narc waste a little long

[ohmeowzer]

.. we had a nurse at the hospital where i work have a pt who had diluaded 1mg scheduled every 6 hours.. well instead of wasting the dose of diluaded , she put in her pocket and saved it for the next dose .. she was written up for it and was just told not to do it again.. she said our policy at the hospital stated that she didn't have to waste it with 2 nurses .. i always thought we did have to waste a narc with 2 nurses and never heard it was okay to stick it in your pocket and save it for the next dose.... she told the nurse coming on shift ..." it didn't make sense for her to waste it because she had to give it again"... she was in the army and she said this is what they do there... this is the weirdest thing i have ever heard... she wasn't fired either just made a level 2 ... i work in a large hospital chain in a big city... what is your policy regarding narc wastes? this happened at the end of shift and i didn't get a chance to check the policy .... has anyone ever heard of a hospital tolerating this??? i've been a nurse for 26 years and never heard of this happening and then getting a slap on the wrist .... thank you for listening to my vent......

[tokmom, BSN, RN]

I used to do that in the past. I have been a nurse since 1985. When we wasted, we had to have two Co signs.I would never do that now though.

[stargazer88]

Doesn't every nursing school teach that you always waste narcs with a witness? It does seem a little odd that a nurse today wouldn't know that

[Altra, BSN, RN]

Doesn't every nursing school teach that you always waste narcs with a witness? It does seem a little odd that a nurse today wouldn't know that

Nursing schools cannot possibly teach the varying policies of every hospital.

[Meriwhen, ASN, BSN, MSN, RN]

I am still confused.

Did she show the hospital a policy that says there is no need for a narc witness?

If so.... the hospital needs to re-write THAT stat.

Even if my facility didn't have a P&P in place addressing witnessing a waste, I would still waste any narcs with a witness, strictly to cover my rear.

I also wouldn't carry a narc in my pocket--if I needed it for another dose I would either lock it back up or, if unable to secure it, waste the remainder and draw a fresh supply for the next dose. Management knows that not everyone who diverts is doing it for themselves--it's common to see diversion occur because a family member/friend needed the drug or the nurse wanted to make some extra pocket money by selling it. So if the narc's not in my pocket, then there's nothing for them to question.

[psu_213, BSN, RN]

Doesn't every nursing school teach that you always waste narcs with a witness? It does seem a little odd that a nurse today wouldn't know that

I really don't think that ever came up when I was in nursing school.

However, I think just about every hospital requires 2 nurses for a narc waste (I know mine does). I also know nurses that have given 0.5 mL of dilaudid and 'held' the other 0.5 mL for the next time around. Just seems like a risky procedure to me. What if he/she forgets it's there, pulls out another dose next time and walks out with the rest of it. Tough to explain away....

[applewhitern, BSN, RN]

I have worked in facilities where it was acceptable to keep narcotics for the next use. When I worked at a large university teaching hospital, we even kept them at the bedside in PICU. The only thing that really matters is that you follow your employer's policy. Heck, I remember when xanax, ativan, librium, etc., were not even considered a "lock up" med. They were just laying around in the patient's drug drawer! This issue has already been dealt with by your hospital's administration, so I don't know why you are concerned with it. Just waste narcs according to your policy, and no, I wouldn't risk putting them in your pocket.

[qaqueen]

Where I've worked, we have saved narcs to use for the next dose, as long as it's the same nurse giving it. We label and date the vial and put it in the med cart in a lock box. We waste what's left at end of shift. We do always waste with 2 nurses. I know of some nurses who do keep it in their pocket if they are giving it frequently. Nobody I know has ever been written up for it. The narc isn't wasted every time because it's expensive. The facility trusts the nurses unless there is cause not to. It's nice to be trusted, but I think that is not the norm in this day and age.

This makes sense to me. First of all, tossing meds, is a waste of money. Second, there have been so many drug shortages lately, I am often unsure if a next dose will be available.

The company policy requires wasting with a witness, and I do comply, but sometimes I wish there was a better way to handle this.

[KelRN215, BSN, RN]

When I worked inpatient, they were actually pretty lax about controlled substances. You had to have 2 people to take them out of the pyxis if you weren't intending to give the whole dose but, because of a poorly designed medication scanning system, you had to bring the vial into the room to scan it. I worked in pediatrics so we'd be giving doses of like 1 mg of IV Valium and it comes in 10 mg/2 mL vials... so whoever was actually giving the medication would be walking around with an extra 9 mg of Valium in a vial. No one ever watched each other actually waste and we all ended up with vials in our pockets at some point during the shift.

I also think it makes sense to save vials for future doses if it's for the same patient. As in the example above, we'd end up wasting 9 mg of Valium every time we had to give a dose. Our pharmacy actually did end up creating smaller doses out of the vials because of the shortage and we were told that, because these were "single dose" vials, it was against federal regulations for them to be used for more than one dose if the doses weren't drawn up under a sterile hood.

[Horseshoe, BSN, RN]

Heck, I remember when xanax, ativan, librium, etc., were not even considered a "lock up" med. They were just laying around in the patient's drug drawer!

I was surprised to find that propofol is not a lock up drug.

[miss81, BSN, RN]

I have worked in facilities where it was acceptable to keep narcotics for the next use. When I worked at a large university teaching hospital, we even kept them at the bedside in PICU. The only thing that really matters is that you follow your employer's policy. Heck, I remember when xanax, ativan, librium, etc., were not even considered a "lock up" med. They were just laying around in the patient's drug drawer! This issue has already been dealt with by your hospital's administration, so I don't know why you are concerned with it. Just waste narcs according to your policy, and no, I wouldn't risk putting them in your pocket.

They're still not locked drugs where I work. Ativan is used left, right and center but it's in the patient's own drug drawer. As far as I know we don't have any issues with that. But I guess I may not hear about some occurences. AND it's not uncommon for nurses to keep narcs to use for later. Especially Morph for chest pain, 10mg mixed 1:1 in a 10cc syringe and you keep it to give 2mg at a time...

[miss81, BSN, RN]

I was surprised to find that propofol is not a lock up drug.

Yes, but at the rate we go through bottles of Propofol we'd never have a cupboard big enough. haha

[noctor4life]

so, a lot of my buddies are starting to joke around about narcotics, now that i'm about to start the nuts and bolts of nursing training. they make jests about "now you can hook up the morphine, bro!" truthfully, i know that they are just making jokes like buddies do. but, in this day and age, i feel so paranoid about drugs and narcotics and stuff, that i don't even want to JOKE about stealing drugs.

do any of you "vets" have any good stories about diversion and stuff that i could tell to my friends, just so i can quench any of these narc "jokes?"

thanks.