Your Policy for S/C Narcotic Discard?

[All4Seasons]

Occasionally we give narcotic via S/C in our PACU (in those floor pts being held here o/n, or as part of the APS orders (I'm not sure you all call it that,so I'll say Acute Pain Service -they do the PCA,CPNB orders etc).

We handle our discard of the narcotic not used a certain way here,and an LPN we recently hired (and let go) who just finished a medication course so she could work in our Phase ll-type unit,says she was taught a different way.

We RNs draw up the entire drug (say we're giving 1mg Hydromorphone from a 2mg/ml vial),connect syringe to butterfly (but not in pt yet), and squirt out (discard) all but the desired dose - we have a colleague witness as we do this,confirming how much we discarded/are giving. She/He then cosigns the narcotic record.

My LPN colleague,newly through her course, drew her drug up,gave it to the pt (didn't even have someone double check her dose as a new narcotic practitioner -I would've!),then directed me over to a Hydromorphone vial with an unknown amt of narcotic in it and asked me to sign for it. Huh??! How can I legally sign for an amount that you haven't shown me? She said her instructor said they only needed to show THAT narcotic was discarded, not the specific amt. I was very uncomfortable with this. Here we have every syringe of IV narcotic double checked by a colleague for drug and label match. As well,amts left in the syringe at the end of care are confirmed by another nurse,then signed for. So we're used to all this checking -and we believe it's good practise.

Do you have a colleague witness how much you're discarding of an s/c dose in your unit - PACU or otherwise - anyone's invited to answer? Thanks!

P.S. And,since I'm asking about meds, do you double check each other's S/C insulin doses? Do you cosign or not?

[azhiker96, BSN, RN]

Maybe her instructor only needs to see that some narcotic is wasted. If she wants me to cosign, I need to see how much is wasted. The only time I haven't shown a collegue an amount was when I stupidly put a syringe in my pocket and created a 5cm wet spot on my scrubs. I asked my CM to cosign for that wastage.

[PostOpPrincess, BSN, RN]

We have special syringes we use so that when we give the narcotic there is no way to "pull it out" of the syringe PRIOR to giving to the patient. It stays put and everyone can see it.

When we waste, there is a sink in front of the Pyxis--we show a colleague and waste in the Pyxis, the stuff goes down the sink.

This happens all day long so...but we deal with it--since we do it so frequently, it's not so bad.