[canoehead]

I am the only nurse on overnight in my ER. I save my narcs that need to be wasted and do it with the day RN at shift change. My manager and pharmacy want me to get the doc to waste with me, or have a med surg nurse come do it, at the time I pull the meds instead of waiting. Clearly there are times when both are busy, or unavailable (sleeping for the doc, low priority task for the MS nurse).

I am progressively getting into more and more trouble because I pull the med when the patient needs it, and waste when I have someone to do it with me. I've been nailed a couple times because shift change brought a critical patient and no one, including me, thought to waste leftovers before the pharmacy tech showed up.

Anyone else work in a small unit alone? How do you deal with wasting narcs? Frankly, if I just threw out the leftovers I'd be in less trouble- no chart audits vrs waste in this joint. I'm not going down that road, but it's frustrating when admin would be happier if they just didn't know about the problem.

Ideas? Advice?

[Larry77]

I've heard of dept's having a lockbox that narcs are placed in with the patient's name and time etc. Are you carrying around these meds? If so, I would look into locking them up until you can get someone to waste with you.

Otherwise I would make it a habit to have the doc waste the meds when you wake him up for something else. I personally would not look to other dept's to help me, plus if you start doing this with the docs they will get used to it eventually.

[obliviousRN]

We also have 1 nurse to staff our ER at night. They usually waste with the med/surg nurses since our hospital is small enough to run and get them (i.e. 100 feet down the hall to med/surg type of arrangement). I've been known to make the pharmacist waste with me also - but I work day shift so much easier.

It's a challenge, that's for sure. Be very careful of what your own state regs are regarding this issue. You might want to check on that. Have your pharmacist print them out for you. I wouldn't wake a doc up to waste a med though. That seems so stupid and a waste of their time - especially if they are on 24 hours straight and their sleep time is limited anyway.

good luck.

[9309]

The problem is that The way most of us waste drugs is a bit of a farce. When I come on in the morning, how do I know what is being wasted? all I know is that about 1cc of some clear liquid is going into the garbage. Could be tap water.

The only legitmate way to waste drugs is for the witness to actually watch the drug being drawn from a closed container.

That being said, I regulary do the same thing. I figure one day it wll bite me in the caboose.

9309

[grammyr]

Do you have a house sup at night? If so that is the person who should be wasting with you instead of waiting until the next shift comes in.

[nursejennie76]

I am also in the same situation, and I usually waste with the house supervisor, or have to wait until morning--- now at our ER there is no pyxis and the narcs are all under a small lock with a key ( I used to work in larger hospitals, so this is weird to me). I hate it and and there is another RN with me on Sunday and Saturday nights only and I swear one of them is diverting narcs and it would be so easy to do it!! I am actually searching for a new job now because if it. Managment says they cant prove anything and will not install cameras in the med room.

[Spidey's mom]

At my hospital, when you are the ER nurse, you are also the Supervisor.

We can use the EMT-II's to witness wasting narcs and that is what we usually do. Or just hold it over until the next nurse comes in. Or ask the doc (this is rare). Or ask a med/surg nurse to come down the hall and witness.

steph

[DVarmit]

Originally Posted by nursejennie76

now at our ER there is no pyxis and the narcs are all under a small lock with a key ( I used to work in larger hospitals, so this is weird to me).

I hear ya! I just came back to ER nursing in a tiny ER.... I did a BIG hospital ER in the past. It's very interesting to see the difference in small versus big ER. I keep telling myself the benefits of this............I get to review how to do things when the technology isn't available. I take time to look things up to make sure we're not missing anything when we get something more acute in........but I must say - I DO miss the Pyxis. I am amazed that there's not some other system in place with the liability that comes with poor med storage.

We have these crazy little ziplock bags labeled with the unit dose med name, but more than once I've found the wrong med in the bag. It just allows another persons hands in the pot to make a mistake.

Our ER staffs an RN and an LPN at night, so I don't have anything to add on that. I'd probably call on the house supervisor also if one's available.