I need help...keep forgetting to waste narcs

[BabyLady, BSN, RN]

I work in a unit where we don't administer opiates or other meds that need to be wasted every day, in fact, you can go a couple of weeks and not administer any.

I never, ever administer a med without getting an employee to witness the waste and watch me put the remainder in the sharps box, sink, whichever is closer. Our facility doesn't care which.

However, our system doesn't "count" it, until you both go to the computer and put in your passwords together at the same time...it allows you to take the med out, but you are expected to enter this into the computer before you leave at the end of the shift, or a report goes out to your boss that you missed the waste.

I cannot, for the life of me, remember to do this and I need suggestions from others of what I can do. The chaos of report, shift change and just being exhausted after 12 hours...I end up remembering about two hours after I have left or when I get an e-mail from my boss.

It happened again a few days ago, and I set an alarm on my cell phone to "buzz" me via vibrate about 30 minutes before shift change, so I don't forget, but for some reason, it didn't go off.

I wished the system wouldn't allow you to clock out without wasting the meds, but obviously, it doesn't because the med system and the time clock are not linked.

Is there ANYONE with a creative suggestion to help me remember??? I'm at a loss.

[mskate]

Do the waste at the computer immediately as you waste the med with the other nurse in front of you. Do not wait until the end of the shift. Ultimately, wastes that are not documented will cause discrepancies that will jeopardize your job and your license. Don't ever wait - document while you do it every time.

[BabyLady, BSN, RN]

MsKate,

Honestly, I would LOVE to do that...but you can't get the other nurse to do it...they alway say, "No point in wasting now, wait until you give everything for your shift and we'll do it all at once" or "I can't right now, I'll do it later"

Now, I'm not trying to push everything on the charge nurse, but we do have a couple of charge nurses that always come through at the end and say, "Did everyone remember to waste?" If we have not yet, we stop report, get up right then and do it.

Not a policy at our facility, but it would help...but I don't want to sound like I can't take responsibility..because I can, but it's hard when you have to depend on someone else.

[JenniferSews]

Do the waste at the computer immediately as you waste the med with the other nurse in front of you. Do not wait until the end of the shift. Ultimately, wastes that are not documented will cause discrepancies that will jeopardize your job and your license. Don't ever wait - document while you do it every time.

Exactly! I'm confused why you are waiting until shift change to waste. I find someone to waste with me immediately. I waste first, then I give the med. Maybe I'm super cautious, but I worry too much to leave any room for question.

[CNM 26.2]

I agree, do it when you waste the med. If the other nurse gives you an excuse just point out to them that wasting at the time is the best practice and it's your license on the line too and you want to do it now. It may take getting a few nurses a little upset at you the first few times but eventually they'll come around and just do it.

I had a similar situation-I work L&D and many nurses were drawing up vitamin K and Hep B vaccines and leaving them near the warmer before a baby was born, then they would go off shift. I refused to use them-I didn't draw them up so I couldn't be sure what they were and we once had a nurse give a baby 25 mg of Phengergan IM instead of the vitamin K. It only took me throwing out the meds a few times before people started to change the practice-then they would take the vials in but not draw them up until they were ready to give the med. I was the "grouchy" nurse for a few weeks but I got over it! ; ) My license is more important to me than what the other nurses think of me!

[shiccy]

That is your problem. I have two options, one of which will be frowned upon by the higher ups...

#1- (and the way it absolutely SHOULD be done) Waste while you're taking a narc out. This is the way, without a doubt, it should be done. You should grab a nurse by the hand and say, "Come waste with me." When we do wastes it's the same as double checking insulin. We don't even say, "Can you waste a narc with me?" ... we say, "Can I get a witness?" Since both narcs AND insulin are taken out of the same machine, doing it right then and there just makes sense.

I know you're aware of this, but narcs are not only offenses that can get you fired, but they also can carry hefty jail/fines. You ABSOLUTELY cannot be accused of this. Talk to your director and see if they can make it mandatory that this happens.

Most Pixis systems, when you click "No I don't plan to administer the whole dose" will not allow you to even pop the pocket open until you get a witness. This needs to be implemented in your facility/floor.

From what it sounds like you're doing #2-:

#2- (I've heard of others doing this from time to time, but not acceptable from JAHCO's standpoint) Keeping the narc in your pocket and using more than one dose that is in the vial. Some people do this, but they don't waste the narc in their pocket until they have a computer witness.until it's wasted in the computer.

These are the only choices I can see where it's foolproof to you wasting your narcs appropriately.=

[Flo., BSN, RN]

It sounds like the culture of your unit needs to change. You really should waste the med fairly quickly after you give it or even before. It is shocking to me that they give you a hard time, but this is coming from an ortho nurse who gives out mostly narcs. I don't have any good tips for you other than wasting as you go.

[BabyLady, BSN, RN]

The way our unit is set up...we have a room where our med machine is set up and the computers, where we scan the med, is where the patients are, which is not close to the med machine.

I agree that it should be set up the same way with insulin....our computer system won't even allow you to scan insulin for administration without a second badge being scanned to verify the dosage....but this is at the computer, not the med machine..the med machine requires a fingerprint scan for narcs.

I understand why the facility has these policies and I agree with them 100%.

I just don't understand why it's so hard for me to remember.

[GHGoonette, BSN, RN]

Whew, when I read some of these posts I realize how far behind the times we are in my country!

We don't use computers or "med machines" to record our administrations, our opiates and other scheduled (potentially harmful) drugs are written in a register. Obviously, the ideal is to do this immediately, but on a busy Theater day when the PACU is humming, it's not always possible.

A second person should always witness you drawing up the substance; our laws (which are clearly different to yours!) state that the entire contents of the ampule must be drawn up and the excess discarded in front of your witness.

To help us keep track of the drugs we administer in PACU, we have a book in which we scribble up all opiates etc given, pt name, hospital number etc etc, all the info we need to record in our registers. At the end of the day, we check our book and make the formal entries in the relevant registers.

Anything in our Dinosaur Era systems that can help you? sometimes in order to go forward, we need to take a few paces back...

[kaliRN]

"I understand why the facility has these policies and I agree with them 100%.

I just don't understand why it's so hard for me to remember"

Sounds like it is hard for you to remember because the system is not conducive to you doing this properly. Why should insulin require two badges and narcs a fingerprint scan? The system, ideally, should force you to remember. The policy and practice should change, just as other posters have mentioned, and you should ask to have another nurse input into the computer with you when you waste the med never at the end of your shift. When they respond, "No use doing it now." "I'm busy, let's do it later." - it hangs you out to dry. I would: get the med - get the nurse - go to the computer and waste there. Don't give them the opportunity to "escape" by doing it where the medications are. Be upfront, "I understand it takes more time to do it this way, but I feel safe knowing it gets documented. I may forget by the end of shift."

Your license and your responsibility and neither should be taken lightly. There is no safe way to have to remember at the end of your shift - for all the reasons you mentioned. It is not because you are somehow inept. Often, when something is not getting done "right" repeatedly - the entire process needs to be evaluated. That is how things are made better. Think about it this way, if an incident report was written every time this occurred, what do you think risk management would do to solve the problem? Require a double check. As I see it you shouldn't be allowed to scan the med for administration until you have entered the two passwords for wasting in the computer. No "forgetting" possible the process requires both nurses to complete the steps in the correct order.

I think you are looking for solutions in the wrong place by worrying it is your memory that is causing the issue. Every nurse that has responded has said the same thing ... Hope this gives you some reassurance and motivates you to act. People often resist change and you may be unpopular for a brief period, but this is a small price to pay when you consider the potential ramifications.

[brownbook]

Hi, there are a lot of good answers, but maybe until you can get the whole computer, waste sign out, thingy changed you could just get a thick rubber bracelet. When you take out a narc you will need to waste put the bracelet on over your sleeve or up high around your biceps. When you are ready to go home this could remind you "oh yeah I need to waste my narcs." (Like tying a string around your finger.)

[AOx1]

Bring this issue to your unit based council for policy revision. Until then, waste immediately and put a sign above the time clock or employee lockers reminding people to waste.