Questions about wasting NARCS ????

Specialties Emergency

Published

perhaps I'm still being a bit anal,...but here's the scenario: RN 1 removes 10mg Morphine at 1500,..she gives 2 2mg doses to pt A (we now have 6 mg left in syringe),...at 1900 RN 2 takes report on pt A and RN 1 gives RN 2 a syringe stating "here is the rest of the morphine,.pt A might need more",...RN 2 (being a bit anal and new to ways of the ER) really doesn't feel comfortable pushing meds that she didn't draw up et dilute herself,.so RN 2 decides it just best to waste the Morphine and take out new herself if it is needed,..in order to waste,.now that RN 1 is gone,..RN 3 has to waste w/ RN 2,. RN 3 is ok w/that,.......IS that ok? or should the original RN who actually took the med out of the Accu dose et documented giving the pt 4 mg of such med be one of the RN's that sign the waste?,.......am I just worrying too much,...

We have 4mg/10mg morphine vials too. I never give a partially used vial to another nurse. Our medics can witness wastes so I usually just give the dose and waste the rest.

steph

Up Vote Up Vote ×
Specializes in icu,ccu, er, corrections.

I absolutely hate wasting meds, due to the cost for the patient. The last ER I worked at had us waste everytime we had some left. Which means getting meds out of pyxis everytime to medicate someone. Very wasteful to my way of thinking. Especially with the 2mg dilaudid vials, since we usually only give 1mg at a time.

Up Vote Up Vote ×

In the E.R. I worked in prn, the 10ml vials were for all nurses to use. Yes, we draw up what we need, and document to which patient we are giving this to. There is no waste unless the patient was unable to take the medication or refused. We never walk around with syringes of medications such as these in our pockets all day, to be discarded at the end of our shift. What if you left with this? I know hospitals can have different rules, but I like this way to prevent any mistakes.

Up Vote Up Vote ×
Specializes in Emergency.
In the E.R. I worked in prn, the 10ml vials were for all nurses to use. Yes, we draw up what we need, and document to which patient we are giving this to. There is no waste unless the patient was unable to take the medication or refused. We never walk around with syringes of medications such as these in our pockets all day, to be discarded at the end of our shift. What if you left with this? I know hospitals can have different rules, but I like this way to prevent any mistakes.

We never have had "community" vials of narcs, but we did share the nitro and liquid ibuprofen/tylenol. We went to an omnicell system last fall and they did away with the "community" bottles. Talk about a big waste.

If I have a chest pain that comes in, I give the standard 3 nitro SL tablets. That leaves 22 remaining in the bottle. If they are admitted, I send the bottle to the floor with them. If they are discharged, the bottle has to be pitched. Same thing with all eye meds. It is a huge waste!

I have been known to carry the 2mg dilaudid or ativan syringes around planning to give the remaining 1mg at a later point, but never hand off the syringe.

Up Vote Up Vote ×
Specializes in Emergency Dept, ICU.

How are your pixis staffed??

Ours have Morphine in 2mg, 4mg, 10mg vials.

Is that not nationwide?

Up Vote Up Vote ×
Specializes in ICU/CCU, CVICU, Trauma.

I have a very big concern with this thread. To those of you who "hold on to narcs", where do you put them? Please, please tell me you do not put them in your pocket. Nurses who "pocket" narcs can be accused of diversion. Many nurses that do divert put narcs in their pocket & when approached state "I forgot" or "I was planning to give it later". I understand the individual signing out and witnessed waste can be a PIA, but please know that the aforementioned excuses may not fly with management. Be careful.

Up Vote Up Vote ×
Specializes in Cardiac, ER.

UPDATE

Email to all employees,..big notes in our communications book,..no more titrating NARCS,..orders that read "2-10mg Morphine IV" will not be acceptable,..it must say "2mg Morphine IV, may repeat x4 prn",..then we must pull out our dose (we have 4mg/10mg in our accudose) draw up the ordered amount and immediately waste the remainder,..we are being timed,.and the original nurse who pulled the med must be the original nurse to sign in on the waste! So,.say CP,.we need 10mg to get pain to 0/10,.we must pull out 4mg 5 times,.wast 2mg each time!! What a huge waste of meds and time!! Perhaps there is a problem in this ER I'm not aware of,..but this seems a bit extreme to me. Perhaps the DR's will start writing orders for 10mg and we can latter waste as not needed??

Up Vote Up Vote ×
Specializes in ED, ICU, PSYCH, PP, CEN.

I too feel sorry for the waste, but having worked long and hard for my license try to stick as close to hospital/ER policy as possible. Don't ever want to look like I could be diverting. That said, in a busy ER it is very hard to stay on policy in emergencies and not all narcs are wasted appropriately. So far discipline in our unit has been lax, and there are probably a lot of unaccounted for narcs. Only 1 nurse in 4 years found to be diverting and dealt with.

Up Vote Up Vote ×

Sorry but I am the pain in the butte that will be finding someone to waste with me. I have been burned too many times by co-workers that I trusted and never would have thought would steal drugs..I simply can not just hand it over to them. What if what you are taking from them is only saline and what if you give them the real thing but they just keep it for themselves and it is signed out in your name?

Up Vote Up Vote ×
+ Add a Comment