Fentanyl patch destruction--just learned I'v been doing it wrong and need advice

[CrazyGoonRN]

I am a new nurse working at my first nursing job for about 5 months. I like it pretty well and I work all over the nursing home. I had a 3 week orientation on day shift but no training on the other shifts. I am PRN and I work all shifts. We change Fentanyl patches every 3 days on the 3-11 shift. I do not always have to change them out when I work that shift because it is not always the day to change them. We have a computer system and when a nurse clicks to sign off that she has changed the patch another screen comes up and tells you what to do next. The first time I changed a patch I didn't have anyone with me because I thought the computer would explain what I needed to do. Then I kept doing it that way thinking I was doing it right.

To get to the point: I have not been clicking on the button to send an alarm to another nurse to co-sign that she witnessed me properly disgarding of the old patches. I have always known that 2 nurses have to witness the destruction of a narcotic but the way the instructions are written in the computer I thought that all I had to do was put it in the sharps. I thought I didn't need a co-signer.

They must not have noticed my error at work because they have never said anything to me about it. When I realized that I was doing it wrong I didn't want to tell the supervisor that was working at the time because she is not all that nice. So I didn't say anything. Which is also what another nurse advised me to do. I am just not sure what to do. Do I need to tell a supervisor at work about this mistake? I have fears of getting fired if I tell or loosing my license. Then again I do not want them to think I am hiding something if they figure it out on their own.

Any advice is greatly appreciated. Thanks.

[elkpark]

If it's supposed to be cosigned and it's not, you will eventually be found out. Hospitals have plenty of double- and triple-checks in place for narcotics records. Much better to "'fess up" on your own ASAP and clarify the policy rather than get "caught" later on and look like you were trying to hide something.

I used to survey hospitals for my state and the Feds, and was involved more than once in investigating deaths related to fentanyl patches. As part of the investigation, I had to clarify with my state DEA what the expectations were for disposing of used patches. The word from my state DEA was that they have to be secured until they are destroyed, and putting them in a sharps box is not considered securing them. Ideally, you cut them in half (so that the remaining gel will dissolve and wash away) and flush them down the toilet, or (since more and more municipalities are putting limits on what hospitals can flush) store them under lock and key until they are incinerated. But "just" putting them in a sharps box is not considered sufficient.

[kelleann]

This same thing just happened to me too. I immediately went to my charge nurse and let her know what I had done. As a new nurse, there are so many things thrown at us that are "routine" for seasoned nurses and we are also critically thinking about our patients. In my experience, it is best to ask questions constantly, and if something goes awry, IMMEDIATELY let your supervisor know. They know we're new and learning. No one wants to make mistakes, but mistakes happen.

[CrazyGoonRN]

I called and talked to my supervisor and she said it was no big deal. I just need to start getting a co-signer from now on. I really hope she is right and that it is not a big deal.

Thanks everyone for the input! :)