What do you do when the narcotic count is off?

[flashpoint]

Last night I went into work and things were going pretty well until we did the narcotic count. According to the narcotic book, one of our residents was supposed to have 28 dilaudid...there were only 26. The pharmacy had just delivered the dilaudid about an hour before shift change...the day shift nurse said that she was too busy to count with the pharmacist, so she just signed the book along with him. She crossed through the 28 that the pharmacist had written and wrote, "Count correction - pharmacist delivered 26 dilaudid, not 28." She then sighed her name and told me I needed to sign after her to resolve the discrepancy. I told her that I would be happy to sign that there were only 26 tablets, but that I had no idea where the two missing tablets were, so I was not going to sign her correction. She then informed me that she is and RN and that I have no choice but to do what she says. I explained that I honestly had no doubt that the pharmacist only delivered 26 tablets (it is a mistake he has been know to make), but since she had signed off that he delivered 28 and since I had no idea where the missing pills were, I was not going to sign. She was obviously angry...her tone seemed threatening. She told me that she was going to call the DON if I did not sign...I told her to go ahead and call because I was not backing down. I tried to call the pharmacist three times and got no answer at the pharmacy, his home, or his cell phone. I also tried calling my DON to see what she wanted us to do, but she didn't answer. I was very comfortable signing that there were only 26 tablets, but I was not comfortable with her explanation. So...she documented in the narcotic book, "Cotjockey refused to sign this count correction, despite direction from RN." The pharmacist did call this morning to say that he found two dilaudid just sitting on his counter...that is where the missing pills were.

Was I wrong not to sign? I really don't want to get in trouble with my DON, but I really, really don't want to get in trouble with the state board...also if there is disciplinary action against one license (LPN), they usually bring equal action against another (paramedic). I worked too hard for both to lose either one or be on probation or anything else. Also, the EMS board is really strict...you can usually get a nursing license back...the EMS board is not so forgiving.

[meownsmile, BSN, RN]

You absolutely were not wrong in not signing that narc count. The pharmacist should have left a sheet or documentation of what and how many he brought, he should have stayed until she counted and verified what he left and signed his sheet off for him. He should have recounted them with her when she found only 26. The RN shouldnt have expected you to sign for a discrepancy that occured when you werent even there unless she could produce proof of how the discrepancy happened. Just because she is an RN doesnt mean she can force you to do something that is against policy or ethics. Actually that kind of comment in a narcotic book shows lack professionalism on her part.

[catlady, BSN, RN]

Nothing short of a code should have stopped that RN from actually counting the narcotics she received. I used to make the pharmacy drivers wait until I counted all the drugs they delivered, not just the narcotics, because it was my signature going on the paperwork and my license if meds turned up missing.

How dare she pull an attitude with you when she was the one who violated all the standards, or that her RN license somehow gives her the right to order you to do the same. Good for you for sticking to your guns, and I hope your DON appreciates you hanging onto your principles.

[babynurselsa, RN]

Uhhh, you were absolutely correct. "Because I said so" doesn't work with narc counts.

As you stated, I would be more than happy to sign off that there were 26. I will not sign her explanation why the count is off by 2.

Call whoever you want.

[luvmy2angels]

You were well within your rights to refuse to sign the narc sheet. I would have done the same thing. and if your DON is any kind of professional she would agree with you and you should NOT get into any kind of trouble. I just love when the Rns say that..."i'm the RN so you have to do what I say!". I don't care who you are, if I am asked to do something that I know is wrong, there is no way i will do it, and there is no reason that I should get in trouble. RNs are not the law makers in nursing. That is why we have the nurse practice act and the state BON!! Good luck to you!! You did nothing wrong!!

[Jolie, BSN]

As the others have clearly stated, you did the right thing.

If anyone ever tries to place doubt in your mind again, just imagine the following situation: You are being questioned by the BON or a plaintiff's attorney. You are asked, "So cotjockey, did you count 26 or 28 pills? Oh, 26. So where did the other 2 go? You say that the pharmacist made a mistake and only delivered 26. How do you know that? Were you present when the pharmacist delivered the pills? NO? Where were you at that time? You were at home brushing your teeth, getting ready to come into work? What else have you charted and/or signed that you did not personally do or witness?"

They would have a field day with you, and your license would be as good as gone.

[txspadequeenRN, BSN, RN]

I would have done the exact same thing!!!!

[Thanet]

I am in the UK... and I totally agree with above posters. well done for sticking to the procedure.

The whole idea to having two people to sign is to double check!

And as for the RN saying you had no choice!!! Good grief!

[TazziRN, RN]

You did right, Mac. She may be the RN but that does not give her the right to order you to jeopardize YOUR license.

[gonzo1, ASN, RN]

Good job sticking to your guns and doing the right thing. Nothing can get you in trouble like missing meds, esp. narcs.

[jodyangel, RN]

I've often found nurses willing to just sign off on things that werent actually checked.

Where I worked they fired a nurse last week after she pulled something out of her purse and loads of Stolen Narcs fell out.

After you see something like that you will NEVER accept someones word for counting narcs.

Cover your butt. Always follow procedure ESP concerning the meds.

[TazziRN, RN]

Something that occured to me: the RN wasn't angry because you refused to follow her "order".....she was scared because she knew she was in doo-doo about how she signed off on the delivery.