very nervous: Narc missing!!

Ginger's Mom, MSN, RN · Feb 8, 2009

Relax chances are the Pharmacy may have made the error. A whole sheet missing, was it ever signed in the book. If not no nurse could have had their hands on it. You did not count them in stock at the beginning of your shift. You know you did nothing wrong and you did the right thing.

Inquisitive one · Feb 8, 2009

When narcotics are received they need to be signed for by the nurse who received them. The signature is written on a carbon copylike invoice, one copy is left with the facility and one goes back to the pharmacy. If the med was delivered the pharmacy will be able to track who signed for it and that nurse will be held accountable because it would have been that nurse's responsibility to log it in the narcotic book. Where I work 2 nurses need to sign the narcotic book when it's entered. This may be an honest mistake. I would let those in charge deal with it for now.

suanna · Feb 8, 2009

Did you take them? If not, what are you stressing about. There are going to be lots of times when the narc count is going to be off- you will have to have the local PD on speed dial if you call them for every time this happens. Is it serious- you bet! Report it to the proper chain of command and let them investigate it. You may end up peeing in a cup- but as long as all they find is pee you'll be fine. Someone may be diverting, or it may be an honest error in count, or dropped meds, or even a poltergeist- it's not up to you to investigate- just honestly report.

achot chavi · Feb 8, 2009

Calm down, the advise of the previous posters is sound, but I would DOCUMENT all that you did and reported, keep a copy and give to your Supervisor, DON and ADON. I would also ask all the nurses who had access to the narc box if they know anything about it. I wouldn't go behind my supervisor or DON's back and call the pharmacy. You did nothing wrong, you reported a problem.

Please let us know what happens.

morte, LPN, LVN · Feb 8, 2009

whoa, guys. this doesnt appear to be a simple count error.....the op specifically said that the card was GONE, along with the signout sheet......had this happen once, and yes it was diversion.....who ever ordered the med needs to be questioned and the last person who signed it off as given needs to be questioned....which is of course not the OP's job to do.....but this IS a big deal.....

StNeotser, ASN, RN · Feb 8, 2009

Same scenario happened to me about six months ago.

I was the one who discovered that a whole card of oxycontin was missing after I had called pharmacy to chew them out because they didn't deliver it. They told me it had been delivered and signed for by the charge nurse. I found the invoice.

I must say I wasn't worried as I knew I hadn't taken it. Management narrowed it down to someone who worked during the evening shift, and eventually they found the culprit. They did it once too often and got caught.

If you didn't take them, you have no need to worry, honestly.

Vito Andolini · Feb 8, 2009

I think you're a little too upset. There's no way anyone can prove you took this if you didn't take it, IMO.

Somebody has made off with the whole card and the sign-out sheet. Were there any indicated as being present when you counted at the start of your shift? If so, you're in trouble. If not, you're not.

BabyLady, BSN, RN · Feb 8, 2009

i've heard this happened before to somebody else but i never thought this is going to happen to me and bang i t happened to me today. just for a info this is a ltc setting and we get our narcotics in a blaster packs and keep it in a double locked door. during my shift a staff from pharmacy called and asked me that they received a reorder form for ms contin and said they sent this medicine few days ago and we still should have this medicine. so i checked the double locked narcotic box but couldnt find the whole blister pack of this medicine. since this med was given for few days, i looked in the narcotic sign out book to see who was the last person who gave this medicine and there was no narcotic sign out sheet of this medicine also. since a doctor increased the dosage of this medicine i thought a nurse returned this medicine to don to be wasted so i called supervisor and notified of this and asked her if somebody returned this medicine to the unit manager to be wasted by her and don. supervisor went to a room where they keep all the narcotics that needs to be wasted and didnt find this medicine and the sign out sheet. since this is the first time that i've experienced this i panicked. i told my supervisor that i wanted to call the police, because immediately i felt my job and license was on the line. i mean think about it. if you are the one who find out the whole blister pack of narcotic is missing, what would other people think? they are going to think that since i have the key to narcotic box, i took the narcotic and the paper or i took those pills while i was working there during my shift. if narcotic is missing isnt police suppose to be called to investigate?
so the supervisor called don and adon and they told her that they are going to do a full investigation on monday. i asked supervisor if i should fill out an incident report and she told me no i dont have to. and she told me to call the doctor and change to the previous dosage. i asked her if i should call the pharmacy and ask them if somebody accidently returned it to pharmacy and she also said no. with that i became suspicious. i felt like they are trying to cover up their ass. but why? and who are they going to blame if they cant find the medicine? one option would be me. they are going to say i who woked the shift when the narcotic became missing or found out narcotic is missing took the blister pack and the paper. and with that theres possiblity i will lose my license. what would you have done in this situation? i am so so so streseed out right now and i'm so scared. :sstrs::yldhdbng::yldhdbng::hdvwl:

please correct me if i am reading this wrong...but i don't see how you think that you are responsible unless you were the only person to have the narc keys, 24/7 or access to the drawer since the last time it was opened.

just because you found the narcs missing...you discovered they were missing because pharmacy asked you to check on it...if that makes you guilty, then so would every manager and every nurse that was ever asked to check for a descrepancy.

you said that pharmacy claimed they sent the narcs down "a few days ago"...well, with no sign out sheet..is there a record that someone on the floor even received the narcs from pharm and can prove that they even got there? seems like that is the issue...what type of system does your facility use?

any record of the new pack ever being given to the patient since the day that pharmacy claimed it sent it down?

there is no way, no way in a millions years, they can even remotely pin that on you.

you stated that there was no narcotic sign out sheet for that medicine....thus the reason why the med can't be accounted for.

ps: try to stay calm...missing narcs is important, but if you automatically make references to "your job being on the line" then it may make them wonder why you are nervous.

oramar · Feb 8, 2009

First let me say I feel really bad that you are going through this. Other people have told me that they went through this and it is quite stressful. Anyone who minimizes the emotional impact probably has not been through it. Sometimes the diverter can leave a twisted trail and it takes time to find out who and how and when. In every case I have known of no honest person was ever blamed though I suppose it could happen.

LPN01112005 · Feb 8, 2009

Try to calm down. If you didn't take the meds, then you'll breeze through the investigation. Like a previous poster said, just because the pharmacy notified you, doesn't mean you are the suspect. They just have to notify and you happened to be the person on duty when notification was made.

My suspicion is that someone diverted the drugs and the card. Believe it or not, at both LTC's that I've worked at, this type of diversion has happened...more than once. Most often, it was a night shift nurse who had diverted the blister pack of pills and the sign out sheet that they thought no one would miss. LTC night shift is the perfect arena for impaired nurses to divert. Right now, I'm working with one that I (along with several other nurses) suspect is diverting. Can't prove it, but the tell-tale signs are there and it will be a matter of time before she slips up and gets caught. DON and Adm. have been made aware, but they choose to ignore "suspicions". Ok, well whatever, but you mark my word....it's happening and she'll get caught. I just hope no harm comes to her residents in the meantime.

CapeCodMermaid, RN · Feb 8, 2009

This happened at my last facility. I (the DNS) was immediately notified and I immediately started an investigation. I didn't call the police, but I did notify the DEA. In your situation, if I were the DNS, I would start by looking through every blister pack in the med cart, narcotic and non narcotics to see if the card wasn't misplaced honestly. Then I would call the pharmacy and get a copy of the invoice so I could tell who signed for the narc. IF the nurse who signed the narc in didn't make a page for it in the narc book,.....well you get my point. These things have to be thoroughly investigated. I reviewed narcotic documentation with my nurses almost once a month and had them sign inservice sheets. That way when the DEA came in, the surveyor knew that the nurses had been told the right way to do things so she couldn't blame the facility or me for their stupidity or sloppy practice.