There is a situation that came up for me, I'm freaking out, have asked a couple people's opinion...don't know what to do, I'm really hoping that someone has a suggestion.
I graduated in May, got hired onto a hospital a month ago, have been working with my preceptor for almost a month now. Here is the situation- We had a patient with an excerbation of COPD..DNR, seemed to be in some respiratory distress etc. The patient was ordered ativan 0.5mg every 2 hours to help with anxiety. So my preceptor and I go into the med room to draw up the ativan. When I was getting it, the vial that it came was a 2mg vial. So my preceptor tells me to draw up the ativan, and then put the vial in my pocket...this patient is going to need more later, her situation is pretty urgent, and that way we don't waste the 1.5mg. My preceptor says if there is any left at the end of shift we will waste it together. Okay, so right here, I didn't feel real comfortable putting the vial in my pocket, but I ignored my gut, we were in a hurry, my preceptor is getting pissed, etc. (I know, I know always listen to the gut) So anyway the day goes on and the patient ends up getting discharged to Hospice. Fast forward. I leave shift go home, change out of scrubs. Okay so today I go to do laundry, and I feel something in my pants pocket (I put the ativan there, thinking that I would feel it and remember it) it's the damn ativan! I think oh ****...we forgot to waste on Sunday...I have no way of getting a hold of preceptor...I work tomorrow.
I'm freaking out...I took this vial home with me, and I just want this thing out of my possesion. My mind starts wondering, freaking out...so I call a friend who happens to be a nurse at a different hospital. She tells me well this isn't good. You took a controlled substance off the unit, what if the preceptor doesn't feel comfortable wasting with you when you go back to work. She suggests I tell a little white lie and tell my preceptor I left in my tool belt, fanny pack thing, in my locker. My friend said that way it didn't leave the unit. Well I really don't want to lie...at the same time this was an honest mistake of forgetting....I just don't know what to do? Do I go to my unit now, talk to the charge nurse (who doesn't know the situation obviously with my preceptor being with me while the situation happened) or do I wait until tomorrow and talk to my preceptor? I am so anxious about this...and I want to do the right thing...and suggestions?? Thanks so much
Specializes in NICU, PICU, PCVICU and peds oncology.
Our facility doesn't consider it a controlled substance per se. We don't track it like a narcotic or like ketamine and it doens't need to be wasted. I accidentally brought a vial home in my pocket once after a trip to CT with a patient, took it back the next day with the seal intact and had no problems with returning it.
If your preceptor doesn't want to waste with you... you can take the med sheet from the log book (where you signed out the drug, where the waste note should go) and the vial to the hospital pharmacy and they can sign the waste for you. It's a vial, it's a substance they can test and see if it's ativan, it's (hopefully) the correct amount.
In my facility, pharmacy is "the fixer" so to speak. Got a syringe of ativan drawn just prior to a code, unlabeled, in your pocket, that never got used? To pharmacy with ya! Let them figure it out, they'll sign it and tell ya if there was a problem. Got a lortab the patient spat out across the room? Pick the gooey thing up, in a glove, and off you go. Or that pocketful of wet glass with the smashed nubain ampule? Yep. To pharmacy fast before it dries, so they can see what you did. (Tip: don't put ampules in pocket.)
It ain't fun making such weird little impromptu trips to pharmacy with strange packages but it is worth it for your license. A little honesty goes a long way.
I haven't been put in this position but I was wondering if it would be ok to just say that you are not comfortable with holding a narcotic and hand it back to your preceptor to do with it what they wish. I never thought about a situation like this and it may never happen but I'd like to have a plan in place just in case. Jules
I've always been anal about wasting what I don't use right away, but it's simply not always possible right at that moment. I saw one nurse do something - she TAPED the vial to her shirt near the pocket (where you couldn't miss it, with 4" wide tape) and wasted it as soon as she could grab another nurse. She never took a vial home accidently, that's for sure, and the tape covered the entire vial so it couldn't slip out. Not something I'd recommend for every day use, but in a pinch, she never forgot about the darn thing either!
DO NOT LIE. The truth comes out the same every time.
Personally, I wouldn't feel comfortable wasting with someone who took a narc home, nor who left it in their locker, and would have to bump it up the chain of command.
If you feel o.k. waiting until tomorrow that's your decision.
Lesson learned: I am diisagreeing with the poster above. Always immediately waste narcs, no exceptions, any time. This is the legal thing in Florida to do as far as I know. I often give trauma patients meds q1h and if I have to hunt someone down to waste q1h, that's what I do.
I know ICU and ER nurses, and even med-surg nurses are going to disagree with me, becuase "they don't have the time, and it's a waste, etc. etc." That's o.k. My mind is made up for myself on this issue and I'm not going to change it.
Good luck.
I agree with Tweety. In the ED, some of the nurses will do this with meds like MSO4--they're sure the chest pt. pain will need more than one dose, for example, so they pull a 10mg MSO4 and keep it in their pocket.
No, no, no!
Always waste what you haven't used immediately.
My suggestion is you take the vial to your NM first thing Monday and fess up. Personally, I wouldn't waste a med with someone who brought me a med after the fact, but the NM might be able to help you with a way to document what happened.
ETA: I just saw that this happened on a Tuesday, so the OP should have corrected the situation right away, not wait.
Many thanks to all of you who responded to my post. Having the opinions of several people helps me look at things from different perspectives. Well, I went to work on Wednesday, found my preceptor right away, and told her that "we" had forgot to waste the med. She looked at me confused, and said she didn't remember that we had given ativan (at this moment I was a bit worried she was going to forget the whole situation) I gave a quick reminder of the patient. She said ok, let's go waste it. We got to the med room, and tried finding the patient on the pyxis (computerized med dispenser). Well since the patient was discharged that same day we gave her the ativan, she was no longer in the pyxis. So my preceptor said she would talk to pharmacy about it. At the end of shift she found a pharmacist to talk to about it. Apparently the pharmacist said that because the patient had been DC'd it would be considered a med error (?) (didn't really understand why) This all took place the at the end of shift, with a staff meeting after our shift. My preceptor ended up saying we would deal with it later, next day together (which isn't until monday). I didn't know what to do...once again this all happened so quickly...so, on Monday I will ask my preceptor once again if we can handle the situation promptly, and if I don't get any action from my preceptor, I have decided to go to the clinical coordinator (the person above my preceptor who deals with all orientees). I am worried about this because I don't want my preceptor to get in to trouble, but considering I am new, and don't know exactly what to do at this point (i hate that the ativan is in my locker at work still) things have just seemed to spiral out of control with the situation. I can't wait until this is all resolved.
Specializes in critical care; community health; psych.
This happens more frequently than many care to admit. Usually it's handled discreetly without a whole lot of hoopla but that's among nurses who know each other and have developed personal friendships providing a lot of time hasn't passed.
This same situation happened to me and it was Ativan. A weekend went by before I realized I had a syringe in my pocket. I had no choice but to approach a nursing supervisor about it. I didn't think it was right to put any of my fellow staff in an awkward position and I don't feel that close to anyone that I could do what others do and seem to get away with. She called it a med error and had me fill out an incident report. She said she appreciated my honesty, knew it was an honest mistake that happens a lot, and there were no further repercusions.
I want to add that different hospitals have different policies about immediate wasting also. In the ER where I used to work it was correct to pull the Ativan (as an example) 2mg vial from the Pyxis, put that you were giving that amount and then on your computerized charting, chart what was actually given. Than...when the pt was discharged or admitted, the rest of the ativan was wasted. The ativan was labelled with the pts name so that at the end of the night, we knew who to waste it to.
However, this was the policy in the ER and it was different on the floors. So..knowing the policy of your unit is important also.
Good luck - don't worry over this. Just don't repeat it. Take care.
I agree with Tweety on this. You need to waste the aliquot with a wittness for each and every time you administer the medication. As it is, you feel you are in trouble, and 1.5 mg of Ativan is unaccounted for. For the very reason you mentioned, you have no way of knowing in advance that your patient will actually need another dose.
I am very aware that there are certain meds that need to be wasted while someone witnesses that waste. The problem that occured was not lack of knowledge with that, but lack of judgement on my part (putting the ativan in my pocket and forgetting about it) I have definitely learned from the situation. Today it was taken care of, a med error was written for it. I know that this is something I will not be forgetting, and something I will NOT do again! That is for sure!
I've always been anal about wasting what I don't use right away, but it's simply not always possible right at that moment. I saw one nurse do something - she TAPED the vial to her shirt near the pocket (where you couldn't miss it, with 4" wide tape) and wasted it as soon as she could grab another nurse. She never took a vial home accidently, that's for sure, and the tape covered the entire vial so it couldn't slip out. Not something I'd recommend for every day use, but in a pinch, she never forgot about the darn thing either!
Nurses are CREATIVE!
:wink2:
This is an excellent idea and one that I will use A LOT:trout: Thanks for the tip. I can never find anyone to waste with me when I actually need to waste!
NotReady4PrimeTime, RN
5 Articles; 7,358 Posts
Our facility doesn't consider it a controlled substance per se. We don't track it like a narcotic or like ketamine and it doens't need to be wasted. I accidentally brought a vial home in my pocket once after a trip to CT with a patient, took it back the next day with the seal intact and had no problems with returning it.