Questions about Missing Narcs

no one could leave at the end of the shift, until all were signed off properly (so that meant everybody had to check back to find out who didn't sign for the narcotic)

Thanks for the information. In our recent situation, the missing narc could not be accounted for as no patient currently had that narc ordered by the doc.

I haven't worked in a number of years but I worked as a staff nurse, a staff relief nurse and Nurse Manager. Counts had to be correct before anyone, anyone could leave the floor. I have never had the experience of a medication being missing that not a single patient had ordered. If that had happen, the shift supervisor would have been called and I would have followed her direction. I would assume she would call the individual responsible for nursing services for her/his direction. At the very least, I would suspect that blood/urine test would have been demanded before anyone was allowed to leave. And perhaps the police would have been notified.

Woody:twocents:

The one time a narc was missing at the last hospital I worked at, everbody had to stay over and was questioned. The MAR's were gone over and the med was never found.

Everyone then had to submit for a urine test. A nurse happened to test positive for benzo's and did not have a prescription. She was let go.

Jeremy

That sounds like a good way to deal with it. A UA was not done on those nurses, which I thought should have been done. If a UA didn't come up positive in the situation you discussed, do you think they then would have done a search as maybe a nurse planned to take the narc later? Anyway, now I'm a bit nervous about working with those nurses in the future as with our system it is not easy to find out who diverts meds.

We used to use the system you describe. If count was off at end of shift the first step was to panic, then we searched the MARs franticly for the source of the missing med. Finaly we notified the pharmacy and the nursing supervisor of the discrepancy. An incident report was filled out. As a rule,we did not have to stay over or participate in any investigation/testing in that it would have resulted in the hospital having to pay overtime-that was out of the question.

You just hope it didn't happen when you worked more than once in a VERY GREAT while. WE love our PIXIS.

Wondering how other facilities deal with narcs missing at the end of the shift. We do not have a pyxxis machine, use blister packs kept in a locked area, several nurses get meds out during the shift, and have 2 nurses do narc count at the end of the shift.

Also wondering if travel nurses have been involved at a higher rate in taking narcs at facilities. I have nothing against travel or agency nurses, but in our situation we had recently hired a travel nurse and the other nurses that worked that shift had been employed with the company for quite some time.

Nurses in recovery are generally not permitted to take on jobs as travelers while they are being monitored by a state program. Travel nursing is dangerous for both the nurse and the patient.

no one could leave at the end of the shift, until all were signed off properly (so that meant everybody had to check back to find out who didn't sign for the narcotic)

RIGHT ON GINGESUE

I've had a problem with how our facility handles this. I also have a very hard time convincing some of the nurses to stay and do the count with me. This was NOT solved when I went to our DON and asked HER to count with me. Yes, she yelled, yes, she fussed, but in the end we have some nurses who tape their report, do not count with anyone else, and just leave.

We had a situation this week where 1/2 way through my shift DON asked for the keys to my cart and told me an entire card was missing from my cart. I had done the count myself (she asked me if I counted, I said, yes alone) and she went over the count with me. Initially it looked like there was an entire card of oxycodone missing. Then we went back to the start date, the amount of pills used each day, and low and behold the number that one of the nurses had written down was wrong--and everyone just subtracted two from that point. So it looked like 30 pills were missing.

And yes, I counted wrong--all my DON has said was "well at least your trying to count them".

The nurse I relieved was very irritated with me last night when I wouldn't take the keys to her cart until she counted the narcs with me.

We also have a problem with nurses who do not go through the proper disposal procedure and/or removal procedure when pts. are discharged or die. When I looked through our book this last week, every single item removed for disposal was initiated by me. I've been complimented on this, "your coworkers will love you for this". I guess I don't understand why anyone else wants to keep this stuff around when it's not needed.

Wondering how other facilities deal with narcs missing at the end of the shift. We do not have a pyxxis machine, use blister packs kept in a locked area, several nurses get meds out during the shift, and have 2 nurses do narc count at the end of the shift.

Also wondering if travel nurses have been involved at a higher rate in taking narcs at facilities. I have nothing against travel or agency nurses, but in our situation we had recently hired a travel nurse and the other nurses that worked that shift had been employed with the company for quite some time.

Always, always, always count. Sunny stick your ground you are right. Any nurse who does not want to count should raise your suspicions. Do not ever accept an assignment where the nurse will not count with you. I cannot believe your DON is ok with this. Be very careful. Nothing feels worse in your gut than a wrong count after your shift. Good for you Sunny, change their bad habits.

Wondering how other facilities deal with narcs missing at the end of the shift.

quote]

Is it possible that the missing narcs could have been given in error - instead of the correct medication? This happened on one unit where

I had worked - because one of the senior nurses had made an error

in that she gave demerol tablets instead of another prescribed

medication (so she made a point to tell all of us that she had made

this error).

My two cents; I have worked in LTC and in clinics as LPN for years. Many, many years....

My experiences with the missing narcotics were always in the LTC facilities. The agency nurses were never responsible for the missing narcs; it was always an employee of the facility. One offender removed liquid MS from 10 ml bottles and replaced the quantity with tap water - as he shot up in the bathrooms. It takes a long time to nail narcotic thieves in the LTC system, so in this case pts were dying and nurses were unknowingly administering tap water for pain.

Another instance of narcotic theft was in a very large LTC (several stories in a large metro area) and the shift supervisor (of the entire building) possessed the keys to all the narc drawers for all the med carts. She regularly took one to two tabs from the blister cards as she had opportunity, and would occasionally take the whole card (30 to 60 tabs per card). Yes, two nurses counted at the end of each shift and the nurse ending their shift immediately became suspect. The sheer volume of med carts in the building, however, created many suspects.

Eventually the thieves were "caught". The MS nurse was brought to the office of the DON and confronted by the eyewitness that saw him taking the bottle of MS into the bathroom and found his used syringe in the wastebasket. The supervisor who was helping herself to narcotics was observed under suspicious circumstances by myself and only by by writing up a detailed report of what I had witnessed and giving to the DON, was this supervisor finally confronted and questioned.

Under no circumstances were police involved. Both employees were terminated on the spot and escorted out of the building by in house security. No reports were ever filed with the Board of Nursing. And so these nurses were free to continue working as addicted nurses elsewhere.

And I must add that the agency nurses I have worked with have always been some of the best nurses I have ever worked with. And that's my two cents.