Very little witnessing going on with drug wastes on my floor! - page 4

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... Read More

  1. Visit  cjcsoon2brn profile page
    0
    In 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.

    !Chris
  2. Visit  samadams8 profile page
    0
    In many units, even with the best systems, it's truly a pain in the arse--costly in terms of time.

    But you need to know that just about all areas are under video surveillance. If anything comes into question, these videos can be reviewed. In fact, there isn't a place where monitoring isn't possible. Even in homecare, there are many homes in which direct monitoring of the client and nurse is done. If you work in nursing or healthcare, get used to the fact that you are always in a fishbowl. So, do you think the dispensing devices, whichever the facility uses, are under video monitoring? There is internal monitoring for waste, but theoretically what is to stop the monitoring of the actual wasting of the med?

    I'm used to the fishbowl b/c of working in intensive care units. Nurses need to follow the protocol to the letter. The problems arise when something is urgent or you are pre-coding or getting ready to code situation--when things are moving quickly. Then you have make sure you go back and reconcile the narcotic, the waste, etc.

    Places have to function as if all are potential abusers, even though many aren't.

    I look at like this. God's big video tape is rolling, so what's more video taping? I accept the fishbowl and am fine with it. Follow the protocol.

    I only wish we could find systems where it wasn't so time intensive or required stopping other people in their work. I mean people are busy.

    Maybe they should provide the meds such that they are at the smallest possible dose to ANY human being and then count up as needed. Of course this would be more expensive, so it's unlikely that will happen. In other words, package for doses of premies and supply up in units. Of course when you get to bigger kids and adults, you will be pulling out an awful lot of small units, but if you go from smallest up, you shouldn't have waste--or at least not much at all. We all know, however, that smaller unit packaging is more expensive that bigger.

    Now, if they had an aseptically automated dispenser system whereby the dose would be calculated and procured with the dispensing system--such that each and every dose is individualized, we wouldn't need co-signers for waste; b/c the machine would draw up and dispense EXACTLY what you are using for that very dose and that dose only; but that would be some expensive engineering.
    Last edit by samadams8 on Oct 15, '12
  3. Visit  sapphire18 profile page
    3
    No one where I work watches either. If someone is going to divert, they will find a way to do it. When they are caught, how are they going to know which nurse's "witness" was legit and which wasn't?
    anotherone, noyesno, and All4NursingRN like this.
  4. Visit  All4NursingRN profile page
    0
    working in an extremely busy ER, and I mean dangerously busy, like a new patient from triage every 10 minutes, or crazy resus bay we never actually stand and witness wastes. Unfortunately we are moving so fast and have so much to do no one makes a big deal out of it because you have to draw it up (and on horrible nights sometimes the syringes by the pyxis may not be stocked, so you'd have to run around the entire ER looking for a syringe and needle just to have someone watch you do it. You wouldn't think 2-5 minutes to do the whole waste thing the proper way is alot of time, but when you have so much to do, patients, doctors calling you, agitated-confused patients, etcc you just need to get on with your work and get things going.

    Sometimes I will take out what I need and and show the remaining liquid in the vial, but like someone said you can put any liquid in their who would know, especially if it's super busy.

    There are so many things we are supposed to be doing but if we actually did it the way we should (which we absolutely should) work would never get done, and trust me i've tried to do things the right way and it just doesn't pan out.
  5. Visit  PMFB-RN profile page
    0
    Quote from All4NursingRN
    Sometimes I will take out what I need and and show the remaining liquid in the vial, but like someone said you can put any liquid in their who would know, especially if it's super busy.
    *** I used to work at a hospital that had colored narcs. I think morphine was green, dilaudid blue, fentanly pink and I can't remeber the others. Still wouldn't be impossible to cheat but it would take some going to get the color just right.
  6. Visit  BrandonLPN profile page
    1
    If someone really wants to divert narcotics, there's no policy on wasting or counting that will stop them every time. Or even *most* of the time. But once somebody starts down that road they will keep going. And get sloppy and get caught. Everyone gets caught eventually, it's just a matter of time.
    anotherone likes this.
  7. Visit  mappers profile page
    2
    The system is broken. People who design these checks and balance systems really work in the trenches to see if it is practical on a day to day basis. Does drug wastage need to be witnessed? Absolutely! But the people who designed the pyxis and the people who designed the bar-coding/scanning software never talked to each other (or to a nurse on the floor.)

    Need some good Old-Fashioned Six-Sigma or Kizan in there to look at this. This is where that kind of approach is appropriate - not on how nurses talk to patients and how to increase "customer service" scores, which unfortunately is where it is used the most.
    tokebi and anotherone like this.
  8. Visit  psu_213 profile page
    0
    A quick question for everyone who actually stays in the med room to watch the other nurse waste the med...do you actually go with that nurse to make sure that nurse actually injects that med into the pt? Whats to say that nurse didn't draw up 0.5 mg dilaudid, you saw him/her waste the other 0.5 mg, then he/she injects the pt with saline and takes the dilaudid for him/herself? Point is, if you are going to be 100% certain the narc actually gets to the pt and is not diverted, don't you have to witness them actually give the unwasted portion of the med?
  9. Visit  psu_213 profile page
    0
    Quote from PMFB-RN
    *** I used to work at a hospital that had colored narcs. I think morphine was green, dilaudid blue, fentanly pink and I can't remeber the others. Still wouldn't be impossible to cheat but it would take some going to get the color just right.
    Not a bad idea, but as a pt I would be a little wary of a nurse injecting me with a mysterious liquid that may be dilaudid or may be Windex.
  10. Visit  mappers profile page
    0
    Quote from psu_213
    A quick question for everyone who actually stays in the med room to watch the other nurse waste the med...do you actually go with that nurse to make sure that nurse actually injects that med into the pt? Whats to say that nurse didn't draw up 0.5 mg dilaudid, you saw him/her waste the other 0.5 mg, then he/she injects the pt with saline and takes the dilaudid for him/herself? Point is, if you are going to be 100% certain the narc actually gets to the pt and is not diverted, don't you have to witness them actually give the unwasted portion of the med?
    Nothing, but what exactly are we witnessing? I think we are witnessing that they waste "extra" portion of the med. I don't know of any place that requires nurses have witnesses to actually giving the med. That's not what I'm signing off on, when I put my code in the pyxis. I don't think it is really our responsibility to make sure narcotics don't get diverted by other people. I mean there is only so much a floor nurse can do. If I suspect something, then sure, I'll report it. But then it is in someone else's hands, not mine.

    By the way, when I worked the floor we did not have scanning at the bedside yet and we did actually witness other nurses wasting meds in either the sink, the garbage can (liquids) or the sharps box (pill fragments.)
  11. Visit  mappers profile page
    0
    Quote from samadams8
    Now, if they had an aseptically automated dispenser system whereby the dose would be calculated and procured with the dispensing system--such that each and every dose is individualized, we wouldn't need co-signers for waste; b/c the machine would draw up and dispense EXACTLY what you are using for that very dose and that dose only; but that would be some expensive engineering.
    They can engineer a system for McDonald's that automatically dispenses the cokes into the correct size cups for the drive thru by order so a person doesn't have to actually, you know, put ice and soda in a cup. (Because God Forbid someone divert diet Mountain Dew). But they can't figure out a way to safely dispense narcotics, heparin, insulin...
  12. Visit  MoopleRN profile page
    0
    Quote from psu_213
    A quick question for everyone who actually stays in the med room to watch the other nurse waste the med...do you actually go with that nurse to make sure that nurse actually injects that med into the pt? Whats to say that nurse didn't draw up 0.5 mg dilaudid, you saw him/her waste the other 0.5 mg, then he/she injects the pt with saline and takes the dilaudid for him/herself? Point is, if you are going to be 100% certain the narc actually gets to the pt and is not diverted, don't you have to witness them actually give the unwasted portion of the med?
    That's a good point that' I've never thought of. No, I don't witness the administration of the med after the waste. Maybe it still got diverted. Hopefully the patient's c/o pain (and the f/u) that would carry on to the next shift would be a head's up the pain isn't being controlled. You raise a really good point that I don't have a practical solution for!
  13. Visit  PMFB-RN profile page
    0
    That's a good point that' I've never thought of. No, I don't witness the administration of the med after the waste. Maybe it still got diverted.

    *** The vast majority of people I give narcs too are intubated and sedated. Usually on propofol. They are in no shape to say wether they got thier narcs or not. Diversion at the bedside would be really, really easy.

    Hopefully the patient's c/o pain (and the f/u) that would carry on to the next shift would be a head's up the pain isn't being controlled. You raise a really good point that I don't have a practical solution for!

    *** No solution needed. The more controls you put on pain meds the less will be given. For example our hospital used to use PCAs all the time. We have a nurse push PCA policy in ICU and we usually ran a basil rate. Then a year ago the PCA charting and checks went from being pretty easy and quick to very time consuming and difficult. All of a sudden we hardly see PCAs anymore. The nurses don't advocate for them so the physicians hardly write for them and when they do the nurses just groan. The nurses would much rather do IV push pain meds than deal with the huge time demands our current (new) PCA policy demands. It is my observation that pain is not as well controlled as it used to be.

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