I recently started working in a LTC facility that in my opinion has a very unusual way of doing change of shift narcotic count.

First of all the actual sign out sheets are attached to each card with a rubber band in the drawer.

The names of the patients with narcotics are on another sheet with the drug (ex: John Doe, Percocet card A)

When the oncoming nurse comes in she is supposed to compare the cards in the drawer with this sheet.  All that is done when a card is finished is that it is 'Yellowed out" on the sheet.  I have worked for over 20 years in nursing and have never seen narcotic counts done so sloppily.  I told the DON of my concerns and that I felt as though I were just taking the word of the nurse ahead of me that everything was there.  How am I to know whether the ones yellowed out were actually finished or destroyed due to the large amount of Narcotics used at this facility.  Her response was, "well, the only people allowed in the narcotic drawers are nurses and as professionals none of them would take any."  Excuse me? Anyone could "yellow out" a card of meds and take the whole card, and the sign out sheet rubber banned to the card of meds, who would be the wiser?

BTW: This DON has been at this facility for 11 years so she is not new to the job.  I am concerned because I am afraid this is a catastrophe waiting to happen.

What are your opinions about this?

You sign for the shift,yes.

but the sheets you compare to are ambiguous.  Basically just a list of patients names and the narcs they are supposed to be on.  When something is completed or changed the nurse merely "yellows it out".  There are no way of knowing whether the meds in the drawer and the ones "yellowed out" on the sheet were actually completed or destroyed.  I feel like I am possibly signing my license away everytime I accept the keys or hand over the narcotic keys.  All a nurse who wants to divert would have to do is remove the card along with the sign out sheet rubber banned together from the drawer and yellow it out on the other sheet.  There is such a large volumn of Narcotics at this facility that there is no way to know for sure what was there and what isn't with this system.  To make matters worse I float from unit to unit.  This is also mostly a short stay facility where the patients are constantly changing.

As a nurse, you have a right to challenge policy that affects your nursing license. I would and I have called the Board of Nursing about things like this. Some facilities keep Narcs from residents that passed away, and use them up for other residents. Other things I have seen happen: facilities don't d/c narcs right away when the MD writes the order. Wrong narcs get delivered from the pharmacy and they keep them anyway. Once a nursing supervisor expected me to co-sign "wasting" a narc that she told me she gave to the wrong resident. (I refused.)

A phone call to the pharmacy can get things changed too. One facility had 3 times as many d/c'd meds as they did active orders, and they were using them. The pharmacy came the next day after I called, and audited the facility. It did not go well for them to say the least.

It is unreal what goes on, but you have to protect your license and the patients under your care.

I have to agree with what has already been said. I work in the hospital and we have a pyxis system, so no problems now. However, we used to have sheets in a book that we flipped through and counted the corresponding medication in the drawer. One night one of the nurses took the sheet and the drugs, but unfortunely for her, she took the demerol sheet and the drug morphine. In other words she screwed up and the morphine was found in a bathroom cabinet.

It sounds like this is the standard of practice where you work and it is a terrible one. Ditto to the above advice. I wonder if your DON knows that 1 in 4 nurses are addicted.... Same with MD's.

It is not only to protect the license of someone, it very well may save someone's life from an accidental overdose, the nurse who is diverting the meds.

Geez, kitty........................if a nurse wanted to work at a place where there is a super lax control of narcs..........this place gets the blue ribbon!  Pixus is is a huge safeguard, that's what we use.  One thing I think is cool is that when you put in the pt id #, then the med they are assigned to comes out of a drawer that is opened by computer access.  When you pull out the drug, you count all the drugs in that drawer at that time.  At shift change its like the changing of the guards at buckingham palace.  Everything gets counted with a witness.  Basically there are checks all during the day with each med given.    Has anybody read up on the wasting of narcs in sinks?  Then its all in the water system?  Is that an urban legend or real?  I'm picturing all the weirdos sucking from toilets trying to get a fix.

angienwgeorgia says ...

Geez, kitty........................if a nurse wanted to work at a place where there is a super lax control of narcs..........this place gets the blue ribbon!  Pixus is is a huge safeguard, that's what we use.  One thing I think is cool is that when you put in the pt id #, then the med they are assigned to comes out of a drawer that is opened by computer access.  When you pull out the drug, you count all the drugs in that drawer at that time.  At shift change its like the changing of the guards at buckingham palace.  Everything gets counted with a witness.  Basically there are checks all during the day with each med given.    Has anybody read up on the wasting of narcs in sinks?  Then its all in the water system?  Is that an urban legend or real?  I'm picturing all the weirdos sucking from toilets trying to get a fix.

I have heard about our water contaminated with medications, not sure they said it was from us wasting in sink, but that obviously adds to it. I am sure that if you can get high sucking from toliets then someone is already doing it... LOL I have to go to the bathroom now..LOL

No, I haven't been able to get any changes made.  Last week when I went in I started counting with the off-going nurse.  The nurse I was relieving on her second day.  She mentioned to me about how Narcotic count is done at this facility.  She was also frightened.  She said she was going to speak with the DON the next day.  I told her that was a great idea.  When I relieved the same nurse a few days later she told me she had spoken with the DON.  What the new nurse told me the DON said to her was the same as what the DON had told me.  I guess I have no choice but to take it further.  Perhaps to State Boards or something.  I am intimidated to do so but I think Narcotics are not probably controlled in this facility.  Even when things are done correctly people find ways to divert Narcs.  In a situation like what is occuring at this facility, it is like a candy store for an addict. 

I have a hard time believing that the DON is the nieve!