Narcotic counts in the home?

caliotter3 · Dec 7, 2016

Many of my agencies have not had control measures in place. Agencies providing hospice, in particular, don't seem to want to be bothered with it. We had a case one time where it was evident that a nurse was diverting. The DPCS told me to start control sheets. Frankly, I think she should have had the clinical supervisor put the accountability system in place. If you are uncomfortable with the situation, like I have been in the past, bring it up to the boss. They will take your concerns seriously or blow you off. If they blow you off, then you will probably find yourself no longer getting any work from them and that is not such a bad occurrence.

Not_A_Hat_Person, RN · Dec 10, 2016

The agencies I've worked for did narc counts every shift. My current agency requires 2-person narc counts at the beginning and end of each shift.

Nascar nurse, ASN, RN · Dec 13, 2016

The agencies I've worked for did narc counts every shift. My current agency requires 2-person narc counts at the beginning and end of each shift.

I think you must be confused. This is hospice care forum...discussing going into peoples private homes to provide care. My agencies census is 50-60 people spread out over 5 counties. It's not even a thought process that 2 nurses are doing narc count at beginning/end of each shift.

nutella, MSN, RN · Dec 17, 2016

Curious whether your hospice routinely tracks narcotic counts in the home for all patients regardless of whether the patient is high risk for diversion. We do not here but there have been some high profile cases in the area of nurses pilfering from patients recently. I certainly don't want to have any suspicion directed at me and I don't know how to protect myself against an allegation by a family member who decides to use me as a scapegoat.

The only reason in the agency I worked at was when the family / caregiver was suspected to divert.

In cases where diversion was suspected, pat would only get 3 day supply instead of 10 days and for example methadone in liquid form to discourage diversion and other meds in liquid form like ativan because it is not that attractive for selling either. Also, lockboxes....

Not_A_Hat_Person, RN · Dec 30, 2016

I think you must be confused. This is hospice care forum...discussing going into peoples private homes to provide care. My agencies census is 50-60 people spread out over 5 counties. It's not even a thought process that 2 nurses are doing narc count at beginning/end of each shift.

My agency does home hospice. The narc count is performed by the nurse and one other person, who is not necessarily a nurse. I've counted with the nurse coming off shift, family members, and CNAs.

taivin · Jan 17, 2017

If something appears amiss then find out what's going on and contain it. If it needs to be reported, than report it. This is one of the aspects of home hospice I enjoy...autonomy. No one is hovering over your shoulder, no cameras, etc... You are on your own and accountable to yourself in the private homes.

As far as counting (especially with the comfort kits these days), have rarely done it in the private homes except to see what I need to reorder, what's working, what's being used most for what etc... I'll go in and look and compare the narc sheets the family fills out with the inventory, but I don't involve the family unless they want to save for the initial and ongoing teaching about dosage, drugs, etc... We have narc sheets where family members are to write down how much and when, but as far as going in and actually doing a narc count...no.

With the liquid morphine sometimes if I'm suspicious, I'll squirt a little out to make sure it's not just water...yea, I've run into some real doozies out there. The liquid morphine doesn't have a smell I can smell, but it's bitter to taste.

You do have your nurses who divert in hospice, but what I've found is it is the family members who are the ones that will have the accidental spill over the sink, and the morphine that somehow turned to water.

For the most part with my experience I haven't run into too many problems in this area. The main problem I've had is family who don't want to give the morphine because they feel it turns the parent/whoever into a drug addict. Lots of teaching in this area sometimes. Don't always assume that families are all in for the morphine/Ativan/etc..., when pain/anxiety is a factor and/or comfort.