narcotic count issue

[Ms.RN]

i work in long term care and i have issue with a nurse i work with. whenever i count narcotic with her, her narcotic count is always wrong. if her count is off once in a while, i can understand because we are all human and i do too make mistake. but everyday, every time i count with her, narcotic count is off. i guess she doesnt sign out her narcotic when she give it to the patient. i know this is wrong but since we have to do med pass up to 30 patients, we dont sign out narcotics when we give it to the patient, but when we are done with med pass, we go back and sign out all the narcotics we've given. once, i told don about this, and still her narcotic is wrong. now i'm starting to think she is doing this deliberately to get me into trouble.. so what would you guys do in this situation?

[SCRN1]

Any way you can get out of counting narcotics with her?

Do you count them with other nurses too who's counts come out right? If so, then the record should show it's only with her they come out wrong.

I'm surprised you don't have to sign them out each time given. I thought that everywhere it was required to sign at the time they're given. Maybe you could suggest that to your DON as a way to help cut down on med count errors.

[PANurseRN1]

Going back and signing off meds after the fact (particularly narcs) is poor practice. It is unacceptable, period.

I'm guessing by the post and your profile that you're a med tech. Are you legally allowed to be passing narcotics and signing for them? Are you legally allowed to be doing narcotic counts?

It sounds like this facility is a little "loose" with meds.

[TazziRN, RN]

It is required to sign out meds as given. This practice of signing later is condoned by the facility but it's not the way it should be done.

If you ever count with other nurses and this is the only time it's off, the fingers should not point at you but her. If she thinks she's getting you in trouble by doing this, she will have one heck of a surprise when it's her that gets looked at. At the very worst she could be investigated for possible diversion.

Do other nurses who count with her when you're not there have the same problem?

[morte, LPN, LVN]

ahhhhhhh, please tell me you are NOT taking the keys when count is wrong?!!!!!!

[GardenDove]

This is tolerated? Whenever it happens where I work, we go back and figure out who made the mistake. We still do old fashioned narc counts. Then, whoever didn't sign out does a late sign out. Pretty much, we don't have this problem, except for rare occasions.

[GingerSue]

sign as given

the count must always be accurate

(even with regular drug sheets, if there was anything left blank, then no one could leave at the end of the shift, until the error was corrected)

[banditrn]

I will only sign for what is actually there at the time of the count.

[txspadequeenRN, BSN, RN]

This is what I would do. Count with her first then when it is off tell her...when you figure out what happened to the med Ill be right over here to get report from you. Do not accept keys from her,because the cart and the count becomes yours . Do not take report until she has this figured out because then you are responsible for the patients. Get all this narc buisness done first so you will be liable for nothing. In the mean time you can inform your DON that there is some missing narcs and you are waiting until after they are found before you get report...

[Mustangsally1]

i'm don of a small long term care facility in tennessee. if the narcotic count is not correct at shift change, the oncoming nurse should not take responsibility for someone's else's error and it should be corrected before the offgoing nurse leaves. our nurses pass medications to 43 residents and it is policy of our pharmacy (pharmerica) that the narcotics administered must be documented on the narcotic sheet upon removal from the cart, documented on the front of the mar (they're usually given prn) and on the back of the mar with explanation of the reason it was given and the effectiveness. how you're getting away with signing them out at the end of the shift of beyond me. this is asking for trouble not to mention increasing the risk for errors! recently 8 of our state surveyors went into a facility on a complaint, 2 of them each went to the 4 medication carts and said, "excuse me, we'd like to do a narcotic count." they, too, did not sign out their narcs until the end of the shift. needless to say, they were slapped with a violation. our pharmacy consultant comes once a month and does an extremely thorough mars audit, which i do randomly throughout the month. if i were the oncoming nurse, i'd refuse to accept narc keys or take report until the count was correct. has she not been investigated for this repeat occurance? maybe a random med pass observation by the don is indicated!