He Missed Narcotic Count by 10 Pills!

I work at an out-patient mental health clinic. On a day off one month ago, a fellow nurse covered my clientele. One of my clientele come in for med boxes to be filled with assistance by the nurse. This client takes Lorazepam BID PRN. The count was 45 pills when the nurse filled client's med boxes. Afterwards, the nurse documents the count at 31 pills remaining.

Two weeks later, when I prepare to meet my client, I count my narcs and discover there are only 21 pills remaining, not 31 as other nurse noted! As the client may use up to 24 pills, this leaves me short for her visit. Not good. I call the nurse in who incorrectly documented amount.

His excuse, no excuse. He states, "Oh, well, you gotta order your pills sooner." Nurse doesn't even acknowledge his error. He states, "Well, I was really busy that day and didn't have time to count them..."

Incredulous, I tell him to correct count sheet and he does. He then begins to tell me how I need to handle my meds in the future! I tell him to leave my office as I now must rush to pharmacy and get missing meds for my member who is patiently sleeping on the sidewalk in front of the clinic!

Subsequent to this incident, this young nurse has not spoken a word to me. He walks by me and only acknowledges me when I make the effort to say hello, boo, anything.

All I had wanted from the beginning was for this nurse to accept responsibility for his error, acknowledge his actions. Now, he has taken it to a new level, telling our super that he was only trying to "give Mark some advice" about how to handle his meds..."

I am very disappointed in this nurse. He has said inappropriate comments to me in the past, but I've let them go due to his youth. But, 10 missing narcs and no accountability has me spooked about him. I no longer I feel I can trust him and am starting to wonder if he may have tried to set me up with missing meds. Given his childish behavior subsequent to this event, I am now considering my options.

Would it be prudent to take the matter to H.R. and let them sort it out?

My ADON now knows, but doesn't seem to concerned. He only says, "You guys gotta work it out." How do you work out a nurse that doesn't count his narcs and will not accept responsibility for his actions?

Would this issue be a matter for the BON?

I dread to go there, but this nurse's behavior has gotten me rattled. How in the world do I know those benzos didn't go down his gullet?? How do I know this hasn't happened before? How in the world can I trust this person again!

Any advice is so appreciated, thank you kindly in advance my fellow nurses,


Mark :heartbeat
The count issue HAS been worked out. Following policies and safe practice would fall under the boss's job description. Document the instance in a letter to the ADON, and keep a copy. Do this every time count is wrong so you have a paper trail to protect yourself. If you report this nurse to the BON it could be seen as going over your ADON's head, and jeopardize your job, so personally I wouldn't do it.

I would have hollered the minute I found the error..... Your facility has a strange way of accounting for narcotics..... I would never work that way, with anyone.

2 things I believe in........Keep your friends close & your enemies closer AND a leopard never changes his spots, soooooooo, make nice with this nurse, go apologise that maybe you were mistaken yada, yada and then sit back and watch If he's dipping into patients meds, it'll come up again I promise. DO give a written letter of concern to your DON and keep a copy for yourself, as the other poster advised and then in the future, if this happens again (and if he's taking pt's meds, it will) you will have some prior documentation to go back on. Lastly, don't report to BON, you have no proof and you'll just tick off your boss and make things hard on yourself. Play nice and this guy will hang himself.

I agree going to BON could hurt you more than him. Let him hang himself but in meantime document and give copy to Management to CYA. And I agree do not trust at all but do not alienate him.. gotta watch this one closely!! Hang in there.

Mark,Tough spot to be in! We do seem to run into this quite a bit in psych/addictions. Document and watch. If he is diverting, it will happen again. It really rattled me the first time a nurse I worked with got nailed for diverting. Hang in there.Sue

I would have acted immediately on finding the missing meds, if they were in fact missing. It would be too easy for the other nurse to say, he must have miscounted or written the wrong amount, leaving you suspect for having taken them yourself. Never leave yourself open. Act immediately in a case of wrong narcotic/ controlled substance count.

Maybe I am missing something, but the math isn't making sense no matter how I look at it. The original count was 45. Client is allowed two per day. So if the client is allowed up to 24 pills, the box is filled every 12 days? 45 minus 24 leaves 21- the amount left when you returned after two weeks (twelve days maybe?). So this was a documentation error? That your coworker reported to his (and your) supervisor once notified of it? I'm sure I am missing something.

Quote from liftedtMaybe I am missing something, but the math isn't making sense no matter how I look at it. The original count was 45. Client is allowed two per day. So if the client is allowed up to 24 pills, the box is filled every 12 days? 45 minus 24 leaves 21- the amount left when you returned after two weeks (twelve days maybe?). So this was a documentation error? That your coworker reported to his (and your) supervisor once notified of it? I'm sure I am missing something.

Quote from Mudder2 things I believe in........Keep your friends close & your enemies closer AND a leopard never changes his spots, soooooooo, make nice with this nurse, go apologise that maybe you were mistaken yada, yada and then sit back and watch If he's dipping into patients meds, it'll come up again I promise. DO give a written letter of concern to your DON and keep a copy for yourself, as the other poster advised and then in the future, if this happens again (and if he's taking pt's meds, it will) you will have some prior documentation to go back on. Lastly, don't report to BON, you have no proof and you'll just tick off your boss and make things hard on yourself. Play nice and this guy will hang himself.

This nurse is an LPN. I didn't want to mention it in my original post as I don't want to go there. But, truth be told, he does seem to have an inferiority complex about that, always trying to demonstrate how knowledgeable he is. The count was off by 10 pills. It is a PRN medication. According to the nurse, he used 24 pills. That is what he charted...I don't trust this guy as far as I could throw him, which is not very far :-)

Quote from ArizonaMarkThis nurse is an LPN. I didn't want to mention it in my original post as I don't want to go there. But, truth be told, he does seem to have an inferiority complex about that, always trying to demonstrate how knowledgeable he is. The count was off by 10 pills. It is a PRN medication. According to the nurse, he used 24 pills. That is what he charted...I don't trust this guy as far as I could throw him, which is not very far :-)

Quote from hecallsmeDuchessSorry, if I'm misunderstanding you but what does being an LPN have to do with it? He either made a mistake or he didn't, his nursing title isn't really relevant at this point. IMHO.