Why is narcotic missing on my cart again

Emergent, RN · Mar 2, 2020

It sounds like a funky place to me. Someone has their hand in the cookie jar. You are an easy target, being part time and willing to go along with their nonsense.

caliotter3 · Mar 3, 2020

Whether lost or stolen, accidentally or deliberately, of course you are the goat. Do you think the other nurses liked it when I demanded to have the book turned in my direction so I could observe what was actually written when the other nurse called out? Of course not. They did not like that I was smart enough to figure out why they always made sure the book faced away from the "scapegoat" nurse. You now know how this place is. You are lucky this time that the supervisor covered your back, probably only because she did not want to deal with the alternative. Reread what you wrote in your third paragraph and what I just wrote if you want to see where the problem lies. Now, how long are you going to remain on the payroll there? That is the better question for you. One or two shifts a month is not worth what is going to happen next time. Get out of there. And change your unsafe practice regarding narcotics count. That is on YOU.

StarShine975 · Mar 4, 2020

Always always always look at the index with the person, and actual number with the outgoing nurse, also we (In my facility at least) are supposed to go in order of index too. So what if you have to keep flipping pages when it's a habit it goes quick. Something could always be "missed" because they know you're not paying 100% attention.

Also I would NEVER let anyone in MY cart without counting narcs first and If I was coming back (Like when I had an emergency at home I was gone for an hour) I counted in and counted back even though the person (Supervisor) said oh you'll be right back... I am that "annoying" person that does count 100% right every single time at this point people in my facility know how to do it, they get lazy and I don't even say anything I just stand there till they do it right, and I do not care, this count is my license.

We worked to hard to be where we are for someone else to mess it up.

amoLucia · Mar 4, 2020

First question (and most important) where are the keys being kept??? Am tagging along on to PP Star's issue re WHO has the keys at ANY time.

I'm starting to squirm when I think of all the WRONG possibilities that could be resp for an error (esp in a LTC as I've been there, done that, seen a lot, know a lot).

Assuming you're still doing the old fashioned med cart system with individual cards of pt meds with signoff sheets in a ring binder system??? And am guessing that you did a thorough physical search in the cart/area etc.

I'm sorry if it seems like I'm asking stupid questions. I know how you feel as I had the most terrible angst until I found the error.

Always be SUPER DUPER vigilant re narc counts. I always looked at, counted and announced the # present of the cards/bottles/patches MYSELF when I came on. Be careful if too often, the other person would just "YES, YES, YES" anything (like they weren't paying attn). So I would slow down the count.

Freq I would just ask to check the sign-out page (just to keep everyone honest). Kind of like above PP, caliotter, wrote about checking or reviewing the book. I also stopped count if the other nurse was stopping too often to write in the last med that she 'just forget to sign' or 'couldn't do it right at the time'. Too many ways for an error to occur.

In all my 35+ yrs of working, there was only 1 time my count (at shift end) came up short. My shift start count was fine (so I thought) - just came up short. I truly, TRULY believe that it was a failure of the other nurse to sign the pill out and had "YES, YES" as we counted along. Of course, she felt her end-of-shift count was correct at the time we counted. Like she 'signed for everything she gave'. Whether true or not, who can remember a shift or 2 later?

Be wary also if you are feeling uneasy with any 1 particular nurse.

Don't feel awkward about being so cautious. My safest approach was NOT to allow the count to become just some DUMB task that just takes up time. This was esp important on 11-7 shift when a nurse might be the only nurse for the wing which has 3 med carts to count. Then that IS time consuming for all the nurses on 3-11 who want to just count & report off ASAP.

You are very wise to be concerned re an 'off count'. Has this been the only time you've found a discrepancy? It really could have been a mis-count error. Shouldn't have happened though.

With all the info you've provided, it sounds like a 'Systems Error' that should be addressed in an error/incident report. CART SHARING is a precipitating factor for a major error just waiting to happen. I would hope that you could have had the opp'ty to comment about CART SHARING in your documentation on an error/incident report. And any Pharmacy Consultant for your facility could validate that problem.

NOTE*** I find it VERY, VEEEERRRRY INTERESTING and INTRIGUING that that one other nurse was asking you about how you counted. Maybe she has felt/sensed some irregularities when counting, too. Also there may be a pre-existing in-house problem with 'error counts'. Maybe she knows SOMETHING you don't know? And that she was subtly cueing you into something?

You may or may not be a scapegoat. But be careful. If you truly feel somethings are just NOT right, no job is worth being targeted for narc issues (think BON, licensing, job and CAREER loss, criminal investigation with charges, etc). There may be reasons why narc counts (correct or incorrect) are lackadaisical at your place. And not a safe or secure place to stay.

Floor_Nurse · Mar 5, 2020

This where the term "C-Y-A" (cover your tail) comes in. Don't expect other nurses to actually be your friends. Document, document, document! You may have to report the wrongdoing of others. Remember, you need to protect your license.

JKL33 · Mar 5, 2020

On 3/1/2020 at 3:23 PM, Buckie said:
1 nurse of the 2 that I shared cart with was asking if I was checking the narc count sheet paper and the actual sheet when I was counting with previous nurse. This is LTC bytheway. I said no, normally I go with the number that is called out during counting. She kept on telling me I should always double check. Which is true but in reality not many nurse does that.

Well, that is at their own peril. No way should you do what they do!

I would not work in an area where access was shared and it was my word against someone else's with regard to narcotic counts.

On 3/1/2020 at 3:23 PM, Buckie said:
In the end supervisor signed off for it that she gave which she clearly did not to make count sheet even.

Just get out of there. That's ridiculous. To whom did she say she gave it? There would be some serious hot water involved in doing absolutely dumb things like that if people find out--it constitutes falsification of a medical record, fraud, etc.

amoLucia · Mar 5, 2020

1 minute ago, JKL33 said:
.... To whom did she say she gave it? There would be some serious hot water involved in doing absolutely dumb things like that if people find out--it constitutes falsification of a medical record, fraud, etc.

She could have just recorded it as a 'waste as fell on floor'.

We all know how these things are freq handled. ?