Thanks for reading this and I'll try to make it short. I am working against a wall of nurses at my hospital who have a hard time with the whole concept of counting with one person from each shift.
When I come in at 7 am, one of my co-workers will often say that the night shift nurses need the time that would be taken up by count to finish up and get out on time.
When it is time to leave at 3 pm, one of my co-workers will often say why don't we just count, that will give them time to set things up.
If I come in at 3 pm, often the story is that none of the day shifters have time to count, right now, because they know that more often than not, two 3-11 people will count together.
I have spoken to my nurse manager about this and she is of the same opinion as I am, DUH! it's a federal law!
This happens on the several floors I float to and on all 3 shifts. If it was only one place or one person I would worry about diversion, but this is driving me nuts.
When I say, " I am sorry, but I won't count with you. It's not personal, but federal law says count is with oncoming and offgoing and I would prefer to do it that way.", sometimes I get a look of WTF, sometimes I get an "okaaaay".
I don't mind being a stickler for this, any opinions or alternative suggestions?
Pyxis also requires a physical count. Don't see how that makes a difference except that each person's entry is noted.
And "Amen" to the manager taking charge of the problem! :angryfire Too many of us want to do what is convenient instead of following the law/rules, especially those that protect us, for goodness sake.
Pyxis makes a big difference. You count what you use and you count it right then and there when you use it. You don't have to count it when you go home!
Do they think that they won't lose their license if something is missing? Or the count is wrong. Like Nightowl said "The law is the law" And it's there for a reason. If the count is wrong, everyone stays until that narc is found. Then if it isn't, the state gets involved. It is a big mess. I've been through that before. Also, the manager needs to insist and assert that two people count one from off going shift and one from on coming shift. There should be no exceptions at all.
We have Omnicell where I work. Oncoming and offgoing nurses run a discrepancy report at change of shift - if no discrepancies found, all is good. If a discrepancy is found (usually someone taking out one more or one less than what pops up on the screen automatically, but forgetting to change it), same rules as traditional count apply - no one leaves until discrepancy is resolved, etc. Difference is, we do have the printout of everyone who has accessed that particular med during that shift. Each compartment locks separately so there is no going in for Morphine and taking out Morphine and Demerol, or anything like that.
We also do a complete narc count once per week. Much more efficient than the old fashioned way. Counting every narc every shift - we'd have to change to 13 hour shifts!
Continue to write people up if they arent willing to fulfill their responsibilities. Eventually some of the write ups will get to the right desk and something will be done. Sometimes you have to go over the NM head to get results with some of these things if they arent willing to make it right.
In our E.R. the counting is left up to the charge nurses while the staff nurses get their reports. This is done on every shift. (2 x 's a day because we work only 12 hour shifts). Nobody is able to go until the counting is done. The charge nurses arrive on time and immediately start the count. Then we worry about the reports to each other after wards. We do have a pyxis but we still need to count every shift!! It has to be enforced by your manager. If it's not then maybe your manager needs a backbone or a new job!!
Where I work my manager states that the feds only require a narc count once in a 12 hour shift. She also states it can be two people from the same shift and it can also be with an unlicensed person acting as the scribe. What irks me even more is that she states you can waste a narc with an unlicensed person! When I ask "How does the person know I am wasting the proper amount if they can't do the math?", she states, "They are just making sure you waste the drug properly." In all my years of nursing at other facilities I have never heard of this. This really pisses me off, especially when she won't put it into writing. What do you think? Have you heard of this before? (Ooh, venting sure feels good!)
And lets not forget the home settings...there are controlled substances at a home vent case that i have gone on, none of the rn's there count them. Don't know if its laziness, don't care, don't think they have to or what. Since i usually would end up giving report to the caretaker, since the nurse is never on time, and caretaker tells us we can leave on time, since she does the care when there is no nurse, well i have been doing the count before i leave by myself each morning. I figure if a medication is missing, at least it was counted by me. Wife does not want to co-sign, and i don't blame her. Oh well...up to the manager to step in , thats what they get paid for!!
SmilingBluEyes
20,964 Posts
Same here Denise. The count and keys must be accounted for before report. That is how it's done where counts are done qshift.