Excessive waste of narcotics

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Specializes in PACU, pre/postoperative, ortho.

So my PACU just changed to electronic orders & scanning meds. Not a big deal for the most part except for the fact that we are now only allowed to give one dose from a vial of fentanyl or dilaudid & waste the rest, even when we will need another dose in 5 minutes.

So I may only give 25mcg fentanyl, waste 75; give another dose, waste half or more of the vial. Our dilaudid comes in 2 mg vials but we only give 0.2-0.4, wasting up to 1.6 each time we dose our pt. It's mindboggling how much is wasted & on a busy day, we basically have to have a free nurse help keep up with wastes at the pyxis.

Explanation from pharmacy is that these are single dose vials & cannot be scanned multiple times, even for the same pt.

Is this the same for those of you that scan meds in PACU? Thoughts?

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Specializes in ER/ICU.

For my PACU we scan once and when the pop-up occurs, we select the dose we are giving (25 mcg). Then as we continue dosing every 5 min we have a separate section in our charting (Cerner) for “PACU medication titration” where we chart all doses. At the end, if we used all 100mcg, we can modify the MAR to say 100mcg given. Otherwise, we modify the MAR (if needed) to say how much total was given and waste the rest.

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I work at a busy ASC and we draw up all of the fentanyl etc... and then administer it in increments. Wastage is recorded on the narcotic sign out sheet. We also have to have a 2nd RN witness each dose of the narcotics.

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Specializes in PACU, pre/postoperative, ortho.

We are continuing to waste after each administration (give 25 mcg, waste 75 & then pull out another vial to give the next 25 dose) essentially wasting more than we ever give. Some meetings were held with pharmacy back in August with more to come & hoping to resolve this...not holding my breath though.

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It's a dilemma for sure with EMRs. When you pull something out that's not in a single dose vial, you need to either waste the extra or allow people to regularly manipulate the chart to accommodate doses over a specific period. We had to do this with ours to adjust the amount of actual medication that was given. Single dose vials increase medical waste, while multiple dose vials (even as low as 100mcg) open a system up for manipulation and diversion.

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On 11/24/2019 at 4:06 AM, fredcate said:

I work at a busy ASC and we draw up all of the fentanyl etc... and then administer it in increments. 

This is how ours works. Say I'm giving 25 of Fentanyl from a 100 vial. We pull up the whole 100 but only give 25. Then we still have 75 left to give. The same vial gets scanned again.

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Specializes in PACU, pre/postoperative, ortho.

Update:

So, it took some time but they came up with a "safe labeling system" that we now use for narcotics (started around a yr or so ago). After pulling from pyxis, we then go to a labeling unit, scan our badge & then the vial. A label is printed with a barcode that is then scanned (instead of the vial) when we administer the med & we are now allowed to give our incremental doses from one vial, limiting the waste. An extra step but so much better than wasting 50-75% of the narcotics we removed from pyxis!

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