Wasting narcs. What's the correct procedure?

  1. Once, I crushed a Dilaudid pill for a pt. Then I realized I took it out of the wrong bingo card, that belonged to another patient. It was on night shift, everyone was busy and there wasn't another nurse around to be a witness. After all the Dilaudid was already out of the card and crushed, so even if I called another nurse to witness the waste, she/he wouldn't have been able to say, what it is that I'm wasting. So I dumped the powder into the sharps myself and I wrote it into the narc log as Dilaudid - one taken and wasted and signed it by myself.
    Was that a mistake? Did I set myself up for trouble?
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  2. 6 Comments

  3. by   sirI
    Quote from estrogen
    Once, I crushed a Dilaudid pill for a pt. Then I realized I took it out of the wrong bingo card, that belonged to another patient. It was on night shift, everyone was busy and there wasn't another nurse around to be a witness. After all the Dilaudid was already out of the card and crushed, so even if I called another nurse to witness the waste, she/he wouldn't have been able to say, what it is that I'm wasting. So I dumped the powder into the sharps myself and I wrote it into the narc log as Dilaudid - one taken and wasted and signed it by myself.
    Was that a mistake? Did I set myself up for trouble?
    Actually, yes, you could have.

    The actual waste should ideally be done in the presence of two licensed individuals. Next time take the "crushed" med back to the med room and waste in the presence of another licensed individual. There must be a mutual trust factor amongst professionals.

    Signing of the waste must be by two licensed individuals to keep you "legal" and prevent any repercussions.
  4. by   estrogen
    Oooops! Is this one time likely to get me in trouble?
  5. by   sirI
    Quote from estrogen
    Oooops! Is this one time likely to get me in trouble?
    Not necessarily. You did, after all, document the waste. Did you alert anyone so they could sign along with you, after the fact? That will be what you need to do in the future in those rare instances where you cannot waste in the presence of the second individual. I would not get into that habit, however. Not a good practice.

    State Health/JACHO love to pick apart these records for lack of witnessed wastes.

    At my facility, I harp on this very fact time and time again. Drill it in everyones' heads.
  6. by   sjrn85
    Make sure you and your witness sign off on the wastage immediately. Don't let someone say, "I'm busy, I'll sign later," or "Just go ahead and waste it, and I'll sign later." Make sure you waste the drug in another licensed nurse's presence, and that you both sign the appropriate form then and there.

    As a one-time error, you're probably OK, but if it becomes a pattern, you'll likely find yourself in front of the BON, and you do not want to go there.
  7. by   HappyNurse2005
    We have the pyxis, and when taking out any narcotic it asks "do you plan to give whole (fill in dosage narcotic comes in)" for ex, if you ahve a morphine 2mg/1ml syringe, but you are only giving 1ml then it will say "witness required" and you have to get another licensed person in there to type in their user id and scan their fingerprint, then it asks how much you are giving/how much wasting. since its computerized, you have to have another person there or you can't get your med (of course, you could lie and say you're giving it all when you're not, but thats not honest)
  8. by   fins
    Happynurse, we have pyxis too. If there's nobody around, you can say you're giving the entire dose, and then document the wastage in the pyxis later (there is a "waste" function.)

    Otherwise, there'd be no way to document wastage caused by dropped pills, patient refused, etc.

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