I need help...keep forgetting to waste narcs

[BabyLady]

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.

[sunnycalifRN]

As all the posters have said, it's not a memory issue. You have to just change your practice . . . do the waste before you even give the narc. Your co-workers and even your NM may say it's okay, but when there's a narc discrepancy it's the police that get involved and your job and license will be history. Nothing your NM says will help you. Just change your practice!

[rn4lyfe08]

Where I used to work, it only took 1 nurse to take the narc out, but required a witness to "waste" the med. We draw our meds up in the pt room b/c that's where we scan/chart them. Our med machine is at the nurses station. I take the med out, go to the room, check mar and draw it up, after giving the med, I immediately go to the nurses station and ask for a "witness" just as one poster mentioned. When we ask for a "witness", it may not be to waste, our cabinet/fridge keys were in the med cart and required a witness to remove them, a witness is needed to override te med cart too, so you never know what you're gonna witness, you just have to show up. Anyway, when your witness shows up, they confirm the amt wasted and you waste right then and they sign for it. That way nothing is left at the end of the shift. This has worked for me. I've never had a narc discrepancy.

[Nurseinprocess]

I never remove a med that needs wasting without another nurse with me to log into the pyxis and "witness" the waste right when I take it out. We can go back later and waste a med, after the fact, but I prefer to just take care of business right away. I have never had a problem getting someone else to take a minute (actually less than 30 seconds) to log in with me. We give A LOT of narcs because all of our pts are post-op and in pain. We don't have to have a witness for insulin administration, thanks to the pre-filled pens :).

[caliotter3]

If your faciity fired you for forgetting, I think you would have an easier time remembering at the next job, when you got another job. The end of the shift is the wrong time to be doing this, already an infraction. You are lucky so far that there is a lackadaisical attitude where you work. Other places would fire the nurse without so much as a warning.

[nursej22, MSN, RN]

Agree that your work place culture needs to change, but that could take a long time without support, and you could lose your job in the mean time!

My idea for a quick fix, is switch your watch to the other wrist, or move a ring or your name tag. Just something small that doesn't quite feel right, until you do your waste. It's sort of like a string on your finger that you will keep noticing until you take care of it.

[Hoozdo, ADN]

I rarely can find another nurse to waste with me when I take out a narcotic.

I know it's best practice, but sometimes not possible.

What I do is:

NEVER put any type of med in a pocket

I have a special place in the room that I put drugs I need to waste.

I yell out to a coworker that I need to waste whatever when we have time.

I do have a problem remembering to clear and document PCA data at the

end of my shift. It helps if the person coming on always reminds the other,

we need to do PCA documentation.

As far as witnessing insulin, I think that's overkill. I am hanging drugs that

would kill someone much faster than insulin and require no witness. Heck, I

even have to mix drugs in an emergency........can't wait for the pharmacy.

No witness required for that either. Just mixed a bag of Levophed last night -

I just verbally check the recipe with another nurse. I just ask, hey the recipe

for Levophed is 8 mg to 250 mL D5, correct?

Asbestos suit is now on.

[Medic/Nurse, BSN, RN]

I think this is ultimately a SYSTEM ISSUE.

However, nursing boards DO NOT CARE about system issue - the end responsibility is YOUR LICENSE. Now - let's find a solution until you can bring the SYSTEM ISSUE to the PHARMACY/MANAGEMENT folks attention.

I have had the same problem - but as the system is the same for them as you - all of you should band together to protect your collective licenses. I get that "only you" do not rememeber - but, since they have to follow the same process as you - I think that there is strength in numbers. The system as it exists makes it possible to "divert" and in some case studies - loose waste regulation makes divert possible. Bad. Bad for all.

The fact that the "charge" make "wasting" reminder rounds - means that there is a PROBLEM...

I agree with the the insulin restriction - ususally it is just IV Regular insulin, but I see the wisdom. I think any high alert med should prompt a duo to confirm. As for the post that details the "place in a safe spot and waste later" - I worked with a nurse that did that and the "remainders" went missing one shift and it was B-A-D for her and everyone that had worked that day. (Investigation, drug testing, DEA reporting). I will agree with you that I give a LOT of meds - just as dangerous, so what gives. Actually, I try to be super deliberate and as when I work with a "new" or "unfamiliar" partner I will verify most everything (paralytics, etc). Good practices are good for patients and my license.

But, what to do NOW????

Emergent administration demands NOW action - anything less you got a little time. Just make it YOUR practice not to administer with first getting the correct waste procedure and although your co-workers may get peeved, it is YOUR license. Just do it.

For now - Place a big red REMINDER sign where you cannot miss it prior to leaving. Another in your car - although I think taking narc's out is risky!!!! In emergent or solo (I was the only nurse in the ER at one facility after midnight and sometimes I HAD to wait on someone, anyone....) I have also taped the waste narc's on the front of my scrub top with lots tape and it usually results in "waste" at the first moment when I leave the bedside.

Don't analyze this to death with your co-workers. There are always some unhappy hater folks out there and you just never know what they may try and pull, don't give 'em anything (no I'm not paranoid, just seen it all and like little of it!) .....

Good LUCK.

Practice SAFE!!!

[BabyLady, BSN, RN]

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.)

I actually like this idea...or something similar to it.

[morte, LPN, LVN]

I am not grasping the problem. All wasting should happen the minute the med is removed from the pixis! No way am i going to sign for a waste when the vial/ampule has been out of my sight! No way, no how, not maybe...

when you go to get the med, witness the waste right then and there.....because if the DEA comes in, EVERY waste not properly recorded/witnessed is diversion as far as they are concerned!

[Meriwhen, ASN, BSN, MSN, RN]

If you keep doing things as you are and there's ever a discrepancy, your claiming that you "forgot to waste" is going to go over like a lead balloon. It may fly once, but if it keeps happening...at the best, they'll think you incompetent; at the worst, they'll think you're diverting. Either way you're putting your license on the line: how much protection do you really think your facility is going to give you if the DEA, BON or other regulatory agencies come calling?

I agree with the others--your unit/facility really needs to address this issue. Until then, you have to protect your license...and if that means hounding someone to waste with you right away, then so be it.

Good luck.

[canesdukegirl, BSN, RN]

If nothing else works, tie a ribbon, a rubberband or something bright and colorful around your keys so that you remember to waste before you go home.

[txm910]

I always waste my narcs immediately with the nurse who witnessed me. It only takes a few seconds to a minute. That way you don't have to think about it at the end of shift when you are finishing up, checking on your patients and getting whatever needs to be done before end of shift report. I usually write it down on my report sheet as a task that I need to complete prior to end of my shift in a situation when I do not have another nurse around and really need the medication for a pt in pain. I always used to forget to clear PCAs, and I started listing it on my task list on my report sheet to remind me. It worked great! Hope this helps! Good luck.