Questions about wasting NARCS ????

RunnerRN, BSN, RN · Feb 9, 2007

Here's my perspective from working in the ER....I often accept meds from the previous shift, but only from the RNs I really trust and work with a lot. In our dept, we have 5:1 and 10:1 morphine vials, and it just seems ridiculous to me to pull out a new vial for each 2mg dose (which is what management wants us to do now that JCAHO is on its way). Anyway, because of this (and also because some of our nurses are less than anal about their narcs) we often end up wasting other people's narcs. I've never had a problem with it. I always waste my own because I know I'm less careful with other people's narcs than my own (make any sense?)

I think you'll be okay. You aren't witnessing that RN 1 GAVE 4 mg of MS, you're signing off that this RN wasted 6mg down the sink.

Altra, BSN, RN · Feb 9, 2007

We frequently do this too, but if it bothers you, then don't. I can't imagine anyone having a problem with this. When you get report just tell the outgoing RN, "let's waste this, then I'll get more if I need it."

I personally get the smallest dose vials (2mg morphine) out of the Accudose to minimize waste, even if I think the patient will probably need repeat doses.

I'm curious - how did you handle this sort of thing on your old unit?

PANurseRN1 · Feb 9, 2007

Where I work, that could be grounds for termination. If you don't use all of the med, you must waste the remainder right then and there. It is not permissible to hold the remainder for later, and for sure it is not permissible to just hand off the remainder to someone else. How do you know what's in that syringe? Way too easy for diverters to get their meds that way, and it just flies in the face of basic med admin. standards.

TazziRN, RN · Feb 9, 2007

It's okay only if the nurses involved are okay with it. RN 2 should never have accepted the syringe if she didn't feel comfortable with that. I will accept leftover narcs from the offgoing RN only if it's in the original vial and not in a syringe, and only from nurses I know.

**canoehead, BSN, RN** · Feb 9, 2007

In reality RN 1 could slip behind a curtain and put the entire 10mg into a NS vial to take home, and only take 30 seconds. So you are never sure what's in the vial unless you follow the RN from Pyxis to patient. We all know that's not gonna happen.

I like the 2mg vials too, but pharmacy only refills once a day, and we would quickly run out. Gotta use those 10's if you work overnights.

caliotter3 · Feb 9, 2007

I don't know why, but I would think that in the ER (never worked in one) there would be an established system for this that is more acceptable and safe for everyone concerned. I worked in LTC and at one facility we had a thievin' DON so I'm really concerned about the whole scenario. After all the fiascos I saw in LTC and other places, I, myself, would be reluctant to accept the syringe in the first place.

MomNRN, BSN, RN · Feb 9, 2007

At our ED they really discourage only using a partial dose of any narcotic type medication and saving the remainder.

Our morphine comes in prefilled syringes (4mg/10mg). We almost always start with a initial dose of 4mg and proceed from there. Very rarely am I carrying around the extra. I do keep it if I know I am going to use it.

I am not comfortable handing off a partial med. I usually waste prior to the end of my shift. While I do feel comfortable with the majority of my coworkers, covering my *&% is more important to me. There are some coworkers I don't trust. Sad to say, but true!

TazziRN, RN · Feb 10, 2007

Caliotter, there's a lot of titrating in the ER over a short period of time, and sometimes it's just too busy to get a witness each time you need to draw it up. Most ER nurses that I know will hang onto it and waste it at the end of the shift or on pt disposition.

nuangel1, BSN, RN · Feb 10, 2007

Caliotter, there's a lot of titrating in the ER over a short period of time, and sometimes it's just too busy to get a witness each time you need to draw it up. Most ER nurses that I know will hang onto it and waste it at the end of the shift or on pt disposition.

ditto that.

BrnEyedGirl, BSN, MSN, RN, APRN · Feb 10, 2007

MLOS

"I'm curious - how did you handle this sort of thing on your old unit?"

Excellent point,..which is why I'm questioning my own, ..not usually so anal,... attitude!!! :smokin: I think on my old unit,..I'd known these people a long time,.even precepted most of the night shift,...that said,..I don't think anyone ever asked me to take meds from dayshift,..IMHO it covers your own butt as you really don't know what happens after you are gone,..and I guess I've always wondered how I can chart a med given that hadn't been removed from the accudose durring my shift?? I've decided that wasting the med at shift change is really the best way unless someone says hey can you give the rest of this now,.. and yes,.it is against policy to ever hold onto the meds for later,..I'm with the other posts though,..why pull out 4 10mg Morphine vials (all we have) to give 4 2mg doses in say 3 hours,.seems foolish to me, especially if your fairly certain the pt will need more!

Thanks for the input everyone,...I really am liking the ER,..this was a very good change for me!!!

Jennifer, RN · Feb 10, 2007

Any unused narc, benzo, etc that I have after giving a pt their ordered dose I label with pt's name and hold onto until either the pt needs more or I can find someone to waste with. At the end of the shift, all the extra narc vials that I have in my pocket (usually not many, maybe 1 or 2) I waste before I go home. I never pass off already used or opened meds to another nurse. How do I know that nurse is going to waste it per protocol if it is not used? Even if we're best friends, I'll waste the med before I leave to save both trouble later. Ask management what they think about passing narcs off to other nurses, I'm sure they'll will have much to say on the matter.