A Ketamine Discrepancy at Shift Change

Document and escalate; never adjust the numbers.

1. Recount with a witness. Recount with the departing technician, then with a third staff member present, so the count is not one person's word against another's.
2. Record facts, not conclusions. Log the actual volume found (2.5 mL), the logged volume (4.2 mL), and the discrepancy - 1.7 mL of ketamine 100 mg/mL = 170 mg - with date, time, and both signatures. State what was observed; do not write what you think happened.
3. Secure the vial. Do not discard it, do not use it, and do not 'destroy' anything at this hour. Place it in the locked cabinet with a note so the registrant can inspect it.
4. Notify the veterinarian on duty immediately and attempt the registrant again, leaving a documented message with the time of the call.
5. Preserve the rest of the paper trail - the treatment sheets, the hydromorphone log, and the day's anesthesia records.
6. Report to the DEA as required. For a theft or a significant loss, the registrant must notify the local DEA field office and file DEA Form 106 (Report of Theft or Loss); many states additionally require notice to the state veterinary board and, if a crime is suspected, the police. That duty belongs to the registrant, not to you, but your written report is what makes it possible.

Do not interrogate or accuse a coworker. A discrepancy can reflect a miscount, an unrecorded dose, or diversion - you are not the investigator, and premature accusations destroy the investigation.

Because it converts a record-keeping problem into a falsification problem.

Legally: controlled-substance records are federal records. A broken vial has to be documented when it happens, with a witness, and destruction or loss is recorded with signatures. A backdated or invented entry for a loss that did not occur is a false record - a far more serious matter than an unexplained discrepancy, and one that can jeopardize the practice's DEA registration and the individuals involved.

Arithmetically: 1.7 mL of ketamine at 100 mg/mL is 170 mg of a dissociative anesthetic, not 'a few dollars.' The hydromorphone arithmetic is worse: three logged doses at 0.2 mg/kg for a 20 kg dog = 4 mg each, so the log accounts for 12 mg while the treatment sheet accounts for 8 mg - 4 mg of a schedule II opioid unaccounted for.

Clinically and ethically: the missing drug may be a diversion problem. An impaired colleague diverting opioids is a patient-safety and human-safety issue, and covering for it enables harm to that person and to every patient in the building. The honest entry protects the practice, the patients, and the colleague who needs help.

Decline, and say why plainly. Only the person who administered or directly witnessed administration signs a controlled-substance entry. Initialing a dose you did not see makes you the responsible party for a record you cannot vouch for, and backdating is falsification regardless of the fact that the drug may genuinely have been given.

Offer the legitimate fix. If the doses really were administered, the correct correction is a late entry made today, clearly marked with the date and time it is written, stating what was given, to which patient, at what time it was actually administered, who gave it, and who is recording it late, plus the veterinarian's countersignature. An honest late entry is normal; a backdated one is a false record.

Escalate if it continues. If the request is repeated, or if you believe a colleague is diverting drugs or signing for doses they did not give, report it to the veterinarian in charge and the practice owner in writing, and document the date, time, and content of the request. Do not negotiate, do not sign 'to be helpful,' and do not discuss it with the rest of the staff. The professional obligation is to the accuracy of the record and to patient safety, not to workplace harmony.