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......

[MN-Nurse, ASN, RN]

thank you for listening to my vent......

Not sure what you are venting about?

RN was unaware she was running afoul of company procedures, but gave all the narcs she pulled from the pyxis. RN told to do it right next time, and apparently agreed?

[loriangel14, RN]

What she did would be considered very wrong where I work.I have never heard of any place not requiring a waste done with a witness.It doesn't matter if she has to give another dose later.Sticking a narc in your pocket is not ok.I wouldn't expect that they would fire over this issue unless she ignores the reprimand and keeps doing it.

[ohmeowzer RN, RN]

NoThe nurse said the company was wrong requiring 2 nurses for a waste and she showed them the policy and they just said ok ... Sorry i didn't clarify that... But I've worked for this company 9 years and always required a witness ..

[stargazer88]

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.

[ohmeowzer RN, RN]

I am ohmeowzer and ohmeowzer RN somehow this computer remembered my old password which i long forgot .. I guess I can go back to my former log in ! Anyway thank you for your input ! This is a weird situation I know

[BostonTerrierLover, BSN, RN]

While I ALWAYS say stick with your hospital's P&P, and even unwritten culture, at some facilities it is Okay, and expected to not waste a narcotic until the end of shift at count- or sometimes not even then! Yes, every facility is different. This practice was usually done at small critical access rural hospitals and medical centers.

That said, a few notes:

1. I would NEVER keep the medication in my POCKET until next dose. I would NEVER pocket a NARCOTIC (Just too risky).

2. I DO NOT like this practice. It is TOTALLY based on trust when you come in, and a TB 1ml Syringe is labeled Morphine Sulfate 1mg/mL! First, the vial has slightly over 1mL anyway- so the dose is going to be "off" anyway- or waste is going to be "off."

3. Most of these small facilities had Multidose bottles of Narcotic Containing Cough Medicine, Liquid Lortab Elixer, Belladona Alkaloids, etc. They were constantly and consistently off by 5-10 mL, and that drove me CRAZY. They were double locked in a tackle box in a Locked Refrigerator.

4. I hated the Buccal Oxycodone for Hospice patients that the RRT administered usually by Nebulizer (a local MD's regular order for the Death Respirations that worked well!) She liked for the nurse who had the patient to keep it on their person for fast access on her rounds- NEVER, . . .Sorry! I could just see losing a HUGE MULTIUSE bottle of Oxycodone, or going home with it. And, . . .It's was impossible to measure it! It was done by gtts/mg! I always had a second Nurse witness WITH me that I was giving the RRT 10 Gtts! I just get REAL FREAKED around Narcotics!

You can't be tooooooo careful, and you will NEVER regret being TOTALLY ANAL about Narcotics! and Narcotic Safety!!!

[tothepointeLVN, LVN]

One of the hospice companies I staff for as a continuous care nurse drives me crazy. There is no monitoring of the narcotics none, zip nada. Other than your narrative there's no record of a med being given or how much is in the bottle when you start your shift. Oh and when the patient passes a nurse from the company comes over not to help you out with all the stuff you have to do. No they come over to pick up the narcs and transport them to god knows where. Other companies have med sheets and require counts and witnessed disposal. Not this one. I've gotten into the habit of counting before their arrive, documenting and then sealing the narcs in the comfort kit box and sealing with signed tape. It's the best solution I can think of. They have no official policy.

[Altra, BSN, RN]

NoThe nurse said the company was wrong requiring 2 nurses for a waste and she showed them the policy and they just said ok ... Sorry i didn't clarify that... But I've worked for this company 9 years and always required a witness ..

So ... either she and the facility are misinterpreting the written policy ... or you & others have been mistakenly misinterpreting it for a long time.

I would go read the policy, as that is the only thing that matters here, assuming that the policy is in accordance with applicable laws.

Policies regarding many, if not most, things can vary hugely from place to place.

[Been there,done that, ASN, 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.

I have worked in facilities that can fire you for putting a narc in your pocket. Sure, it is a waste and a bother to throw away the extra dose and find a witness.

Oh well, she needed to get over it.. follow the rules.. instead of trying to prove them wrong!

[Horseshoe, BSN, RN]

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......

So are you saying you wanted her fired? Unless she was diverting, I see no reason why she wouldn't just be written up, counseled as to the proper policy, and told to follow it in the future.

Years ago on my unit, we did exactly what she did-someone on frequent narcs-you'd just hold on to the morphine (usually in a drawer but occasionally in the pocket) for the next use. Two nurses did have to waste, though. Policies have changed on this, but I can see how someone who worked for years at a place where needless wasting of medications was avoided could have been unaware of this policy in a different environment.

[netglow, ASN, RN]

Yeah, don't get why you are so peeved OP.