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?

Specializes in Med/Surg/Tele/Onc.
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.)

Specializes in Med/Surg/Tele/Onc.
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...

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!

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

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.

There's a million ways narcotics could be diverted. No facility has a fool proof system and none ever will. But addicts are addicts. And addicts are sloppy and desperate. That's why addicts always get caught.... Eventually.

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Moved to Nursing and Patient Medications.

Specializes in Pediatric Cardiology.

We usually witness, the nurse will draw up the medication and waste the proper amount in front of the witness. The nurse then takes their syringe and empty med bottle in the room to scan and administer. Easy enough and no one is witnessing then running away. Occasionally, if it's really busy people will say they trust you and you waste without anyone around. It takes an extra second since it's expected that you have everything ready when you take a med out of the pyxis.

I often couldn't find anyone to witness so I just said I was giving the whole of dilaudid or morphine, then would come back later to waste when someone was with me. There were a few times in the last several weeks where the shift would end and I couldn't waste the medications I had not given. For some reason someone on my floor likes starting rumors. She said I was having an affair with a day nurse (I work nights). She later told someone in administration that I was using drugs in the bathroom. When they heard this and saw that my wasting didn't match, they fired me and now I'm being brought before the board. I am probably going to lose my license. Always waste right away with a witness. Make them watch you and report them to your manager if they wont.

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