Narcotic missing

[Mbarbour]

I counted my narcs with oncoming nurse and I have a narcotic missing. I am upset because I have no clue what happened to it ? Will I be fired ? Or worse ?

[Alex_RN, BSN]

Posted in error.

[canoehead, BSN, RN]

If you are using a Pyxis, check behind the drawers and in the back. I got a miscount once, and that's where they found it, a week later.

[psu_213, BSN, RN]

I don't know what happened to it ? I might have punched it by error or something.

Unfortunately, this really does not help you cause either. If you may have punched it by error and then do not know what happened to it, does it mean that you mistakenly administered it to someone? The correct patient? If they got this, does it mean the pt. did not get something else they were supposed to get?

I sorry if we are over hard on you, I'm not suggesting that you did anything wrong intentionally, but there are a awful lot of unanswered questions that do not look good.

[JadedCPN, BSN, RN]

If you have a clean urine test you should be fine. I am sure it is not a big deal and you wont get fired. But just know that if it happens alot, they will open up a case on you

With all due respect, this is not very sound advice. Not everyone who diverts (not saying the OP is actually diverting) medication takes it themselves - some sell it or give it to others - so a clean drug test does not clear the situation at all.

[NurseBlaq]

I'm confused. Did they let you go home with an off count? Did you report it to anyone? The person working after you actually let you go without notifying someone the count was off? If she/he did then they become responsible. We need more information. What was the outcome?

[amzyRN]

You should always report a discrepancy immediately. Usually, the med was either miscounted or possibly stuck in the Pyxis in a weird place. If the med is really missing it's your responsibility to report it by filing and incident report, notifying your charge nurse and/or manager and possibly pharmacy too. Pharmacy needs to report it to the DEA or the hospital gets fined.

There was an incident at one of my old hospitals in the ER. It was a very busy place very sick people needing things right away. I had a kid with a seizure that came in emergently and the charge nurse helping grabbed me some ativan to give this kid. I documented this in the medical record but who ever pulled the med did (I don't know if the charge nurse even pulled it or another nurse) did not pull the med correctly or did not document the waste correctly and there was a "missing ativan".

I got called into the office because this was my patient and I showed them that I documented the med as given and the nurses name who brought in the Ativan. I think I also documented the waste in the medical record. I think there was a policy/either written or unspoken that a nurse who pulls a med needs to give it (at this particular facility). Whoever did the inventory that day did not report the discrepancy or tell pharmacy and pharmacy was irate because they are supposed to report this to the DEA or get a huge fine. It's a big deal.

I did not get consequences because of the circumstances surrounding the Ativan and that I didn't pull the med. However, in retrospect, the person who pulled it should have and could have given it which I should have insisted on. My point is that you probably won't have consequences but you need to report this next time because you will cost your employer money by not doing it. On top of that, you don't want them thinking you arer diverting narcs. If they wanted to urine test you, it should be done the same day so that you build evidence that you aren't a drug diverter.

[Have Nurse, ADN, RN]

Well what did you do when you noticed the discrepancy during count? Did you notify whomever needed to be notified and track down what happened to it?

I recently had a narc count off when I came on shift. The other nurse and I double-checked all documentation, called the Nurse Supervisor and the Admin-on-call per policy and relayed our findings and where we suspected the count had gone off based on the documentation we could find. Once that was done the other nurse was able to leave and the supervisor took over the investigation and ultimately figured out where it got off and what happened - everything worked out okay in the end and no one lost their jobs or was even punished, but it was a lot of phone calls and paperwork.

If you noticed the discrepancy and left with out doing anything about it, there is definitely a chance it will come back to bite some one - likely you.

I'm afraid I agree.

[Meriwhen, ASN, BSN, MSN, RN]

With all due respect, this is not very sound advice. Not everyone who diverts (not saying the OP is actually diverting) medication takes it themselves - some sell it or give it to others - so a clean drug test does not clear the situation at all.

It's nice to see someone else saying this besides me :)

OP: Narcotic discrepancies are taken very seriously by facilities as these are controlled substances and must be accounted for.

I don't know if you'll be fired as you gave us precious little detail other than a narcotic is missing. And to be honest, giving us precious little detail is not a bad thing, especially if you are under investigation. What you should do is cooperate with the investigation and honestly answer any questions you are asked. You could offer to do the UDS, but like others have mentioned, don't rely on a negative result to get you entirely off of the hook.

If this was your first--and hopefully only--discrepancy, you may just receive a reprimand and it will end at that...but be sure that they'll be keeping an eye on you to see whether it happens again. And again, what will to happen to you will be up to the employer.

Next time, if you encounter a narcotic discrepancy, get it resolved ASAP--do not leave work until it has been resolved. And remember to be vigilant when dealing with narcotics.

Best of luck.

[bgxyrnf, MSN, RN]

If you are using a Pyxis, check behind the drawers and in the back. I got a miscount once, and that's where they found it, a week later.

Me, too... 1 mg Carpuject of Dilaudid found between the cartridges... we were never sure who had dropped it there, myself or the next nurse. Either way, it was a HUGE sigh of relief.

[caliotter3]

If you are using a Pyxis, check behind the drawers and in the back. I got a miscount once, and that's where they found it, a week later.

This advice also works with regular med carts. No telling what can be found with a complete med cart check.

[Sparki77]

Home work?

My first thought too.

[Sparki77]

For some reason this post reminds me of an unfortunate incident:

A co-rn was pulling a scheduled ativan to be administered via GT. I was in the med room waiting to use the pyxis. After completing what checks she could in the med room, she began popping the meds to crush 'em up. Well that Ativan flew out of the pack and literally circled a drain in the middle of the floor before it fell on in.

IMO we should've just wasted the narc with the reason typed into the "other" field since idk that is why that option exists??? Nope. She called the RN sup that was on that evening. We could actually see the damn thing disolving in a little pool of H2O using a flashlight. The RN Sup paged maintenance who took an eternity to respond so he could undo the drain cover & the Sup retrieved what was left with a spoon only to THROW IT IN THE SINK lol!!!

We had a ton of paperwork to fill out. I'm sorry but if that was my call to make I'd have her witness the bizarre waste, type it in the "other field" and go about my night.

Long story short???? Some weirdo stuff definitely happens from time to time.