[RN-Cardiac]

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,...

[RunnerRN]

Here's my perspective from working in the ER....I often accept meds from the previous shift, but only from the RNs I really trust and work with a lot. In our dept, we have 5:1 and 10:1 morphine vials, and it just seems ridiculous to me to pull out a new vial for each 2mg dose (which is what management wants us to do now that JCAHO is on its way). Anyway, because of this (and also because some of our nurses are less than anal about their narcs) we often end up wasting other people's narcs. I've never had a problem with it. I always waste my own because I know I'm less careful with other people's narcs than my own (make any sense?)
I think you'll be okay. You aren't witnessing that RN 1 GAVE 4 mg of MS, you're signing off that this RN wasted 6mg down the sink.

[Altra]

We frequently do this too, but if it bothers you, then don't. I can't imagine anyone having a problem with this. When you get report just tell the outgoing RN, "let's waste this, then I'll get more if I need it."

I personally get the smallest dose vials (2mg morphine) out of the Accudose to minimize waste, even if I think the patient will probably need repeat doses.

I'm curious - how did you handle this sort of thing on your old unit?

[PANurseRN1]

Where I work, that could be grounds for termination. If you don't use all of the med, you must waste the remainder right then and there. It is not permissible to hold the remainder for later, and for sure it is not permissible to just hand off the remainder to someone else. How do you know what's in that syringe? Way too easy for diverters to get their meds that way, and it just flies in the face of basic med admin. standards.

[TazziRN]

It's okay only if the nurses involved are okay with it. RN 2 should never have accepted the syringe if she didn't feel comfortable with that. I will accept leftover narcs from the offgoing RN only if it's in the original vial and not in a syringe, and only from nurses I know.

[canoehead]

In reality RN 1 could slip behind a curtain and put the entire 10mg into a NS vial to take home, and only take 30 seconds. So you are never sure what's in the vial unless you follow the RN from Pyxis to patient. We all know that's not gonna happen.

I like the 2mg vials too, but pharmacy only refills once a day, and we would quickly run out. Gotta use those 10's if you work overnights.

[caliotter3]

I don't know why, but I would think that in the ER (never worked in one) there would be an established system for this that is more acceptable and safe for everyone concerned. I worked in LTC and at one facility we had a thievin' DON so I'm really concerned about the whole scenario. After all the fiascos I saw in LTC and other places, I, myself, would be reluctant to accept the syringe in the first place.

[MomNRN]

At our ED they really discourage only using a partial dose of any narcotic type medication and saving the remainder.

Our morphine comes in prefilled syringes (4mg/10mg). We almost always start with a initial dose of 4mg and proceed from there. Very rarely am I carrying around the extra. I do keep it if I know I am going to use it.

I am not comfortable handing off a partial med. I usually waste prior to the end of my shift. While I do feel comfortable with the majority of my coworkers, covering my *&% is more important to me. There are some coworkers I don't trust. Sad to say, but true!

[TazziRN]

Caliotter, there's a lot of titrating in the ER over a short period of time, and sometimes it's just too busy to get a witness each time you need to draw it up. Most ER nurses that I know will hang onto it and waste it at the end of the shift or on pt disposition.

[nuangel1]

Originally Posted by TazziRN

Caliotter, there's a lot of titrating in the ER over a short period of time, and sometimes it's just too busy to get a witness each time you need to draw it up. Most ER nurses that I know will hang onto it and waste it at the end of the shift or on pt disposition.

ditto that.