narcotic count issues

[finne1]

Hi just curious how others would have handled this: during narcotic count, an opened bottle of morphine liquid from the ekit was on count for over one week. No patient name, no dose, etc.... I refused to take the count as being correct. what would have done? better still, what should be the repercussions of my refusal to take the count? the supervisor came down and stated it was ok. I felt very strongly against this and asked to leave to which the supervisor agreed.

[classicdame, MSN, EdD]

I agree. I would also think the Pharmacy should be informed.

[clemmm78, RN]

I'm not sure I understand. Because the med wasn't a patient's you don't want to count it? I've worked in many places where a narc is sitting in the cupboard either waiting to be picked up by pharm or as a prn stock. If it's there, you have to count it. I can't see the point of refusing to count it or is there something I'm missing?

[Jolie, BSN]

I'm not sure I understand. Because the med wasn't a patient's you don't want to count it? I've worked in many places where a narc is sitting in the cupboard either waiting to be picked up by pharm or as a prn stock. If it's there, you have to count it. I can't see the point of refusing to count it or is there something I'm missing?

The med was opened, and not labeled. How would the nurse account for how much was missing and to whom it had been given?

[heron, ASN, RN]

Would the dose be signed out on the e-kit log?

[Sun0408, ASN, RN]

Wow, why was it there "for over a week"? How often does your unit do a narc count? And why would you have to leave over it? I would have informed the NM and went on with my shift and let her/him and the pharm track it down..

[caliotter3]

In such a case we would have noted the amount there and listed it and counted and signed for it, with no explanation, if information not available. This is what is usually done in the home when there is no nurse to nurse count and there are shifts where the family is responsible and does not sign off on the controlled substance sheet. It does not make for full accountability, but you are stating the amount you find when you come on duty.

[clemmm78, RN]

The med was opened, and not labeled. How would the nurse account for how much was missing and to whom it had been given?

Ah, I get it now. Sorry, was a bit dense before supper.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

A week! Who knows what's even in the bottle? Lots of people hate to be the bringer of bad news, but now a whole weeks worth of people need to explain what may be a simple error at least, or maybe even a crime. I've seen many ways to divert narcs over the years, and I'm sure I'll see more. I'd rather be the one reporting than ignoring the occurrence.

[Selene006, BSN, LPN]

In our building, there was only one emergency narcotic kit, and it was on my unit. If a nurse from another unit had MD order + pharmacy permission to access the kit, I would have to document in the narcotic book + narcotic log the patient's name,drug opened, amount of drug used, amount left, patient unit, MD name, cosign with the nurse, etc.

Once the kit is opened, an order has to be immediately faxed to the pharmacy to send a new emergency narcotic kit so that nurses don't have to keep counting all the meds from that opened kit at the start of shift. Once the kit is opened, there are no patient labels on the emergency medications but all reference for count pertaining to the opened narcotic kit goes back to the narcotic log information.

Hope this makes sense.

[carolmaccas66, BSN, RN]

Where I have worked we have manuals for narcotic drugs. If this is not signed in in the manual (by pharmacy), it doesn't exist. If something has been left opened for a week, it is usually destroyed and witnessed as destroyed by 2 RNs. It shouldn't be used if it is opened anyway. Any empty containers/narc packets are given back to pharmacy.

I didn't understand all of this post - was it left over from giving to a patient?

[DizzyLizzyNurse]

I don't understand why you went home over this? Next time resolve it with the nurse manager and then just get to work.