A post-operative patient requires narcotics, but there is a miscount at the narcotics cabinet. How should the nurse proceed?

• A. Involve the charge nurse and document the discrepancy
• B. Document and proceed with the order as usual
• C. Call the physician and obtain a new order
• D. Charge nurse do not document

Answer: (D)

When dealing with a narcotics miscount, the priority is safety and proper accountability. A miscount signals potential loss, diversion, or an error that must be investigated before any opioid is given. The best course is to involve the charge nurse and document the discrepancy. This activates the proper chain of command and the facility’s narcotics reconciliation procedures, ensuring there is an accurate trace of all controlled substances and that patient safety isn’t compromised.

Key steps include performing a double check count with another licensed nurse, verifying against the medication administration record, securing the cabinet, and following the facility’s policy for reporting and reconciliation. Notify the charge nurse and, if required by policy, the pharmacy or medication safety officer, and file an incident report. Do not administer the narcotic while the discrepancy is unresolved. If analgesia is urgently needed, follow the physician’s orders and facility policy for alternatives or re-authorization once the counts are reconciled.

Documenting the discrepancy is essential; failing to document or proceeding without resolution undermines safety, regulatory compliance, and patient care.