Narcotic counts

[CoffeeRTC, BSN, RN]

***I put this in the LTC section but wanted to reach out to the rest of the board. ***

Old fashion way...paper charting...no computers...punch card system. How are you doing it?

Of course it is done by the on coming nurse and off going nurse each and every shift. (unless you are doubling and keeping your cart).

Narc comes into the building from pharmacy.

Verify the count when you sign it it and take it from the delivery driver.

Sign med into the master log in the front of the book.

Complete the count sheet for the med. NOte the page # on the master log.

During count, I like to see the number in the book and the actual pill count.

When the card is done, note it on the master log.

If a resident is dc'd with med, note it on the master log

If med is wasted/dc'd have two nurses waste and sign and note it on the master log.

We've now started counting the # of sheets vs the # of cards each shift.

I've been doing this for 20 or so years, so I'm good with this part.

What is your policy on any discrepancy?? This is what I really would love to know.

[CoffeeRTC, BSN, RN]

Anyone?

[sallyrnrrt, ADN, RN]

They way you initially described is the way I have always done

[Cob94]

Been nursing over 20 years. First thing I do when I get to work is actually count narcs, then I actually check placement of fentanyl patches. Only then do I accept keys. Guess I'm old fashioned.

[CoffeeRTC, BSN, RN]

Cob94..me too!

I guess my question to all is about what happens when the count is wrong? (no math error) or you notice that there are missing pages from your log and the meds are missing (patient is not discharged or the med wasn't discontinued) or that there are weird patterns of waisting the med?

I would refuse to accept the cart and call the DON/ supervisor. What then is your facility's policy on dealing with this? Incident report? Staff interviews/ statements? Drug testing?

[HouTx, BSN, MSN, EdD]

Any discrepancy? No one leaves until it's resolved. Srsly. Our acute care facilities are all on Pyxis, & LTACS, LTC & Clinics are still on paper at this point - but the process is essentially the same with discrepancies.