Narc Mistake.. Freaking out

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Hello and help!

I am a new grad with about 3 months experience on my own now in the pediatric world. I just remembered a mistake I made at work two days ago and I am freaking out. My patient had Adderall due at 0900 but he was nauseous at the time and refused the medication. I place the medication in the lock med server to check back in one hour to see if he was going to take the medication. When I checked back in he agreed to just skip the medication for the day so I documented refused in Epic. My shift got very hectic from then on out just trying to keep my patients stable I forgot to return the Adderall to the pyxis. I LEFT IT in the locked med server in the patient's room. I am so anxious as to what could happen since I did not return this medication as it is labeled as a narcotic. I am terrified that when I return the patient will be discharged and the med server will have been emptied. Any advice to calm me down?

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Specializes in Critical Care.

On the bright side of things, Adderall is definitely not a narcotic, it is however a controlled substance which is what you probably meant.

At every place I've worked you're free to go in and resolve a missing med, such as one left secured but unresolved in the Pyxis. While this is sort of a pain in the butt to deal with this on a day off, the piece of mind it brings is usually well worth the off-time spent dealing with it.

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I don't do that type of nursing, but couldn't you call and ask somebody to check to see that it is there?

I suppose if you work with nurses who abuse adderall, and one of them accessed the box, saw your mistake and figured it was worth the gamble to steal it, you could have a problem. Do you work in that kind of place? If not, it is either there, or has been dealt with responsibly.

And, as mentioned, Adderall is not a narcotic.

As far as mistakes go- this is not a big one. I don't know if this is any comfort, but in the future, you will make much worse mistakes like the rest of us.

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Get this resolved today. Don't go nosing around to see if the patient/med is still there—contact a trustworthy supervisory person and ask them to help you resolve it properly. Let's hope it was sorted out properly by someone else.

You need to change your practice: Either the medication is administered to the patient or else it should be returned right then (now you know why) - or wasted right away if it drops on the floor or something. Likewise, if you are removing a controlled substance and know you will need to waste some of it, get a witness and waste the proper amount at the time it is removed from the machine. A controlled substance that can't be accounted for will/may be considered diverted. There is just very little (as in almost nothing) that is worth risking the kind of trouble that can manifest if we don't develop the practice of handling controlled substances by the book every time.

??

PS - I appreciate the less-tightly-wound responses above mine. But I think chances are pretty good that sooner rather than later you're going to run into either a coworker or superior who sees fit to take a very hard line about this. So just save yourself and change your practice now.

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This is no big deal. The medication is locked. This is a classic rookie mistake.

This is where honesty is the best policy. Call your manager and say, "I screwed up...this is what happened."

That is all you can do. As a nurse still in orientation I lost a partial bottle of morphine. Could...not...find...it. It takes time to become "fluid" in your habits.

Nobody cares about one mistake...nurses that are truly diverting, trust me, mysteriously have tons of them.

Don't worry about this.

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Specializes in oncology, MS/tele/stepdown.

The only way to resolve your panic is to call and deal with it asap. It's not the worst of sins since it was in a locked box, but you took responsibility for this med when you pulled it; this will either be a big deal or not a big deal depending on your leadership and whether the pill is accounted for or not. Next time return it as soon as you realize you can't administer it. It is always worth the extra trip back and forth to the pyxis for a controlled substance.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I hope by this time you've called and gotten this resolved. We've all had a day where we remember something that occurred at work, that happens. Some of the outcome will depend upon your manager and coworkers. If someone else already found the medication in the lockbox they may have turned it into your manager and things are out of your hands. If it's still there, you have a very reasonable explanation for what happened, and you can easily prevent this from happening again by making sure that medications are either immediately administered or discarded. You can always pull another med from a pyxis after wasting the original dose if it happens like this again. I'm sure your instincts told you that was the best option, but time constraints probably made just locking it up and waiting seem easier. No big harm here, but definitely a place to improve your practice for the future. Good luck!

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I get nervous about this too when I start out.

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Easy to be nervous when nurses are under suspicion all the time. How to deal with it is get in there and take that adderal back to the cabinet with a witness as soon as possible. Next time if you take something out and they don't want it return it as soon as possible. They get more suspicious if a controlled substance is taken out but the administration time is way after.

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Thanks everyone. It turns out that someone the next shift actually returned the medication. Thank you all for the great replies and comfort.

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