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

Nurses Medications

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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?

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.

Ugh, 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.

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.

I 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.

Specializes in Med/Surg, Rehab.

Most 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?

Specializes in Emergency Nursing.

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 :specs:

In many units, even with the best systems, it's truly a pain in the orifice--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. :)

Specializes in ICU.

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?

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.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
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.

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.

Specializes in Med/Surg/Tele/Onc.

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.

Specializes in Emergency, Telemetry, Transplant.

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?

Specializes in Emergency, Telemetry, Transplant.
*** 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.

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