Understanding how the system timestamps and tracks each action is essential to maintaining an accurate count.
Overview
Caregivers may encounter discrepancies in narcotic counts due to backdated entries, missed documentation, or poor shift-to-shift communication. Understanding how the system timestamps and tracks each action is essential to maintaining an accurate count.
Initial Setup: Adding a Narcotic
- Go to the Narcotic Count module.
- Click to add a medication (e.g., Oxycodone).
- The system automatically selects the Narcotic flag.
- Ensure the start date reflects the actual date the medication was received or first administered.
- Example: If the medication was started on May 26 but added on May 29 without backdating, the system will incorrectly assume the full count (e.g., 50 pills) started on the 29th.
Reason for This: The system logs the narcotic count based on the timestamp of when the medication was added—not the backdated start date. This mismatch can create confusion when subsequent doses are logged with earlier dates.
Editing the Start Date: Limited Effect
If a caregiver realizes a narcotic was added with the wrong start date:
- Edit the medication entry and change the date to the correct start (e.g., May 26).
- Save the entry.
Important: This does not affect the system’s internal timestamp, which still reflects the actual time the entry was created (e.g., May 29 at 10:00 AM). Any backdated medication administrations will then reduce the count on an earlier date, even though the system believes the medication didn’t exist yet.
PRN Administration After Incorrect Start Date
If a caregiver later charts a PRN medication as given on May 27:
- They enter it correctly as a backdated administration.
- They complete all necessary steps (Administer, Complete, PRN Effectiveness).
Outcome: The count drops based on the backdated administration, but the system still reflects a confusing timeline because the medication wasn’t officially “on record” on that date.
Reason for This: The system is working correctly based on its logic, but the lack of alignment between entry timestamp and action date creates ambiguity.
Correct Workflow for Adding and Administering Narcotics
To avoid discrepancies:
- Delete the incorrect medication entry.
- Re-add the medication with the correct date (e.g., May 26).
- Confirm that the count starts at the expected number (e.g., 50).
- Log any administrations (e.g., PRN given on May 27).
- Use: Administer → Complete → PRN Effectiveness
- Verify the updated count (e.g., now 49).
Change of Shift: How Miscommunication Causes Errors
Scenario:
- Caregiver A forgets to chart a medication.
- Caregiver B performs a Change of Shift Count assuming all meds were documented.
Example Steps:
- Caregiver B records a new count of 45 pills on May 29 at 10:29 AM.
- Later, someone logs a backdated PRN for May 28.
- System adjusts the count down from the pre-shift count, which causes the count to misalign (e.g., drops to 44 unexpectedly).
Reason for This: Without proper communication, the system will reflect “ghost deductions” due to backdated entries not accounted for in the previous shift’s count.
Best Practice: Team Communication Before Shift Handover
Before documenting a Change of Shift Count:
- Caregivers should confirm with the previous shift whether any PRNs or administrations were given but not yet charted.
- Establish a clear workflow where caregivers verify and complete all narcotic logs before a handoff occurs.
Reason for This: Prevents timestamp conflicts and maintains an accurate rolling count of medications.
Summary Recommendations
- Always set the correct start date when adding narcotics.
- Avoid backdating after adding a narcotic unless you also adjust related logs.
- Use consistent communication between caregivers during shift changes to prevent phantom discrepancies.
- When in doubt, delete and re-enter medication records properly to reestablish a correct baseline.
- Use the Help button in Synkwise for support when discrepancies occur.