Questions about Missing Narcs

[medsurgrnco]

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.

[Crystal2dish]

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.

[kenny b]

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.

I've often wondered if anyone ever takes advantage of the presence of an agency nurse. After all, the fact that they are the newest member of the team makes them suspect in a lot of minds right off the bat. Has anyone ever seen this?

Also, could someone please fill me in on how these machines work, because it seems as though all they do is allow people to record what they supposedly took from a drawer. How does a machine verify this?

Thanks in advance!

Regards,

Kenny B.

[medsurgrnco, BSN, RN]

Thanks for all the replies. When the count is off, we go through the MARS to try to figure out what wasn't entered. Apparently they couldn't figure it out this shift. Seems as tho my facility could have been more on top of this situation, guess they are waiting for a pattern to emerge.

[jmb410s]

I've often wondered if anyone ever takes advantage of the presence of an agency nurse. After all, the fact that they are the newest member of the team makes them suspect in a lot of minds right off the bat. Has anyone ever seen this?

Also, could someone please fill me in on how these machines work, because it seems as though all they do is allow people to record what they supposedly took from a drawer. How does a machine verify this?

Thanks in advance!

Regards,

Kenny B.

It knows how many are in the drawer. If the count is off then it knows the name of the nurse before you that accessed that medication. So only two people are involved instead of everyone.

[FireStarterRN, BSN, RN]

I do think there is a small percentage of agency and/or travel nurses that are fringe characters who are trying to stay under tha radar. That's my intuitive guess.

For instance, if you work all the time at a facility, people will notice that your patients always get top allowable dose for their narcotic doses, or always need morphine when they haven't had it for days under the care of other nurse. Or maybe your patients get their morphine according to the MAR, but always complain to the next shift that it didn't do the trick.

I think probably the pyxis and accudose machines most likely have some sort of automatic tracking system to alert pharmacy staff of suspicious activity.

So, if you are an agency nurse, you could more easily escape detection. Since I've read that nurses with drug problems often are highly functional in their jobs, then agency nursing would be an ideal avenue for them to pursue.

[SuesquatchRN, BSN, RN]

For instance, if you work all the time at a facility, people will notice that your patients always get top allowable dose for their narcotic doses, or always need morphine when they haven't had it for days under the care of other nurse. Or maybe your patients get their morphine according to the MAR, but always complain to the next shift that it didn't do the trick.

There's only one thing wrong with that pattern, though.

On my first job I was the one who always administered prescribed pain meds, and at their maximum doses, and was told that I was perceived as "pushing pain meds." Well, I had co-workers who "didn't like" that stuff and wouldn't give it, even to patients in obvious pain.

[FireStarterRN, BSN, RN]

There's only one thing wrong with that pattern, though.

On my first job I was the one who always administered prescribed pain meds, and at their maximum doses, and was told that I was perceived as "pushing pain meds." Well, I had co-workers who "didn't like" that stuff and wouldn't give it, even to patients in obvious pain.

Yes, that's another possible scenario if you work with uncompassionate, heartless you know whats...

[flashpoint]

Where I work, only one person per shift has access to the narcotics. If the other nurse needs a narcotic, they have to ask that nurse to get it for her. When I am counting, I like to look at the narcotic book as well as looking at the bubble pack...one of the night nurses has a bad habit of just saying that whatever number we say is in the bubble pack is the number on the sign out sheet and I have been caught more than one where I find out that the count is actually correct, she just forgot to sigm something out and said that whatever number the nurse who has a the bubble packs is correct. I also try to sign my narcotics out before I give them...a lot of nurses wait until the end of the shift...very bad idea if you ask me.

If we do end up with something missing, we finish the count to make sure that everything else matches up and go through the MARs to make sure the nurse didn't just forget to sign something out. If we can't locate it, we call the DON and pharmacist and the corporate office and they decided whether or not they need to do UAs or blood tests or whatever.

[SuesquatchRN, BSN, RN]

I also try to sign my narcotics out before I give them...a lot of nurses wait until the end of the shift...very bad idea if you ask me.

PITA in LTC that it is, I signed them as I gave them.

[flashpoint]

Something else I do is...about an hour before my shift ends, I try to go through the narcotics and the book and make sure I have signed everything out. It's a pain to have to try to figure out what I did with something when I have five CNAs impatiently waiting to go home while I try to remember what time I gave Myrtle her T3.

[kenny b]

It knows how many are in the drawer. If the count is off then it knows the name of the nurse before you that accessed that medication. So only two people are involved instead of everyone.

It knows! That's kind of creepy!

It's interesting that they don't operate by dispensing the item requested rather than opening the whole drawer. It seems to me that this would narrow it down to one person rather than two.

Rgds,

Kenny B.

[medsurgrnco, BSN, RN]

It's interesting that they don't operate by dispensing the item requested rather than opening the whole drawer. It seems to me that this would narrow it down to one person rather than two.

Some of the machines do dispense only the number of pills requested.