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The narc drawer...I'm so upset.

Posted

Specializes in LTC.

Hello all,

At the end of my shift we do a narcotic count...the oncoming nurse counts the actual med/narc packs against the other nurse who reads off the signed off drugs from the DEA book. Well two of the narcs were off at the end of my shift...meaning two were missing from a resident's pack against the DEA book(the percocet med packet had two less when the oncoming nurse counted as I left my shift) and I signed off two percocets given by me at 2am. I will admit I dont always lock my cart but i'm in and out of them rooms so fast that I don't see how anyone could steal them. I'm currently on orientation and have been for a month and three weeks now. I was written up for giving Roxicet to a resident after the preceptor told me she has been giving it and told me to give 5mls after is was d/c'd. She also got written up. Then at first I got blamed for giving Fosimax out when it was supposed to be given once a week because I was on that "hall" that week, BUT I was off the weekend and it was caught the second night when I was on the other hall(we switch halls when there are two nurses) which makes that 4 pills and there were 4 in the packet and those 4 were gone within 4 days...at first I was written up to make a long story short but then they figured out what happened and it was ONE nurse on the weekend I was off and ANOTHER nurse two days after I was on another hall. So that got thrown out thank goodness. Anyways, now I'm worried about this. Either I didn't hear the count correctly at the beginning of the shift, or she called out MORE than there was (by two) in which I wouldn't have known because I'm not checking the packs of pills against the DEA book at the same time as she is verbally calling the number out(I'm sure the system is pretty much this way in most places?). Nobody does. I work the night shift and haven't slept yet, I hope this all makes sense but I'm sitting here crying. I worked so hard for this license, what do you think they are going to do. I went to the supervisor and told her that the count was off this morning and I have no idea what happened but I know I signed of the two I gave the resident. This particular resident gets percocet PRN every 6 hours for pain, and if you look at the mar and dea sheet history, she does usually get two around 6p or 8p every night but didn't tonite/last night in which I'm thinking it wasn't signed off but given but I SHOULD have caught that, and could have heard it wrong or I don't know. You would think she would have called out the right number, I would have seen it wasn't right, and she would of said "oops I need to sign that out" which happens alot. The supervisor told me not to worry about it and go to sleep but I have a feeling I will get written up for this.

Please advice, support, comments, anything.:o I may have to look for a new job but I dont want to BUT at the same time I do not want to lose the license I worked so hard for.:cry:

Edited by CrystalClear75

The best thing to do is take responsibility. Find out what you did wrong (didn't lock the cart, didn't check the book) and admit to it - preferably BEFORE anyone calls you into their office. Don't try to make excuses or accusations against coworkers, but be clear you didn't steal the medication. Crying and carrying on won't help you at all. The other thing is that drug addicts are master thieves, sneaks, and liars. They'll do whatever they have to do to get their drugs, and they don't care what happens to you either, so if you're in charge of narcotics, you need to be just as vigilant as they are sneaky. I don't have any idea what will happen to you, but what I've written here is good policy for all of life.

CrystalClear75, BSN, RN

Specializes in LTC.

Thank you. None of us check the book, we just go by what the other nurse who was on that shift says and I or the oncoming nurse counts the actual meds. For all I know she could be a drug addict telling me there were two more pills when there wasn't...and it's not standard procedure to check the actual meds against the DEA book that she just reads off from ya know? But it should be that way because it would be so easy to lie. So that's what it's boiling down to at this point or that I heard the wrong number and she forgot to sign them off. I really don't think anyone has actually stolen them from my cart because when I'm passing out meds not many people are around and that narc drawer is locked in and of itself anyway. So I don't know.:o

iluvdetroit

Specializes in Hospice, Adult Med/Surg.

(((((hugs to you))))), first of all. I wish I could give you a pat on the back and tell you that it will all be okay. I have been a nurse for a long time, and there have been several times in my career where the narc count was off on the unit I was working on. Every time, someone has come forward, either me or one of the other nurses on my shift, who simply forgot to sign something out, and it all works out fine. Have the other nurses on that hall during that shift who would have access to the same narc drawer all been questioned to make sure that they didn't give any Percocet and forget to sign it out? Your post makes it sound like you were the only RN with access to that drawer, but that is normally not the case, so who else gave Percocet on that shift? Every place I have ever worked, there are a lot of patients on Percocet for post-op pain, so have them double check who all got Percocet on your shift. Also, I don't think this sounds like something you would lose your nursing license over. It happens. If it happened over and over and narcs were constantly disappearing on your shift, that would be one thing, but something like this...it happens. Please try to get some sleep. Things always seem worse when you are completely worn out and dead tired. I'll say a prayer for you. : )

CrystalClear75, BSN, RN

Specializes in LTC.

No not the only one with access to the cart but I guess you could say that I was responsible for that particular shift in which it happened on...like when the oncoming nurse came on the count was off by two. I don't know how it could have been off, you would have thought that I heard or counted right...a few other times I caught the nurse and said "no there is only 10" when she called off 12 for example and she'd say "oops" or something and sign it off. But it didn't happen this time, so I have NO idea. I don't want to get written up.

"None of us check the book" This is an excuse, don't use it. If nobody checks the books, then everyone will know nobody checks the books. If checking the book could have prevented the problem, take responsibility.

"For all I know she could be a drug addict" Don't say this to anyone when discussing this issue. Don't point the finger at other people.

"I really don't think anyone has actually stolen them from my cart" It's possible that it happened that way, and you should have locked the cart, so take responsibility.

I think you'll be OK in the long run. No reasonable person is going to give you problems over one incident. You just have to be extra vigilant from now on.

Be calm, take responsibility for what you did wrong, be proactive in offering corrective action, don't play the blame game, and tell the truth. People will respect you more if you do these things. :)

CrystalClear75, BSN, RN

Specializes in LTC.

I never gave any indication that I was blaming anybody was I? I was just coming up with what COULD have happened, that doesn't mean that I'm going to actually say I think somebody stole from my cart or play the blame game. I'm just trying to figure out what happened and get advice from those of you..especially about whether or not this calls for a write up on my part. And yes I left it unlocked but honestly the preceptor said "Don't worry about locking the cart these kids won't steal off you." So I took her advice but should not have done so. But I never said I was going to blame anybody, just thinking aloud about what could have happened.

About the book, yes no matter what you say, she could have called out more than there was, and it is daily standard procedure of how these meds are counted. It's not an excuse it's the way we do things. Thanks for the advice.

Midwest4me

Specializes in A myriad of specialties.

Hugs to you from me too! It's a very frustrating situation, I know. In our hospital BOTH nurses, during count, look at the book AND at the narcs.

I remember a narc problem years ago at another facility where a friend and I worked. We relieved each other and therefore counted. One weekend we counted and I thought the cards looked odd--she'd punched out a # of them then taped them back in---count was off, had to call the supervisor--what a mess. It was AFTER she took her life a few months later that I learned she'd been diverting narcs, had problems with the Board of Nursing, ended up having her license suspended and, not knowing what else she would ever do career-wise, became so despondent that suicide was the only answer for her. How incredibly sad .... such a brilliant nurse!

military spouse

Has 20 years experience.

Thank you. None of us check the book, we just go by what the other nurse who was on that shift says and I or the oncoming nurse counts the actual meds. For all I know she could be a drug addict telling me there were two more pills when there wasn't...and it's not standard procedure to check the actual meds against the DEA book that she just reads off from ya know? But it should be that way because it would be so easy to lie. So that's what it's boiling down to at this point or that I heard the wrong number and she forgot to sign them off. I really don't think anyone has actually stolen them from my cart because when I'm passing out meds not many people are around and that narc drawer is locked in and of itself anyway. So I don't know.:o

That's the bad thing about count. I've often thought that if we had enough time, the oncoming nursing should stand there with the book AND the meds and the off-going nurse should watch. I like to see the actual written number and the actual number in the blister card. You might ask her if she gave the meds at 2000, like you think may have happened. Try to get some sleep.

HeyHeyitsMaay

Specializes in Hospice. Has 10 years experience.

I'm so sorry that you're going through this. ;/

Please, please please please I don't care if you upset every nurse you work with that has to count with you or not. ALWAYS physically look at the meds when you count. I can't imagine just accepting what someone else says when narc count is done. Check the amt. the MAR or DEA book says should be in the pill pack and then check the pill count before you agree to the number you're being told by the nurse going off shift. There is just waaaay too much room for error when you take someone at their word when it comes to narcs. I'm not saying to be untrusting, but mistakes happen. We work our butts off! And at the end of a shift, we're still humans, very tired ones sometimes. We can't take responsibility for something we don't know is correct, so the narc count needs to be physically looked at with your own eyes.

I'm such a passive person. I just started working a couple of months ago and the first thing I learned is that people will eat you up and spit you out if given the chance, at least at my place of employment. :( But in the end, when you sign your name, you're putting your license on the line. Ultimately yo'ure the only one responsible. Keep that in your head, and it might annoy others, but you have to protect yourself and your patients.

Good luck.

ChocoholicRN

Specializes in Med-Surg. Has 4 years experience.

We keep our narcs in the Pyxis, not a locked cart or cabinet, but we still count the same way you guys do. Usually there is one person counting and checking the expiration date and the other person entering the numbers. Any time a message comes up that the count is off, the second person (the one who was entering the numbers) counts them as well. That way you have 2 people witnessing and counting, thereby decreasing the chance of an error or having someone diverting the narcs elsewhere. While this may not be the policy at your facility, I don't see why there should be any problem if you were to say to the other nurse "hey why don't I count those too, just to double check and make sure our numbers match." We have all made mistakes when it comes to medication, I know I have. The best thing to do is to admit to your mistake right away or as soon as you realize it. I made a huge mistake one time where I was covering another nurse for her break and gave a patients pain medicine IV instead of PO, and we all know that it is not a 1:1 ration with narcs so this patient got much more than she should have. Needless to say, I notified the appropriate people right away, checked on the patient, and got written up. But I still have my license and have learned since then. Just keep your head up and if your ever unsure of a count or a medicine, double check or have another nurse check with you. You will be fine, just a small bump in the road.

You say that you are not checking against the log at the same time. That is one mistake. I insist that the log be placed in such a way so that I can check it too. I have had other nurses get angry because I insist on this (among other things), but I figured out some of the ways nurses pass on discrepancies. Most of them involve slipping something past you because you don't take the time to check it yourself.

i work in two states and it is policy in both that BOTH nurses check the book with each med....i would surmise it is the same where you are, and you have been taught improperly....and know you have learned the hard way why it is done that way.....i, too, have been caught....the 2nd shifter had given a med and gave me the number that would reflect that, but didnt stop and sign it off, and forgot to at the end of count......good luck

Lovely_RN, MSN

Has 11 years experience.

I'm sorry you had to learn your lesson this way but hopefully you won't be penalized to harshly.

I was too trusting when I started out but I learned quickly. Thankfully I have never had to deal with any repercussions but I could have been in big trouble.

I had a near miss with a nurse when I didn't bother to watch her count because me and her were so "cool" I ran to another floor to punch in because I was working a double shift and hours later she called me and claimed a narcotic was missing. Luckily, the supervisor was willing to sign that it was wasted and no harm came of it. I never did this again and later on I find out that another nurse was written up over narcs because of this same nurse. It happened a third time...again the other nurse was blamed and written up. Funny how it always happened with the same nurse but since she is friends with the DNS she was getting away with it until a resident said that she is swapping their percocet 5/325mg with look a like ES tylenol. I never would have suspected her but drug addicts don't look like what you might think they should.

Now I know when I count that it means I must put my hands on the blister pack, turn it over to look for tampering, compare RX # to DEA book. When the other shift is taking over make sure they write down a number and sign as well. At first the other nurses make fun of me for being overly cautious but now they know not to question me

I don't care what they do on their shift but I don't play with my license.

Be leery of people who encourage you to be lax in your practices. What's the big deal about locking the cart when it only takes a second to unlock?

Do not leave the cart unlocked when it is out of sight EVER. One of my nurse co-workers almost lost his license at his second job because a drug addict darted out of a room and stole a lot of methadone off his cart while he was in a resident's room for only a few seconds. Not all residents are bad but the ones that are have nothing to do but watch our routine. They know down to the second how long it takes us to pass a med. Also sometimes they can be working together...maybe one is the lookout while the other one steals? You just don't know so take no chances. The only reason this man has his license today is because the resident was arrested selling the methadone while he was out on pass.

I hope everything works out for you but in the future be more careful.

We have always done the same thing. One has the book and one has the meds. After getting burnt by this, I always read the book while I am checking the narcs too. Yes, some nurses get snarky about it...but it is my license. One of the other things I have been seeing a lot of, is nursing giving there narcotic keys to another nurse after counting. Like, if a nurse goes on break and someone request a pain pill, she will let another nurse go into the barc box and medicate them. Well, you just signed the count was correct, so what if that nurse takes decides to take some meds from another resident in the narc box how are you going to prove that??

CrystalClear75, BSN, RN

Specializes in LTC.

I'm sorry you had to learn your lesson this way but hopefully you won't be penalized to harshly.

I was too trusting when I started out but I learned quickly. Thankfully I have never had to deal with any repercussions but I could have been in big trouble.

I had a near miss with a nurse when I didn't bother to watch her count because me and her were so "cool" I ran to another floor to punch in because I was working a double shift and hours later she called me and claimed a narcotic was missing. Luckily, the supervisor was willing to sign that it was wasted and no harm came of it. I never did this again and later on I find out that another nurse was written up over narcs because of this same nurse. It happened a third time...again the other nurse was blamed and written up. Funny how it always happened with the same nurse but since she is friends with the DNS she was getting away with it until a resident said that she is swapping their percocet 5/325mg with look a like ES tylenol. I never would have suspected her but drug addicts don't look like what you might think they should.

Now I know when I count that it means I must put my hands on the blister pack, turn it over to look for tampering, compare RX # to DEA book. When the other shift is taking over make sure they write down a number and sign as well. At first the other nurses make fun of me for being overly cautious but now they know not to question me

I don't care what they do on their shift but I don't play with my license.

Be leery of people who encourage you to be lax in your practices. What's the big deal about locking the cart when it only takes a second to unlock?

Do not leave the cart unlocked when it is out of sight EVER. One of my nurse co-workers almost lost his license at his second job because a drug addict darted out of a room and stole a lot of methadone off his cart while he was in a resident's room for only a few seconds. Not all residents are bad but the ones that are have nothing to do but watch our routine. They know down to the second how long it takes us to pass a med. Also sometimes they can be working together...maybe one is the lookout while the other one steals? You just don't know so take no chances. The only reason this man has his license today is because the resident was arrested selling the methadone while he was out on pass.

I hope everything works out for you but in the future be more careful.

Funny you mentioned this, I did give my keys to the other nurse on the unit who was supposively my preceptor...and me and her are cool. She is very friendly and invited me over to her house, to go shopping with her, etc. But she would have had to do steal the narcs so quickly that I really don't think it was her but there is a small possibility. I called the 11-7a supervisor just a bit ago and she told me not to worry about it and she thinks she knows what is going on but needs to investigate. She said "don't worry your not going to lose your job over this." I mentioned how I worked so hard for my license and was concerned about losing it bla bla and she said "this happens so don't worry." I asked her if I was I going to get written up for this since I was responsible for the cart that shift?"(thinking ouch it may sound like I'm guilty but I AM worried) and she said again "don't worry about this." So we will see. I'm getting used to the job, already got my insurance cards in the mail and my insurance is in effect and active so I don't know.:o I'll just try to forget about it, I will admit it is still bothering me a bit but what can I do.

I appreciate all the responses. It's such a shame and I only started a Sep 14.

Edited by CrystalClear75

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

First of all...just because you go to a different facility doesn't mean your license if safe. Not to sound harsh, but if your practice is poor (and leaving the narc. drawer unlocked is very poor practice) your practice follows you where ever you go. There are scads of ways to steal drugs. I insist that both nurses look at the book AND the card of drugs. Someone said their supervisor signed a med was wasted when count was off??? Stupid practice. I tell my nurses NEVER to sign for something they haven't seen and if their coworker shows them something crushed in applesauce and asks them to co sign it as wasted, they are to write 'altered in applesauce' on the page in the narc book. Never give your keys to anyone without counting off. Never take someone's word that count is correct without looking at it. When counting duragesic patches, take each patch out of the box and look at it. At one facility, someone slit the pouches on the bottom. No one found out for days because there were 3 pouches in the box and it was assumed there were 3 patches. Always have 2 nurses sign in narcs from the pharmacy. 2 nurses should sign a page change as well. And, please, don't just sign. Look at the number of pills your coworker says they moved to the new page to make sure the number matches the actual number of pills on the card. And never give ANY med without making sure there is an order for it.

Edited by CapeCodMermaid
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tiroka03, LPN

Specializes in LPN. Has 18 years experience.

Another tip: Always, sign your nar book when giving a naroctic, double check the actual pack against the count in the book both before and after you take the med out of the pack, and before you give it. Once, I almost gave an incorrect med, but the count was not correct, so I checked again It saved me from making an error. I say this because sometimes my eyes see what they want to see. I can drive past a sign, and my brain will finish a word I see without me even realizing it. So when you are in a hurry to give a narc, and you reach for the pack of narc's your eyes can incorrectly finish the word, or your hand can misgrab and get the wrong med.

I haven't been personally checking every nurse and reading the book, I usually check for people I don't know or have don't have a good relation with But, it is a good idea to do it the right way all the time. My first job I had as a nurse was with a person who did eventually get caught for stealing naroctics. This nurse could have cared less if I would have been fired. Thankfully, I was very diligent and spoke often to my supervisor when things seems to be suspious. At the time I thought I was being paranoid, but now in hindsight I am glad that I was careful. It kept me employed, and my liscense intact.