Sharing a med cart with narcs

tokmom, BSN, RN · Mar 16, 2010

Back in my day, we shared a med cart with all the nurses on the floor. We counted at the beginning and end of the shift. If the count was off, we were all held responsible. Not sure what they are asking. Is illegal.

mamamerlee, LPN · Mar 16, 2010

Back in the Jurassic era, there was one set of keys for the narc cabinet, and any nurse who needed to get a narc had to get the keys from the charge nurse, get the med, sign it out, and return the keys. There was only one count per shift, despite 4-6-8 nurses having access to the narcs. The exception to this was when a nurse unexpectedly had to leave the unit for the shift - she was sick, had an emergency, etc. Then we would try to do another count if she had been in the narc cabinet at all.

And although there are certain standards that apply, it is 'legal' for more than one person to access the narcs when needed. If you were off the unit, on break or lunch, someone else might have to give one of your patients a prn med that is locked up. We would not do another count at that time, just the end of shift.

Kooky Korky, BSN, RN · Mar 16, 2010

As for legality, that's a question for a lawyer.

As for wise or not so wise, I agree that the situation creates more opportunity for counts to be wrong. And as usual, it's the nurse whose head is in the noose.

That said, a lot of us have shared a narc container, be it on a med cart or in a narcotic cabinet inside a med room in the olden days, as others here have said. That doesn't mean it was or is a good situation.

If a count comes up wrong, they really can't blame any one person if 2 or more people had access to the narcotics. They will question all staff to try to discover where the discrepancy lies, but how can any one nurse actually be blamed? That said, some staff are going to be believed over others - due to friendships, personalities, whatever. Woe be unto the nurse who seems to be at fault more often than others. And, of course, agency and float nurses are often particularly suspect.

Do keep a list during your shift of what narcs you give, to whom and when. Be sure to sign for your narcs right away, be sure to have wastes witnessed and co-signed. Do not agree to sign for wastage for another nurse if you don't actually see it happen.

There might be a camera installed that views all activity near the narc room. That would be a little harder to do, but not impossible by any means, with several mobile med carts.

I have never had any problems with counts, even sharing the narcotic cabinet key, over lots of years of Nursing. Hopefully, you won't either.

caliotter3 · Mar 16, 2010

Korky gives good advice about keeping a list. I once saw World War III occurring at a cart one time with, I think I remember, five nurses all fighting over what was wrong with the cart. I would not want to do this if I could help it. Just adds to the possibilities of being held responsible for others' mistakes. My own mistakes are enough I think.

metfan · Mar 16, 2010

I work as an LPN in LTC and they tried to make me share a narc box with another nurse. I was very upset especially because I was suspicious of this other nurse. I am a relatively new nurse and we learned in school to never share your key much less the box. We each had a key. I told my supervisor I was not comfortable and nothing was done. I asked my DON and nothing was done. I have nursing insurance and called them for legal advice. They had me call a local lawyer that specializes in nursing issues. I finally contacted the administrator who went into action and fixed the problem. It was so stupid because the "issue" was one box fell and was no longer bolted to the wall. Apparently, maintainence could not fix it because they needed two workers on to fix it. One to hold the box and the other to bolt it. I offered to hold it but was told nurses could not do that. So stupid. I really don't remember if I was told if it was legal or not but I felt like my license was on the line. I was so frustrated because no one was listening to me. Other, older nurses thought I was just a trouble maker. It is a big deal. Do not mess with narcs. Metfan

morte, LPN, LVN · Mar 16, 2010

simple, you need another cart...

kcochrane · Mar 16, 2010

Only one person should be responsible for the narcs at one time. I'm sure the state or BON would have a field day with this arrangement. I agree that a separate cart needs to be made. In the meantime, you need to count when that cart switches hands. I know it is a hassle, but it will be a big hassle if narcs dissapear.

In my LTC facility we had one narc cabinet. One person held the keys. We pulled our narcs for each med pass and each nurse had a key to their own cart. If a PRN was needed, yes you had to hunt down the other nurse. But you do get pretty good about knowing who is going to ask and pull them ahead of time. On some units each nurse had their own narc cabinet for their residents - which is the best scenario.

nikkimodl · Mar 16, 2010

As inconvenient as it may be, a count every time or a list would be your best bet...and that is the only way you can cover your butt. Anytime your license is in jeopardy, that takes priority over anything else