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.
