Gave a patient someone else's unwasted dilaudid - page 3

First of all, let me tell you a little background about myself. I graduated in 08 and found a job at a rehab facility because no one would hire a new grad at a hospital unless you knew someone. I... Read More

  1. Visit  fiveofpeep profile page
    1
    I have a question. often times at work if a pt is getting 1mg, we wont waste the other mg and leave it locked at the bedside in case it is needed later. if it isnt given we waste it. I always wondered, what if they go and look on the narc list and see 2mg were taken and none was wasted but the patient is prescribed 1mg? would they think you used it for yourself or that you gave extra accidentally...or would they understand that you were trying not to waste the med so you save it (locked away) for later? I should check with my boss too, since this is common practice where I work...but Ive always wondered.
    sharpeimom likes this.
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  3. Visit  cardiacmadeline profile page
    2
    Quote from fiveofpeep
    I have a question. often times at work if a pt is getting 1mg, we wont waste the other mg and leave it locked at the bedside in case it is needed later. if it isnt given we waste it. I always wondered, what if they go and look on the narc list and see 2mg were taken and none was wasted but the patient is prescribed 1mg? would they think you used it for yourself or that you gave extra accidentally...or would they understand that you were trying not to waste the med so you save it (locked away) for later? I should check with my boss too, since this is common practice where I work...but Ive always wondered.
    You shouldn't save half used syringes for use later and I think the reason is because there are no preservatives in them.
    fiveofpeep and sharpeimom like this.
  4. Visit  oncrnpa profile page
    1
    It sounds like there are 2 issues here...

    1) There appears to be a cultural issue amongst nurses of not "wanting to waste meds". I myself am stingy and love to save a buck (even if its not mine) however the mentality of keeping it around just in case opens you up to too many issues of liability. In addition to continuously having to worry about the paper trail that dose has and whether or not it is correct, who else has access to it if its at the bedside or in your pocket (ever take your jacket off), petentially giving it in error when your storing 2 patients meds for similar purpose in your pocket, what about the stability of the medication once its been opened keep in mind that one reason why it usually is a single dose unit is because it has no preservatives. Always use a new unit for every dose and waste the remaining immediately. Get your pharmacy to stock in the lowest available unit. I'm actually surprised the hospital pharmacy isn't having a "bird" about this practice.

    2) You writing is expressing feelings of being overwhelmed "numb" and not caring about the place that you work for or the professional job that you are doing. PLEASE STOP WORKING AND SEEK PROFESSIONAL HELP NOW! You are placing your patients IN JEOPARDY. If I were your manager and you had been employed for a few years this would be an immediate dismissal offense. IMHO, however you are newly off orientation and obviously overwhelmed (I'm making the assumption here that you know this practice is WRONG and will NEVER save or split doses of narcs again and that if you weren't so overwhelmed you would not have done this to begin with) I may give you another chance. But giving you another chance isnt going to correct you feeling overwhelmed or making poor judgements because of it..... Please think about your health, your patients right to safe competent care, your license, and how this job helps or hinders all of those.
    Last edit by oncrnpa on May 16, '10 : Reason: removed fragment
    wooh likes this.
  5. Visit  litbitblack profile page
    1
    Quote from oncrnpa
    It sounds like there are 2 issues here...

    1) There appears to be a cultural issue amongst nurses of not "wanting to waste meds". I myself am stingy and love to save a buck (even if its not mine) however the mentality of keeping it around just in case opens you up to too many issues of liability. In addition to continuously having to worry about the paper trail that dose has and whether or not it is correct, who else has access to it if its at the bedside or in your pocket (ever take your jacket off), petentially giving it in error when your storing 2 patients meds for similar purpose in your pocket, what about the stability of the medication once its been opened keep in mind that one reason why it usually is a single dose unit is because it has no preservatives. Always use a new unit for every dose and waste the remaining immediately. Get your pharmacy to stock in the lowest available unit. I'm actually surprised the hospital pharmacy isn't having a "bird" about this practice.

    2) You writing is expressing feelings of being overwhelmed "numb" and not caring about the place that you work for or the professional job that you are doing. PLEASE STOP WORKING AND SEEK PROFESSIONAL HELP NOW! You are placing your patients IN JEOPARDY. If I were your manager and you had been employed for a few years this would be an immediate dismissal offense. IMHO, however you are newly off orientation and obviously overwhelmed (I'm making the assumption here that you know this practice is WRONG and will NEVER save or split doses of narcs again and that if you weren't so overwhelmed you would not have done this to begin with) I may give you another chance. But giving you another chance isnt going to correct you feeling overwhelmed or making poor judgements because of it..... Please think about your health, your patients right to safe competent care, your license, and how this job helps or hinders all of those.

    Ok so you made a mistake and you learned from it. Why are some of you still going on and on. to the OP, its difficult going from a rehab to acute care. If you feel overwhelmed and it doesn't seem to get any easier go talk to your manager about it or the person who set up your preceptor/orientation. There are alot of people who want to save money and stuff or just as a convenience to them during thier shift. But the bottom line is, waste what you are not using with a witness, and don't stick it in your pockets. as to the aide who had a question, No your not supposed to borrow from someone else but I won't say it doesnt happen. it is not a recommended practice. The nurse who is allowing you to do this is risking their license on a med error.
    netglow likes this.
  6. Visit  wooh profile page
    4
    First off, don't take it personally that people aren't "helping" since you've been off orientation. On orientation, more than likely, you weren't counted in staffing, so you were "extra." Now, you're counted, and I can almost guarantee you're getting a lighter assignment (even if it doesn't feel like it, I've seen new nurses feel like they were being dumped on, and it's not happening, they'd be overwhelmed no matter what patients we give them). So the other nurses are getting heavier assignments, and however much they may want to help, they're just bogged down themselves. Especially since it sounds like you work evenings, and that is a BUSY shift. Worst 8 hours of the 24. I've worked every shift there is, and evenings just plain suck.
    You're new, it's going to take a while to adjust. Sounds like you're doing med-surg, and it's all about organizing yourself, planning ahead to prevent fires instead of having to put them out, and prioritization. These are skills that take time to develop. I had some great experiences in nursing school, and some great nurses to learn from when I got out. The BEST advice I ever got was to just do one thing at a time. To this day, when I feel overwhelmed, it's because I'm trying to juggle more than one thing at a time.
    And work smart, not hard. Get your assignment, spend a bit of extra time at the beginning of each shift getting everyone settled, let them know you're there for them, your plans, and I guarantee 9 out of 10 patients will call you less, so fewer interruptions as the day goes on. And just every hour or so, check in, ask if they need anything, make sure all is ok. It seems to take more time, but it's keeping some control over the time you have. It's easier to stay focused on your charting if you've just checked on everyone, know they're settled, and not having them call for silly little things, all because you took an extra couple of minutes before starting so that you'll be able to have some uniterrupted time.
    As for this particular issue: I've seen nurses not wanting to waste meds. It really does just open things up to a world of liability for all sorts of things. Get the meds out of the pyxis and waste for EACH administration. It's just safer all around.
    It's easy to say (and I'm sure some do practice) not ever putting meds in your pocket for any reason. For me, I strive for that, but know that there are times I use my pockets. So dump your pockets at the end of each shift. I carry the world in my pockets (I hate needing something when I get into a room and not having it) but I dump everything from every pocket into my locker at the end of the shift. That way I know I didn't take anything home. If you don't have lockers (I used to not) then have a bag that you keep your work stuff in, and dump everything from pockets to bag at the end of your shift.
    Mistakes happen. We do our best, but sometimes it's just tough and we make a mistake. Forgive yourself but also quickly rectify the mistake asap. If you're like me, you beat yourself up more than anyone else could.
    Hoozdo, nursel56, leslie :-D, and 1 other like this.
  7. Visit  NC Girl BSN profile page
    2
    Quote from fiveofpeep
    I have a question. often times at work if a pt is getting 1mg, we wont waste the other mg and leave it locked at the bedside in case it is needed later. if it isnt given we waste it. I always wondered, what if they go and look on the narc list and see 2mg were taken and none was wasted but the patient is prescribed 1mg? would they think you used it for yourself or that you gave extra accidentally...or would they understand that you were trying not to waste the med so you save it (locked away) for later? I should check with my boss too, since this is common practice where I work...but Ive always wondered.
    At our hospital, YOU MUST WASTE any medication that is not given to the patient at that exact time to prevent such suspicion. If I were you, I would waste that medication everytime. Don't put yourself in an awkward positon.
    fiveofpeep and wooh like this.
  8. Visit  NC Girl BSN profile page
    0
    To the OP. Not trying to scare you but this is a major offense. If you were at my hospital, you would be written up and drug tested for sure. Don't be suprised if they call you in for a drug test. I hope things work out in the end and I KNOW you will NEVER do this again. I think your efforts were genuion but that is a huge No No. Make it a habit to never put medications in your pocket again. Take care and keep us posted.
    Last edit by NC Girl BSN on May 16, '10
  9. Visit  CrazierThanYou profile page
    0
    Quote from Hoozdo
    That is a horse of a different color and can't even be compared.

    We are talking about a potent IV opioid here.
    I am aware of that but thank you sooooo much for pointing that out.
  10. Visit  Spacklehead profile page
    4
    The other reason that you have to waste the med is if you are getting it out of the Pyxis or Accudose - the patient whose name you took it out under is getting charged. If you use the unused portion of that med on another patient - the other patient is technically getting the med for free - at the expense of the other patient. It also isn't showing up under that other patient's name, so when pharmacy pulls up the accounts - it will look like that patient never even got the med although it's documented on the MAR. This can cause BIG problems if audits are conducted.
  11. Visit  Daliadreamer profile page
    6
    Thank you everyone for your input. I am well aware that I committed a huge error, and I have been beating myself up for it. I know that I am NEVER ever going to do this again, no matter how overwhelmed I am. This event is going to stay with me for the rest of my life.
    When I came into work this afternoon, the nurse manager came to the breakroom with me and we just sat down and talked and I of course had tears. She was really supportive, and wanted to know what she could do to make my anxieties lessen. I just really need to ask questions all the time when I am unsure, even when everyone else is busy.
    When the night shift came in, one of the nurses I give report to also took me to the side and said that she heard what happened and we talked about it. She also said that I am doing very well for being new, and that she doesn't say that about most new nurses. Apparantly I am doing something right.
    My lesson has been learned, and I know that dilaudid will haunt me for the rest of my career, but I know now to be more diligent and aware of what is going on around me. Thank you all who replied that gave me encouraging words, I really appreciate it.
    wooh, TDCHIM, DeLanaHarvickWannabe, and 3 others like this.
  12. Visit  Batman25 profile page
    2
    You seem to have a great manager and a staff who really does care about and support you. It seems you are doing a wonderful job and they see that. We all make mistakes and we have to learn from them and grow. Sounds like you did just that. Glad things worked out.
    wooh and Multicollinearity like this.
  13. Visit  nursel56 profile page
    0
    Agree with Batman-- you are so fortunate to have a manager and at least one co-worker who are supportive. It also makes me happy to see that it really is possible to have a year pass between graduation and your first acute care med-surg job, that you are hired, and despite the steeper learning curve, you will be successful at it.

    There are lots and lots of "old" new grads wondering if it can really be done. You're proving that it can. Best wishes as you continue in that journey.


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