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?

[noyesno, MSN, APRN, NP]

Doesn't sound unusual. Not one nurse on my floor actually sticks around to witness. We just scan our finger in the Pyxis and run back to the med/surg hurricane.

[KelRN215, BSN, RN]

That's how it was when I worked in the hospital. The pyxis required fingerprints and, due to med scanning, you had to bring the vial into the room with you. Valium, for example, came in 10 mg/2 mL vials. Hardly anyone would watch the nurse caring for the patient draw it up and watching him/her waste the vial after they scanned it in the room most certainly never happened. This was pediatrics so we were frequently giving doses of like 1 mg of Valium. Someone could easily have pocketed the other 9 mg and no one would have known the difference because the waste was documented in the pyxis. As far as I know that never happened, but I wouldn't be surprised to find out if it did...

[nurse2033, MSN, RN]

This lax approach is pretty common, but you're right, it has little accountability. They probably haven't had a drug stealer get caught yet, because that would be when they revise their policy. When you feel comfortable with your boss I would schedule a meeting to discuss it. Hopefully they embrace the open door policy. From your boss' perspective, it wouldn't hurt them much if you lost your license in a bad situation. A slightly better way is to bring the extra back to the pyxys and have it witnessed then. This might require a reprogram of the machine. If you put this in an email to your boss, you would show initiative and have a record that you tried to do something about it. It really is for safety of staff and patients.

[CalicoKitty, BSN, RN]

Our system lets you remove the medications first "Just say yes to planning on giving it all" then coming back to witness the waste on the pyxis later. I do that with the remainder in vials sometimes if a witness isn't in the room when I take it out.

[june2009]

We had a similar system in the hospital I worked at and guess what? I pocketed the wastes every time. I self reported to my state BON and have been clean for two years now but those things do happen. I was caught pretty early on due to my other symptoms of using but I'll tell you if I ever go back to hospital nursing, I'll make sure to actually watch nurses waste the unused medications.

[Perpetual Student]

We had a similar system in the hospital I worked at and guess what? I pocketed the wastes every time. I self reported to my state BON and have been clean for two years now but those things do happen. I was caught pretty early on due to my other symptoms of using but I'll tell you if I ever go back to hospital nursing, I'll make sure to actually watch nurses waste the unused medications.

All they gotta do to get around that is put some clear fluid in the vials. Shy of taste-testing or sending it to a lab, there's no way to really be sure.

[BlueDevil,DNP, DNP, RN]

No, not unusual. No one has time to stand around and watch someone else draw up and waste. In 20 years I think I could count on my 20 fingers & toes the number of times I actually did that "by the book" or was observed "by the book." I was always honest about my wastes myself, because I didn't ever have anything else I wanted to do with it, lol. I have no idea if the people I was "witnessing" were always honest or not. Probably most of them were, but statistically some of there were not. C'est la vie. I wouldn't make a big deal out of it if I were you. Your manager already knows this, and s/he isn't going to thank you for making her acknowledge a situation s/he would much rather turn a blind eye to. You and she both have bigger problems, I'm sure.

[h=1][/h]

[CASTLEGATES]

I know several nurses who have taken advantage of that situation by collecting the wasted meds and having a party. Always stick around. You don't want to supply that 10% of nurses who are getting high (we're no different than the general population and in acute areas, stats say the percentage is higher). If not, I'll take care of them once their license has gotten into turmoil and the trouble that comes to those blind witnesses who supplied them.Wait for someone to die at the workplace from an overdose and you'll do things differently. Most facilities know of at least one who did so at work only to see the weeping family filing in after the incident when they didn't survive.

If you want to find whose using on your unit, it's not that hard to find 'em if you KNOW what you're looking for. Most every unit has at least one. Why don't people think about the rules and why they're there? We went to school for how long to get our licenses? We could easily be supplying our friend for their death.

...Perfect example of State Board's "did the nurse follow Basic Entry Level Nursing Practice (or not)?" -and they will question WHEN, not IF the person using the wasted drigs is nabbed, 'cause that's always the question, "How did you obtain schedule III, II narcotics"). Attend your state disciplinary hearings and federally charged DEA cases and you're eyes will be opened to the suppliers and the users neccesary to kill someone (patient or coworker). I know SEVERAL (not one or two) who died from "wasted" drugs.

Questions always follow why established federal laws were not followed (federal charges don't have parole). I'm shocked at how many mentioned consciously ignore federally mandated DEA laws, 'cause I can't imagine a state shirking this responsibility. They do however, write it clearly when we're all licensed in case the state failed to properly train and warn of the DEA.

[Jasminelfue]

If its me , I will stick around. Just remember its our license on the line. A couple extra seconds and you keep your license.

[JZ_RN]

It's not good practice. I wouldn't sign as witness or scan my badge as witness for someone unless I absolutely trusted them. If I didn't know them, I'd watch. I'd probably watch even if I did know/trust them. I also am happy to say I've never used narcotics at work, or ever (except one time I was hospitalized) and have never diverted. That doesn't mean everyone is as trustworthy though, and I wouldn't have hurt feelings if someone insisted on watching me waste.

That said, no one even has 5 extra seconds to spare anymore with how low and crummy staffing is. So I see both side.

[RosesrReder, BSN, MSN, RN]

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.