job is getting to me today

emtb2rn, BSN, RN, EMT-B · Dec 20, 2014

That actually is a big deal. It was a 2mg vial, correct? Your order was 1mg, did you waste the remaining 1mg? I think not, based on your comments. So, what would happen if the next anticipated dose wasn't ordered? You would have 1mg of explaining to do.

And seriously, you left a controlled substance on the counter in the pt's room? Really? Only ativan? Hey, it's gone! Where'd it go? Personally, I think you'll be lucky to only get a verbal warning.

SquishyRN, BSN, RN · Dec 20, 2014

Wow. I understand you came here to vent, but you won't get a sympathetic ear from me. It scares me how nonchalantly you not only completely brush off the seriousness of your actions, but turn around and blame your coworkers for being "petty." Everything you did was obviously out of P&P, and you fail to realize why those P&Ps are in place.

You disregard the seriousness of leaving the bottle at the bedside because "he can't kill himself or penetrate the bottle w/o a needle" and he's being watched from the nurses' station. It doesn't take very long for a suicidal person to grab the bottle, break it to expose sharp edges, and swallow it. That could be done in the blink of an eye before you reach him.

Secondly, last I checked, Ativan IVP comes in single use vials that are counted because it is a controlled substance. As such, whatever was not used when you gave it should have been wasted. To give the remaining 1mg would mean it would result in a discrepancy of the Ativan count relative to doses given.

Despite your view that your co-workers were being petty, I, like them, would not give the remainder of a single dose medication ESPECIALLY if it is a narcotic. I would not know if the Ativan you left is in fact Ativan or saline. While you may not do that yourself, your naivety shows in your failure to see other potential situations that P&Ps are designed to address.

It's one thing when new nurses make mistakes and learn from them. We are all human, we all make mistakes. What is absolutely intolerable is your CONSCIOUS disregard for the rules simply because YOU find them "illogical" because you haven't been around long enough to see all the sh*t that can go wrong that is the reason why these rules were put in place.

Editorial Team / Admin · Dec 20, 2014

I would never, ever give a controlled substance that was removed from the Pyxis by another nurse unless it is a dire emergency situation. Too many ways things could go wrong with that. I would also never leave a controlled substance in an easily accessible area, whether I can see it or not. Controlled substances are nothing to mess around with, and I value my license enough to want to keep it safe. Keep doing this, and not only will you be playing with fire in regards to your job, but you may just find yourself in hot water with the BON. Read your BON's newsletter, and you will see that most suspensions are related to drugs, not nursing practice. You're setting yourself up for trouble with suspicion of drug diversion by leaving them accessible and not being appropriately wasted.

LadyFree28, BSN, LPN, RN · Dec 20, 2014

I would never, ever give a controlled substance that was removed from the Pyxis by another nurse unless it is a dire emergency situation. Too many ways things could go wrong with that. I would also never leave a controlled substance in an easily accessible area, whether I can see it or not. Controlled substances are nothing to mess around with, and I value my license enough to want to keep it safe. Keep doing this, and not only will you be playing with fire in regards to your job, but you may just find yourself in hot water with the BON. Read your BON's newsletter, and you will see that most suspensions are related to drugs, not nursing practice. You're setting yourself up for trouble with suspicion of drug diversion by leaving them accessible and not being appropriately wasted.

^^^^^THIS. ^^^^^

AZQuik · Dec 20, 2014

Our policy, like most here, would be to waste what was left in the bottle after pulling the dose out. We need a second nurse or pharmacist to do that, and through pixis you need a fingerprint. Never is a second dose of a controlled substance pulled out of a used vial. While there may be some lazy wasting practices, it would always be wasted.

In our department this would be a near miss and there would be discipline for it above a verbal reprimand.

Sent from my iPhone using allnurses

Editorial Team / Admin · Dec 20, 2014

I just went through and looked at other threads the OP has started. All I can say is wow. This is definitely not an isolated incident of the OP having issues, and he/she needs to do some serious soul searching.

AnnieOaklyRN, BSN, RN, EMT-P · Dec 20, 2014

That is poor nursing judgement!

1) you left a controlled substance that needs to be accounted for out in the open where anyone could take it.

2) you left a controlled substance that could harm a patient in a suicidal patient's room.

3) You left a medication accessible to anyone who felt like trying it out - This includes other patients, unfortunately staff that may have issues, NO MEDICATION should be left out on the counter. You must remember that patients can have young visitors that may get into these medications!

4) NEVER assume a suicidal patient or any patient cannot find a needle in a hospital, they can, they may already have one on them somewhere. You are naive!

5) You left a medication in an open area where you have no way of knowing whether the vial has been accessed by someone else and contaminated with another medication or worse changed to saline (remember even healthcare workers have medication addictions), this is the equivalent of administering a medication that you have not drawn up and have not seen the vial for!

- Sorry, but you need to do some serious learning here, that was very dangerous for you to do, dangerous for your license, young visitors, this patient etc.

HPRN

enuf_already · Dec 20, 2014

In my years of practice I have found that most policies and procedures were developed primarily because of some unusual occurrence.

There is no way another nurse should ever give a controlled substance left by another nurse. This is asking for trouble!

Leaving a vial of a narcotic where a patient or family member could gain access is a big red flag. What if the patient who is suicidal swallowed the vial? What if he used the glass to cut an artery? What if a friend shot him up in an artery with the med you left on the shelf?

These scenarios may seem far fetched but sometimes you have to think outside the box and understand the potential for harm and your duty to protect the patient. There is a reason we lock up controlled substances and limit access to them. OP, your coworkers are not being picky.

HappyWife77, BSN, RN · Dec 20, 2014

This is basic 101 knowledge of nursing and narcs....The sooner OP realizes this and appreciates it, the better. No other way to put it.

kbrn2002, ADN, RN · Dec 20, 2014

Sorry joe007, if you are expecting a sympathetic response you are probably not going to get one from anybody. Leaving a vial of a controlled med laying on a counter in a patients room is beyond poor judgment. Your fellow staff are not being petty for reporting this, they are following the correct procedure. I don't of course know the policies and procedures where you work, but I would think you will lucky to get out of this with your job intact.

joe007 · Dec 20, 2014

Thank you all for the replies. They have made me feel better because I am getting differing perspective. I had a preceptor who told me to not waste ativan if you knew they would need more. So, unfortunately I have been following his logic, but will follow policy. I take responsibility for it being left out.