Coached on carrying Narcotics in my pocket...

xtxrn, ASN, RN · Aug 12, 2011

I checked out two Norcos for my patient but at the bedside, I noticed he is allowed only one at a time. I told him he can have the other one in 4 hours. I put the pill in my pocket and gave it after 4 hours. When my supervisor found out, she had me sign a "coaching record" and told me I should have learned this from school - not to carry narcotics in my pocket. I have been all upset since this happened and can't get it out of my head. Any thoughts? Thanks!

Your supervisor is absolutely right. Basic med administration rules. Never carry any med around with you- ESPECIALLY narcs... great way to find yourself unemployed, or reported to the BON.....

Anna Flaxis, BSN, RN · Aug 12, 2011

Your supervisor is correct. You should have returned the extra pill and taken out a new one four hours later.

milwerica, MSN, APRN · Aug 12, 2011

When I was in nursing school doing my clinical rotation I had a preceptor do the same thing with IV push morphine. Kept it in her pocket until she remembered later that night to put it back. I felt it was time to say good bye to that preceptor. She had no idea why I was flustered. Really IV push morphine in your pocket on a peds unit... but it is the way others tend to get slack when they are in the same job for so long I guess... I hope to not get that slack. It is important to follow the rules because you never know if you may lose the med, have to go home early.. so on

Crux1024 · Aug 12, 2011

I agree with the manager too. Where I work, a narc has to be given 1/2 hour after its taken out of Pyxis or we get a warning as well. It just serves as a reminder. Learn and move on.

cometnurse · Aug 12, 2011

Try not to beat yourself up about it, think of it as an opportunity for education. New things happen all the time and even though what you did seemed harmless, it is not the best practice. Your supervisor was correct in helping you realize that and it is realy for your own protection, not just to cause you an uncomfortable situation. We have a very strict policy about narcotic administration and returns/wastes where I work that was instituted to proctect us. Drug diversion is a problem all over the country and it is best to avoid any sort of situation that can make you questionable. Try not to loose sleep over it though, its done and overwith and now you know what the best practice in this regard for the future.:)

TiffyRN, BSN, PhD · Aug 12, 2011

I used to work on an adult unit that routinely had orders for "morphine 2-5mg IV q2-4hrs PRN". It's going on a decade since I worked there and it's my understanding that those kinds of orders are no longer acceptable.

So anyways. . . I used to pull out a 10mg/ml morphine (the only concentration stocked in our pyxis), pull what I needed for the 1st dose, then tape the vial to the back of badge over the scan bar used to clock out. That way I wouldn't clock out without wasting any remainders. If the patient needed another dose, I pulled it from the same vial, in my mind, saving them money!! I saw later how potentially dangerous this was, but no one thought anything of it on this unit.

I also feel really old in that in the days before we got our Pyxis, space was at a premium in the narcotics lock box. Therefore only C-II and C-III were locked up. Which meant things like ativan, restoril and xanax were just sitting in the unlocked patient med drawers.

It may have been kind of harsh to write you up the 1st time this happened, but I can understand it, especially if this supervisor had dealt with true diversion in the past.

xtxrn, ASN, RN · Aug 12, 2011

I used to work on an adult unit that routinely had orders for "morphine 2-5mg IV q2-4hrs PRN". It's going on a decade since I worked there and it's my understanding that those kinds of orders are no longer acceptable.
So anyways. . . I used to pull out a 10mg/ml morphine (the only concentration stocked in our pyxis), pull what I needed for the 1st dose, then tape the vial to the back of badge over the scan bar used to clock out. That way I wouldn't clock out without wasting any remainders. If the patient needed another dose, I pulled it from the same vial, in my mind, saving them money!! I saw later how potentially dangerous this was, but no one thought anything of it on this unit.
I also feel really old in that in the days before we got our Pyxis, space was at a premium in the narcotics lock box. Therefore only C-II and C-III were locked up. Which meant things like ativan, restoril and xanax were just sitting in the unlocked patient med drawers.
It may have been kind of harsh to write you up the 1st time this happened, but I can understand it, especially if this supervisor had dealt with true diversion in the past.

I also remember the days of no Pyxis (the rep stocked ours with candy when we first got it so we'd all go foraging for stuff and learn how it worked ).

It will also protect the nurse to just do it right- if people get used to doing it wrong, then it's hard to explain away anything that comes up that may seem like diversion....and nobody wants to go down that road. :) Even a nurse with no prior hx of diversion can come under fire, since a LOT of the ones who do divert are often very good nurses, and nobody suspects them. This may be a favor, to bring it to your attention :)

NicuGal, MSN, RN · Aug 13, 2011

Absolutely right, you should have returned the other pill. That would have been bad if you forgot about it and walked out with it.

OCNRN63, RN · Aug 13, 2011

I checked out two Norcos for my patient but at the bedside, I noticed he is allowed only one at a time. I told him he can have the other one in 4 hours. I put the pill in my pocket and gave it after 4 hours. When my supervisor found out, she had me sign a "coaching record" and told me I should have learned this from school - not to carry narcotics in my pocket. I have been all upset since this happened and can't get it out of my head. Any thoughts? Thanks!

Big no-no. But I have to admit, I did something very similar to this when I worked in the ED. If we had someone in with chest pain and MSO4 was ordered, most of us would sign out a 10mg carpuject of MS, give what we needed then tape it to the back of our badges, because we knew we were more than likely going to push more in a few minutes.

Putting pt. narcotics on your person can put you in a situation where you could be accused of drug diversion. Take the counsel you were given and chalk this up to a lesson learned.

tokmom, BSN, RN · Aug 13, 2011

Back in the stoneage, you could put a pill or vial in your pocket. Those days are gone (thankfully) and people have to be accountable.

I actually worked with a nurse that was suppose to count a pt's own ativan out of a bottle that was kept in pyxis. Instead of counting, she pretended to return it. Her excuse? It took to long to count. Can you say 'write up?'

You learned your lesson. No harm or foul. Move on. :)

SydneyJo1 · Aug 13, 2011

I had a clinical instructor who actually instructed us to carry meds in our pockets!! I had no idea how big a no-no this was until I was in my last clinical rotation and my instructor just about had a stroke after seeing me pulling meds out of my pockets.