Coached on carrying Narcotics in my pocket...

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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!

Specializes in LTC, Hospice, Case Management.
I she had me sign a "coaching record" !

As a supervisor, I love to use a coaching record too. It is a way of saying "Hey you screwed up, I want you to do it like xyz, and I am pretty sure you just didn't know better so at this moment I am giving you the benefit of the doubt without making it a formal write up".

Don't be too hard on yourself. Just learn from your mistake and move on. Also, appreciate that you have a boss that is apparently not one to over react at the first mistake - some are.

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Specializes in PICU, Sedation/Radiology, PACU.

As soon as I read this post I checked my pockets to make sure I had not accidentally left work with anything I shouldn't have. :nono:

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:redpinkhe

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.

OMG! I'm sitting here laughing because I remember we used to tape the Fentanyl ampule to the warmer in NICU. We had to sign it out in Postpartum and it made sense to not waste the vial when we used so little! I also remember patient's who would refuse their Darvocet or Xanax, no big deal, at the end of my shift I'd empty my pockets and stick em back in the patient's drawers. You can bet I'd never get away with that now! Seriously, you'll look back at this one day and laugh.

Nowdays with diversion at an all time high, I'm gonna be squeaky clean. The Recovering Nurse Program is nothing nice, and there's nothing like having to call everyday to find out if it's your day for a random drug screen. Coaching is just that education, it does go in your file but it's not a write up. Relax, eat some chocolate, call a fellow nurse and get some sleep

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Anyone else think it just seems unhygienic to be putting meds into your pockets? Who knows what's been festering in there after a few hours on a shift. I can vaguely look past the diversion issues, but the infection control issues here seem concerning.

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Specializes in ICU.

For people who do not divert drugs, it is hard to imagine that there are nurses who actually do. Not just narcotics, either. Don't try to save the hospital money, just go ahead and waste any unused narcotics, and don't carry them in your pocket. We live in an addicted world now, and nobody will believe you just innocently dropped a narcotic in your pocket, fully expecting to use it.

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Specializes in Emergency Dept. Trauma. Pediatrics.
Anyone else think it just seems unhygienic to be putting meds into your pockets? Who knows what's been festering in there after a few hours on a shift. I can vaguely look past the diversion issues, but the infection control issues here seem concerning.

I would think the outside of my pockets are probably cleaner then the inside. I am not sticking dirty things into my pockets, my shirt pockets anyway. My hands are in there but I wash them entering and leaving a patients room. Not to mention all the meds I give are packaged. So not sure how they are contaminated. I am not touching them either.

We can't return Narcs, they have to be wasted.

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Specializes in Cardiac, PCU, Surg/Onc, LTC, Peds.
I would think the outside of my pockets are probably cleaner then the inside. I am not sticking dirty things into my pockets, my shirt pockets anyway. My hands are in there but I wash them entering and leaving a patients room. Not to mention all the meds I give are packaged. So not sure how they are contaminated. I am not touching them either.

We can't return Narcs, they have to be wasted.

We can return oral narcs that have been unopened with a witness. The same with an unopened vial or syringe of say dilaudid.

I would not guarantee my pockets are sanitary. That is why I wash my hands before touching the patient and don't put any type of patient supply in my pocket.

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Specializes in Emergency Dept. Trauma. Pediatrics.

I wouldn't guarantee mine are sanitary either, I just don't see how they are any MORE dirty. Or how meds would be contaminated in them when they are in sealed containers and packages. I wish we could return them, I see so much go to waste. Especially because we have primarily peds patients and the stock is more fitting for adults. Like the 12.5 mL containers of Tylenol with Codeine and most times I am only using 2-3 mL's. The other day we only had 10 mL vials of Morphine and only needed 1 mg each time. Lots and lots of waste.

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Specializes in Paediatrics.

I'm so glad we don't have this pyrix system (?sp). Here we only lock up the S8's like the morphine, fentyl and the S4's (like panadine forte and diazapam) All other drugs are just in the cupboard and we take them out and give them, none of this electronic recording. It seems so big brother, but I'm sure it's helped pick up diversion and other issues too, just to me, who's never experienced working with this scan system before it seems overkill.

I can't say I've ever carried medication in my pockets? Maybe paracetamol (When in med/surg) and ibruprofen, so when a patient asks for some I didn't have to do the big trek back to the treatment room to get some out the cupboard (:p lazy much?). Everything else is pretty routine, get out of bedside drawer/ treatment room cupboard or sign out of the S4 and S8 drug book. Double checked as we get it out of course.

Here our S8 left-overs are wasted. If patient refuses or something, we can put it back in the locked cupboard and cross out our order in the book with two signatures, stating 'not give, client refused' or something of the like.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

You'll be fine. Most of us have made mistakes in our careers...the trick is to learn from them.

Use your critical thinking when considering a short cut...

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Specializes in PICU, Sedation/Radiology, PACU.
Anyone else think it just seems unhygienic to be putting meds into your pockets? Who knows what's been festering in there after a few hours on a shift. I can vaguely look past the diversion issues, but the infection control issues here seem concerning.

Pills come packaged in sealed plastic or aluminum wrappers. As long as the package is opened correctly there is no more infection control risk than holding the package in your hand or setting it on a bedside table. Actually, the bedside table is probably even worse. I wash my scrubs every time I wear them and clean my hands hundreds of times a day. But I highly doubt the beside table is washed nearly as frequently. It's not like opened medications are going straight from the pocket into the patient's mouth.

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I remember reading a thread quite a while back. This really hit home. It was from a soon to be NP, I think working CCU who had been confronted with something like 13? violations having to do with the fact that she consistently for months took out IV narcs and kept them through the shift for easy access. She said she got into the habit from not having someone around to witness/waste. Nobody called her on it all that time. She was right at the end of her NP program, and was faced with this. Just think of how big a deal that was going to be. IDK if she lost her license or what happened to her.

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