a low paid one at that. Thus, the risk of them making a dangerous error, or working in an unsafe manner is probably (I'm just postulating based on anecdotal experience) higher than someone who has a license or career on the line. I hope that makes my point more clear.

Sorry, I didn't read all of the original post, but I can relate. I had a similar situation where there was a missing narc. Not signed out, just gone. I told the off-going nurse I would not sign, and then called my DON. They worked it out ... someway; but I still never signed. I believe the DON ended up signing.

bluegeegoo2, LPN

Specializes in LTC. Has 11 years experience.

Follow up: The dust has settled and all involved are still employed. The only change is that 2 nurses must count the bottles of narcs, while the med aides are still allowed to count blister packs.