Very little witnessing going on with drug wastes on my floor!

[Nurse ABC]

I'm new to this med-surg floor. When we get a drug like morphine out of the Pyxis it asks if we are going to give the whole amount. If we say no it asks for a witness. The "witness" will come in and scan their badge and leave. The pyxis will then open the drawer for you to remove the narcotic. We then take it to the room, scan the pt and med, draw it up, waste the proper amt and give the rest. No one witnesses this. I first tried leaving the extra med in the bottle so I could prove what I gave and was told this was wrong-that we withdraw all of it and squirt out in the trash what we don't need. No one will stand at the Pyxis and wait until the med is drawn up and wasted because their ID is needed before the med is even taken out of the Pyxis and no one has time to watch. No one follows you to the room to actually witness. Once it's drawn up, no one could prove it's really the narcotic. I'm not sure what to do. Everyone just says I trust you and if anyone has a concern they'll just drug test you anyway. Is this common? I'm a little concerned because I don't want to be someone's witness and it come back that they were abusing drugs or selling them or giving the wrong amt or whatever with my name beside theirs. Am I worrying too much or should I talk to the manager?

[psu_213, BSN, RN]

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.

[cardiacrocks, BSN, RN]

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.

[tyvin, BSN, RN]

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.

[Heart2015FNP]

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.

[PMFB-RN, RN]

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.

[MoopleRN]

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.

[SCSTxRN]

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

Same way with insulin.

[madwife2002, BSN, RN]

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

[lockheart678]

At my first job, I always watched the waste. I never saw anyone around there who would just walk away without watching the med be wasted before signing their name. Where I work now, people will just state what they're wasting and half the time, they've already squirted it out before you even had a chance to look. I do watch people waste, but most don't watch me when I do it. The way they've got their system worked, it would be so easy for someone to get quite a stash if they have a drug problem. I've even heard of someone who did have a drug problem before I ever started, yet that experience has not changed anything that they do.

[NurseOnAMotorcycle, ASN, RN]

So much easier to just put a camera in the med room. Then we can all just do our jobs without putting our license on the line for someone else's actions.

[turnforthenurse, MSN, NP]

It's like that where I work, too. There is a camera in the med room and all of us trust each other, too. We had a nurse who we knew was stealing drugs, it was very obvious...so when we always stood there and watched her waste. Otherwise, we just put in ID/password or fingerprint and then go back to the craziness on the floor.

[OnlybyHisgraceRN, ASN, RN]

I don't stick around for the waste. If someone wants to use narcs on the job, it really isn't that hard. As someone stated, they can draw up the narc, and refill the vial with water. We never know what is in the vial.