Very little witnessing going on with drug wastes on my floor! - Page 2

It's not good practice. I wouldn't sign as witness or scan my badge as witness for someone unless I absolutely trusted them. If I didn't know them, I'd watch. I'd probably watch even if I did know/trust them. I also am happy to say I've never used narcotics at work, or ever (except one time I was hospitalized) and have never diverted. That doesn't mean everyone is as trustworthy though, and I wouldn't have hurt feelings if someone insisted on watching me waste.

That said, no one even has 5 extra seconds to spare anymore with how low and crummy staffing is. So I see both side.

At our facility, we have to 'waste' at the pyxis and have that person witness at the pt's bedside by entering their credentials into the charting system and their password.

When we are going to give the narcotic, one of us grabs the syringe and needle that are next to the pyxis while other pulls the drug. It is quickly drawn up and wasted in the sink by the pyxis. Then both scan go it, scan the pt and witnesses in the computer.

It does take a little bit of extra time but for the most part it doesn't because you are mindful of how busy the other person is and have the caremobile (scanner) logged in and ready to go, plus all the 'waste' supplies are readily available where the pyxis is located.

I don't feel comfortable not making sure someone actually witnesses my waste the moment I pull it out of the pyxis.

On none of the units on which I have worked (3 of them) have the nurses followed the 'correct' wasting procedure (i.e. watch the person pull up the desired amount, watch them waste the rest, watch them give the desired amount).

Either someone is in the med room with the RN pulling the drugs, they ask for a waste, and the 2nd RN 'witnesses' a waste of 0.5 mg dilaudid, even though they never see the 1st RN waste the 0.5 mg or give the other 0.5 mg. Sometimes, the person will come out of a room with a vial with 0.5 mL of a clear fluid, say that is 0.5 mg of dilaudid and "will you waste this with me?" Pretty much every RN (and that includes me) will witness that waste. An even worse scenario: the RN comes out of the room and says "I gave 0.5 mg Dilaudid from a 1 mg vial, but I threw out the other 0.5 mg in the sharps bin before someone witnessed it....can we waste it in the pyxis?" Usually, it gets wasted. I'm not defending these 2 circumstances (I've been the 'witnessing' nurse in both of them), but this is how it happens many times.

I imagine that if the nurse who pulls out the drugs diverts the narcs, then the witnessing nurse could be called out on this. On the other hand, I know of a circumstance where a nurse signed out percocets saying that she was giving a pt's his PRN dose. After a couple of days, another nurse asked the pt if he was still in pain after his percocet dose, he said he hadn't needed percocets for a few days (this was a post op pt). Nurse was investigated and it was determined that she was diverting the percs. Point is, even if the waste process is properly done, a nurse can still steal narcs.

At my facility we ALWAYS watch the waste. We do it right in front of the sink, our acudose is next to the sink, we draw it up and someone witnesses it and then we sign off on the waste, ALWAYS. I have never seen someone just walk away. We don't walk away to another room to draw it up.

You don't have to walk away...if you are the one who is the witness just watch. Now if the nurse urges you to leave then there's a problem. Yes it's common and if there are any issues they can drug test you. The reality is no one has time so they may trust you but you don't trust them so just watch...nothing wrong with going by the book. If word gets around that you always watch wouldn't it be interesting to see who doesn't ask you to witness. I myself always have them stick around just in case...some of those nurses are very tricky when it comes to diverting.

There is ALWAYS time to witness a narcotics waste. Trust or not, I am putting my license on the line to document that I witnessed the waste. I don't care if I have a reputation of being too uptight. Besides, it's always the ones that you TRUST who may have diversion problems. When they are eventually caught, your trust will cost you when an internal investigation shows that you and many of the trusted colleagues falsified records as a witness. In my opinion, shortcuts and trust never works. Stick to actually witnessing a waste.

The standard joke in my hospital is "will you waste this 1ml of clear fluid I claim is fentanyl?". Seriously though you are not reponsible for what other nurses do. However when YOU accept responsibiliety of witnessing a waste, make sure you actually do so.

I always made them stay to actually witness me and it was a rare occasion when I didn't stay to witness them. We had an omnicell and when I needed a waste, I'd draw up the entire contents, waste what I didn't need, document with my witness on omnicell, and carry my dosed-ready syringe and empty vial to the pt's room. It didn't take long.

In the acute care settings, I was never watched, and I always watched.

Same way with insulin.

My Advice to you is dont sign for what you didnt see! I worked in a hospital where we did what you described and an RN was using it on herself!
I have never ever since that time not witnessed a waste