Very little witnessing going on with drug wastes on my floor! - page 4
by Nurse ABC 12,232 Views | 55 Comments
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.... Read More
- 1Oct 14, '12 by SugarcomaThis is pretty common practice. On both units I have worked in my career. Very few nurses actually eyeball your wastes. The first unit we were so crazy busy that we would wait until the end of the shift to meet in the med room and waste all medications at once for each nurse. Not ideal I admit.
I do know that some facilities monitor pyxis access. I was told twice that I had been flagged as someone who pulled a large amount of narcotics. This was usually after a 3 day stretch of several Q2 Dilaudid patients. I am the nurse who will medicate you per order as long as your vitals are WDL. I would have been required to have a drug test if I had forgotten to chart any one of the doses.
The bottom line is that it is frighteningly easy to divert medications if one were so inclined. We have to trust each other a little bit. Honestly if you witness for a coworker who is later found to be diverting,how can that be linked back to you? How could anyone prove that they diverted the dose/s YOU witnessed for as opposed to those some other nurse had witnessed?
- 0Oct 14, '12 by GreenkjiWow! Interesting discussion. I am a new grad (no job yet), but I am shocked that drugs are so often wasted without a true witness. In all of my clinical and preceptor experience, the drug was always drawn up, wasted (with a witness) and then brought to the patient. Always. I would be extremely uncomfortable signing off on anything that I did not actually see with my own eyes. Another point, even though it sounds like all of the nurses are practicing this, I highly doubt it is written that way in the hospital's policy and procedure.
- 4Oct 14, '12 by Nurse ABCIf most people aren't truly witnessing then it's a flawed system and a waste of time to have to find another nurse to scan their badge/fingerprint to get the med out of the machine. Just another way for the hospital to cover themselves while not really protecting the nurses it seems. It would be nice to just have a camera and forgo the whole witnessing thing! Thanks for all the honest responses!
- 0This happens where I work too. Someone has to get the med out, then go to the med cart, draw it up, and then waste it. Some people watch, very few do. The reality is that there are times , I stand around waiting 10minutes OR MORE for someone to even ask to witness, especially on night shift when the number of licensed staff is pretty low. That person is usually on his/her way to do something else and doesn't want to stand there watching. I like to take the med out, bring the order up on the MAR again, then draw it up while looking at the order and the vial/ampule/ whatever a few more times. I don't like to bring the needle in the med room and draw it up there in a rush without checking the order again while drawing up.
- 0Quote from Jessy_RNUgh, we don't have the supplies where the pyxis is. Also we often have a few pts on q1-3 hr morphine/dilaudid etc. What about when pts ask for meds, you draw it up, waste the right amount, go in the room and the pt refuses? in your unit, it's helpful that the other nurse is actually there to witness this also. This happens often enough where I work. (no, i don't want the dilaudid, now I want oxy, no now i want percocets etc) Unless you go and ask the pt if it true who knows whether it is or not.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.
- 1Quote from IndyI don't know where you work or what type of diverters where there but on my unit we get many pts who ring nonstop for pain meds, we get A LOT OF post op pts or pts with chronic pain issues now with acute pain issues. I would never think it suscpicous that one nurse's pt is not sleeping but " in pain" sicne most of the other pts aren't asleep either.Also you can note whose patients actually sleep versus whose patients are on the call light constantly for pain med. Hmm. And docs don't write standard orders for all of what's in a vial all the time, because that stuff is supposed to be based on weight, situation, and tolerance... not on what's convenient for the nurse. Not all patients are huge and addicted. Some are little and delicate.
- 1Oct 15, '12 by sbostonRNMost people at my job do not witness wastes. I am one of the few that do. We have carpets in our hallways (where the Pyxis is), so the nurse usually draws the whole vial of med, then squirts out the unneeded amount onto the carpet (of course this is for small amounts like 1/2 mL).
However I have never gone into the room to witness the nurse give the med to the patient. Yes, the nurse could chart that she gave it while she pocketed the dose. But that's a possibility ANY time a narcotic is given, even when a waste isn't entered. I don't watch nurse #1 give her patient 2 Percocets, so why would I witness her give 1.5 tabs?
- 0Oct 15, '12 by cjcsoon2brnIn our facility most of the nurses don't stay in the med. room to see someone waste the med. that they are witnessing in the Pyxis. Whenever I scan my fingerprint and witness the wasting of a med. I always stay in the room to watch the person waste it. It only takes a few minutes but its worth protecting my license.