Narc count is driving me nuts!!

1 So I recently started a new job and I really like it. The only thing that is driving me bonkers is the way they do their narc counts. Instead of having blister packs that you just pop the med out of, they have boxes upon boxes of individually packaged narcs! For the past two nights it has taken me 30 minutes if not longer to count with the oncoming shift!! And then by the time I give report I am at the very least at least 40 minutes past quitting time. The narc log is atrocious!! I mean in the cart I worked tonight there were at approx 20 BOXES of meds with each box containing at least 10 pills. I have to unroll this giant roll of narcs count them and also make sure there is actually a pill in the pack, because of the way some people tear the previous pack off. This afternoon when I counted with day shift, there was a vicodin just chillin in the bottom of the drawer. It's super annoying. The girl I counted with tonight couldn't stop talking to one of the CNAs long enough to count, she started then stopped then started again with the same roll of pills. I'm new, and not wanting to ruffle any feathers didn't say anything. Also in the narc drawer tonight, there was a hospice emergency kit for one of the residents. that contained roxanol and 3 other meds that were just in bottles, not wanting to touch them I had to idividuallly try to tap them into the lid of the bottle to be able to count them. Seems to me there that there just has to be a better system, considering that this place uses computerized med pass and that you have to scan every other med other than the narcotics you give. It just doesn't make sense to me. Anyone else ever have to a crazy narc count like this? Guess I just needed to vent a little!! thanks!!
Yeah- that would bug me too. I don't understand with either blister packs or Pyxis so available why you'd still have to count unit dose boxes. How are the regular meds packed? If those are in blister cards, it shouldn't be a big problem to have the pharmacy order bulk narcs (bottled) and pack them in blister cards. The loose Vicodin could turn into an issue if it disappears (even honestly, with nothing to keep it contained) and the count comes up short. I think you have a legit issue. The big thing that may be a problem is budgeting for any changes. It sounds like the pharmacy is sending the format that requires the least amt of work for them, which may be some sort of discount for the facility drug charges. jmo

I worked at one place where instead of blister packs there were pill bottles. Had to count a thousand individual pills per shift. Also took 30 minutes.

One nursing home I worked at about three of the residents got there narc in pill bottles. This was due to their insurance sending them mail order. They would send a three month supply and we had to count all those pills individually. There happened to be a safe in the medroom from when the place was built. We got the DON to agree to put all the extra pills in there. We only had one bottle of each med for each resident in the med cart. This made it considerably easier. It still was a pain in the rear. We had those trays like they use in a pharmacy and we'd empty the pills into them and move them with a tongue depressor. Occassionally a pill would fall out and end up on the counter or even the floor. This was an infection control issue. They should get the cards with the blister packs of 30 pills.

Other nurses drive me nuts with the narcs. One likes to reorder WAAAY early and our pharmacy is so backwards, they send out refills of stuff 40 pills in advance when it's unnecessary and then put a refill sticker that you have to pull on exactly that day or someone won't get a scheduled narc (and I HATE signing and circling). Then you got those nurses who LOOK for pinholes and waste narcs if the foil on the back is even scarred (not to mention almost everyone keeps rubber banding packs too tight so they're almost ALL buggered up). So then the count goes something like, "Jane Smith: Ativan, 28 with 20, 16, 9, and 2 out"...and there's a repeat offender who constantly does that. I think she does it just to make me crazy. Then the other day, this one steel-faced nurse relieves me after my third 12 hour shift in a row and I said the wrong number. Now, don't get me wrong, I don't mind at all if they want to visually see the narc book during count. But this wretched person grabs the book, hovers it, and wants me to look over her shoulder and call out the numbers treating me like I took the pills. I was like, "Do you really need me for this count, or do you want to do it yourself?" If she hadn't had her TWO very YOUNG children at work with her (which is just unprofessional to me, and I say that as the mother of a 6-year-old), I would have said something more like, "Count 'em yourself b__ch. They're all there, and the ones I signed out were routine". I wouldn't mind boxes if I worked with a different set of people. Though I give the first shift nurse I usually relieve and get relieved by credit because we never have issues...caused by anything we've done. lol

Haha, I hate having pill bottles. When possible, I give them to the DON to destroy, or beg the pharmacy to repack them into blister packs. I found this one lady who had brought all of her home meds, including 150 teenie Xanax pills, and a pile of Lortab to top it off. DO NOT WANT! Sent those suckers off to the DON next time I saw her.

When I worked ltc 2 yrs ago, they had what looked like big huge tackle boxes (red, blue, black) with narcs in each individual compartments. Counting was a joke! They also had the locked and put in a locked closet. Each time you had to break the locks, count the narcs, put on the new locks and record the numbers for the locks. It took forever and still haunts me. Every time I needed to go into it, I dreaded it. I feel your pain

Dear Pyxis,I love you.Thanks,MN-Nurse

LTCs in my area are finally putting a stop to hundreds of scheduled pills in bottles.Some facilities insist on bubble packs while others have placed limits on the supply.I don't know if or how much this is due to conversion to electronic records, but so far this conversion has brought about some serious improvements with reference to med passes.