Narcotic count (Drug and Alcohol Rehab)

S.G. · Jul 23, 2013

I don't think it's a law. It's probably based of facility policy. When I worked in ltc (only for a month) we just had two nurses do the count. They didn't care which shift as long as it was done morning and night.

ETA - it may differ based on state as well. They desired one nurse from each shift but really just wanted the count done so didn't fuss about who did it.

Home Health Columnist / Guide · Jul 23, 2013

Please check your facilities policy and procedure manual and follow it exactly.

Is there a state rule on how to count narcotics? - Nursing for Nurses

Narcotic Treatment Programs Best Practice Guideline - Recordkeeping

Taynak · Jul 23, 2013

Please check your facilities policy and procedure manual and follow it exactly.
Is there a state rule on how to count narcotics? - Nursing for Nurses
Narcotic Treatment Programs Best Practice Guideline - Recordkeeping

well thats the thing... the company is only 6 months old. they don't have a book or anything. no policy. we were counting the normal way, one person from each shift then it changed because swing was complaining that they wanted to get out on time but always did anyway. we set up our shifts so that there is a 30 minute overlap in the schedule so that we can get the count and report done. but the tech sup is saying it can be two people from the same shift.

But thank you NRSKarenRN. your first link lead me to the board of pharmacy for washington where i found the info i was looking for... Washington state only requires a count done once in a 24 hour period. so... thats a little discouraging to me... you think that it would say something like done at each shift... and doesn't say anything about which people it needs to be just that 2 people do it.

BrandonLPN, LPN · Jul 23, 2013

It seems to me that if two people from the same shift count the narcs, it would create some liability issues.

Who's responsible if a narc comes up missing? Are both techs working that shift in and out of the narc box? That could get very ugly very fast.

If your facility really only needs one tech to pass meds, then that tech should be the only one with the keys. If the workload is truly such that you need two techs to pass narcs, then each tech should be working out of his own narc box that he's soley accountable for.

And it really should be the previous shift and the oncoming shift counting. When first shift is counting in the morning, I (night shift) want to be present during that count. I would never be comfortable with two day shift nurses verifying count with me nolwhere around. How do I know they won't just shove some pills in their pockets and come out and say the count was wrong?

Taynak · Jul 23, 2013

and that's what I was saying.. who's to say they don't pocket something and say "well the count was right when we counted it" so when I came on shift tonight they said they had already done the count and I just looked at them and said "well we're doing it again cuz I'm not taking keys until I verify that count is right" and I got some attitude for it but it's my reputation on the line,

jadelpn, LPN, EMT-B · Jul 23, 2013

Yikes! And is there a licensed person on the premises at all?

By Med Tech, do you observe residents taking their own pre-poured medications?

I am not sure I would want to be an unlicensed person having access to narcotics to give to residents--after what assessment and by whom? If the resident has a negative outcome from the medication, I wouldn't want to be liable for any of that. Especially if the resident is in acute ETOH and/or drug withdrawal. This is typically medically based, and is not always straightforward.

i would worry about the fact that there isn't any policies in place. It must be a private pay situation, as I am not sure what state agency would license a facility without policies.

In most facilities, the outgoing medication nurse counts with the incoming medication nurse to make sure that the narc count is correct. But I am not sure why this is being done by UAP's in a situation of giving out PRNS, and not something that is specific to residents.

So this goes deeper than a narc count. I would proceed with caution, and ASK to see the policy. Which have a way of magically appearing when the count is off, and the licensed person in the facility has to take the heat.

Esme12, ASN, BSN, RN · Jul 23, 2013

well thats the thing... the company is only 6 months old. they don't have a book or anything. no policy. we were counting the normal way, one person from each shift then it changed because swing was complaining that they wanted to get out on time but always did anyway. we set up our shifts so that there is a 30 minute overlap in the schedule so that we can get the count and report done. but the tech sup is saying it can be two people from the same shift.
But thank you NRSKarenRN. your first link lead me to the board of pharmacy for washington where i found the info i was looking for... Washington state only requires a count done once in a 24 hour period. so... thats a little discouraging to me... you think that it would say something like done at each shift... and doesn't say anything about which people it needs to be just that 2 people do it.

The government regulations only give minimal requirements usually...the rest is "best practice" and policy. Even if the facility is 6 months old there should be a policy.

Usual and customary is 2 people count...one from the on coming and on from the off going "count" the narcs. Many facilities make the licensed personnel on duty be one of the counters.

dishes, BSN, RN · Jul 23, 2013

Is the employer saying they do not have policies in place because they have only been open for 6 months? They are supposed to have policies in place before they open.

Taynak · Jul 23, 2013

The government regulations only give minimal requirements usually...the rest is "best practice" and policy. Even if the facility is 6 months old there should be a policy.
Usual and customary is 2 people count...one from the on coming and on from the off going "count" the narcs. Many facilities make the licensed personnel on duty be one of the counters.

and after last night that's how it is now... look below...

Is the employer saying they do not have policies in place because they have only been open for 6 months? They are supposed to have policies in place before they open.

yeah i know... The people that started the facility were employees of another facility that split off because the other company was going under... i don't really know the whole backround but anyway...

So like i had posted before i told the shift that i wasn't taking the keys until we counted... the count got done... and i went about my evening...

in the morning when i was being relieved i found out that we had a new tech supervisor... so i waited for her to get in and i chatted with her about it and she was flabbergasted that the swing shift and that the other supervisor thought that it was ok to do that... she said that while it was technically not illegal or anything, they shouldn't do that... they should count when they are being relieved... with a person coming on and a person going off...

so thank you all for your advice... and i really appreciate your help!! You'll probably see me more in the next couple years as im getting ready to start school in fall..

Taynak

Taynak · Jul 23, 2013

Yikes! And is there a licensed person on the premises at all?
By Med Tech, do you observe residents taking their own pre-poured medications?
I am not sure I would want to be an unlicensed person having access to narcotics to give to residents--after what assessment and by whom? If the resident has a negative outcome from the medication, I wouldn't want to be liable for any of that. Especially if the resident is in acute ETOH and/or drug withdrawal. This is typically medically based, and is not always straightforward.
i would worry about the fact that there isn't any policies in place. It must be a private pay situation, as I am not sure what state agency would license a facility without policies.
In most facilities, the outgoing medication nurse counts with the incoming medication nurse to make sure that the narc count is correct. But I am not sure why this is being done by UAP's in a situation of giving out PRNS, and not something that is specific to residents.
So this goes deeper than a narc count. I would proceed with caution, and ASK to see the policy. Which have a way of magically appearing when the count is off, and the licensed person in the facility has to take the heat.

yeah i have to admit that there is a lot of grey area in this... since this is a rehab, according to state law, the only requirements are that you have a clean background and that you have 2 years sober... since i have no background and i have 28 years sober (i'm 28), i didn't need any special training or license.. though our new tech sup is supposedly doing some sort of training...

As far as the meds go, the ETOH patients are on Q2's and the others are on Q4's until they have 3 days of steady vitals then are checked 1x daily until discharge. We have a Doctor that is already there and he handles all the dosages and what meds the patients are on.. then we have med books as to how much to dispense of what and everything is written down with how many time and date and initialed... We have an RN coming in soon..

All i can do is make sure the count is done properly at start and end so that my butt is not in the fire and ride it out until i get through school...

Mandychelle79, ASN, RN · Jul 23, 2013

We do it both ways where I work. If we are counting the accudose narcs for a once a week check, we use two from the same shift. If we have a narc locked in the narc closet, we use the out going nurse and in the incoming nurse. I would not be comfortable not counting the myself at the beginning/end of shift and being the med nurse.