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Forgotten Morphine

Updated | Posted
by p007 p007 (New) New Nurse

I just started two months ago and am still with my preceptor. We (I) pulled morphine from the pyxis and gave the correct dose to the patient with her watching the whole time but we forgot to go back to the pyxis and waste the remaining in the vial. I discovered after an appointment that I still had the remains dose in the vial in my pocket. So I returned to the hospital to waste it properly in the pyxis with another RN. We reported it to the manager of the unit and I wrote a note about the situation and exactly what happened. I am so worried that I will be fired over this situation.

Ado Annie, ASN

Has 8 years experience.

I had this happen in my first few months of nursing. My manager was gracious about it but begged me to be more careful and not endanger my license. I developed the habit, at that hospital, of never leaving the med room without wasting in the pyxis. At my current job, that isn't really feasible, but it was doable there. I encourage you to develop that habit.

Hopefully they will be understanding. What did your manager say?

As the previous poster advised, you must develop a personal policy of not leaving the pyxis area without wasting. You will see a lot of people around you who succumb to the pressures of the environment and have their various reasons for not doing so (don't have time to wait, etc.). It will be up to you to establish practices that leave no question about your appropriate handling of controlled substances.

Nurses do a lot to compensate for their environment, and not wasting right away is one such thing. They feel rushed and don't want the patient to have to wait for pain medication and don't want to get behind on tasks. But the handling of controlled substances is serious.

While you're at it, make a habit of not witnessing other nurses' CS wastes that you can't verify. Ask people to let you know before they pull the med if they want you to witness a waste.

Edited by JKL33

marienm, RN, CCRN

Specializes in Burn, ICU. Has 8 years experience.

Just for your future practice: when you remove a controlled substance from the vial, remove all of it. Waste the portion that isn't needed from the syringe. Half-empty vials shouldn't go in your sharps bin or in your pocket...it unfortunately makes the sharps bins too tempting, and it will be really hard to explain why you're carrying it around. It sounds like your preceptor was present when you withdrew the med, so that was the perfect time to waste the remainder (and then not forget to take care of it in the Pyxis! 😀).

Unfortunately, even though I am a nice person I would not have witnessed this waste with you...you came in from outside with an opened vial of who-knows-what and asked someone who wasn't originally present to sign off on it? I would have told you to take care of it with your preceptor the next time you were both at work. To be clear, I don't think you should be fired! Take this as a lesson and don't do it again. You'll be protecting yourself and your coworkers.

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing. Has 12 years experience.

I would jot down some notes in a legal-size notebook where you can't tear pages from it without it being noticeable. Write it like it's a nurse's note and sign at the end. Don't write it in the chart. That way if there's ever a question about your practice you'll remember what happened. Best of luck.

rx3500

Specializes in Pharmacy, ADC ( automated dispensing cabinet). Has 12 years experience.

Hello, I am a pyxis manager at a large hospital and see this all the time. It was good that you remembered to go back and waste before the patient was discharged. Documentation like this is hard to update in pyxis once the patient has been discharged. I would utilize the waste upon removal function, so it's documented. Plus you will need the witness and they may be more likely to remind you of disposing of the remainder before you leave. Protecting you in the future.

If you have any future questions I'm more than happy to respond😊

rockchickrn, ADN

Specializes in Psych. Has 26 years experience.

I always always always waste right away and do not walk around with a partial vial of whatever in my pocket. Make this a habit now! It is your license.

JadedCPN, BSN, RN

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 15 years experience.

On 3/21/2019 at 3:15 PM, JKL33 said:

Nurses do a lot to compensate for their environment, and not wasting right away is one such thing. They feel rushed and don't want the patient to have to wait for pain medication and don't want to get behind on tasks. But the handling of controlled substances is serious.

While you're at it, make a habit of not witnessing other nurses' CS wastes that you can't verify. Ask people to let you know before they pull the med if they want you to witness a waste.

This. Thankfully my very first job as a new grad in the PICU had a culture that was very strict about wasting and actually witnessing people waste, so it was ingrained in me. Almost every other place I have worked since then have been more lackadaisical about the wasting process, and I have made many nurses unhappy but not going along with it.

In general unless it is a code emergency:

-If I am wasting a controlled substance, I am wasting it as soon as I pull it out of the Pyxis.

-I am drawing everything out of the vial at once and then wasting it in the appropriate area.

-I am expecting you, as my witness, to actually stay and witness me waste the med.

-If I am your witness, I am expecting to see you pull the med from the Pyxis machine and see you waste the med while we are there.

-I will NOT witness you after the fact. Sorry not sorry.

Edited by JadedCPN
typos