Narcotic Wasting Mistake

mauxtav8r · Jul 25, 2009

When I changed jobs a while back I had an exit interview with one of the higher ups . . . one of the main topics I addressed with her was the hospital's pia policy about narc waste.

Our hospital's stance: the only appropriate place for a narcotic yet to be wasted is in the palm of your hand.

Suggestions from the assistant DON: grab someone while you are at the bedside to watch you draw up the pt's med, and draw the remainder into a second syringe, waste the second amount (into the sharps by expelling the med), toss the vial in, too, and do the pyxis deal later when you have the time. That way you are walking around with a NOTE in your pocket, not a VIAL of med.

Their stance about leaving the building with narc in pocket: you may EXPECT to lose your license over this.

Due to staffing issues this has obvious drawbacks, so please hold your criticisms to a minimum. It's just another idea to prevent this in the future.

pagandeva2000, LPN · Jul 25, 2009

I am sorry to hear that this happened and I absolutely believe that this could have happened to anyone. I have no real advice, but think in this case, honesty is the best policy. I would probably make an appointment for a meeting with the powers that be and say all that you said here, emphasizing that you do love your job and am so sorry that you made this error.

No nurse that is diverting would return the drug. I remember once, I almost took the narcatic keys home from my clinic. It was sort of funny, because my facility has it's own police department, so to speak...we have peace officers that can arrest. My husband is the lieutenant (this is how we met). Anyhow, the nurse in charge of that clinic knew my husband so she called him and told him to please reach me. I was fortunate that day, because instead of taking the bus, I had gotten a ride from another nurse. We were three blocks away from my house and my hubby calls my cell and tells me I had the keys. Those suckers were right around my neck, so, we had to come back. That charge nurse did not report me, she laughed and said she sent an APB out on me and would have had my husband personally escort me back before she would have called anyone. I guess the difference was that this is a clinic where there is no relief staff, so, no one would have had access to our narcs, anyhow, but it sure taught me to empty my pockets before I walk out of the door.

I really hope that they are empathetic and give you respect. Really, it could have happened to anyone.

pagandeva2000, LPN · Jul 25, 2009

I am going to try to answer the questions that I have seen arise in the discussion to the best of my ability. I would like to start by saying that what happened as told to you all is true. It may seem crazy and people ask, "why didn't she turn around?" I did not have a malicious thought about the drug. I figured, "eh I'll bring it back to work when I go." Obviously the fact that I was so far away and hadn't slept probably played a role in that. Once again though shoulda, woulda, coulda!
The cops that found my purse were from a small town (not the same area my husband is a cop in) and I told them the truth. They were satisfied and they are done with this as far as they are concerned. No charges will be pressed. My manager also believes that it was an honest mistake, and they have checked into records in pyxis, my locker and things like that finding absolutely nothing fishy. The medication was still in the vial. It was .5mg of morphine (not NS).
The only person that is now pushing the issue is the head of security at the hospital. To those of you that have admitted you have been an addict that is a huge and wonderful step. I am not an addict, and I am finding it incredibly frustrating to have people judge me and my situation. I welcome the prayers and suggestions, but the judgements are not needed. I feel awful to be in this situation and wish more than ever that I had just turned around. I am worried about my job and have been on suspension. Not only is this my source of income I absolutely love being a nurse! I have worked incredibly hard to become a nurse and would never jepordize it purposely! In my heart I know that this was not an error in judgement but a mistake. My only error in judgement was not turning around when I found it.
Again, thank you for your suggestions prayers and thoughts and if it makes people feel better to judge and make assertions then I guess that's what happens when we blog. We leave ourselves vulnerable. I wish everyone well and will keep you updated on the situation. Hopefully I'll know something later this week. :redpinkhe

I answered this thread before I read further. I also agree, the head of security should have diddly squat to do with a nursing issue if your supervisor is not pressing the situation. Records were checked, everything added up, end of story. Are they still considering termination? I really hope not, especially now that I read that everything added up! If they are not considering letting you go, then, are you more worried about what this security guard is thinking? Can he make your life more difficult? It seems to me that he is trying to make a point or to justify his role aggressively. The man should mind his business at this point, I feel.

Ginger's Mom, MSN, RN · Jul 25, 2009

I am going to try to answer the questions that I have seen arise in the discussion to the best of my ability. I would like to start by saying that what happened as told to you all is true. It may seem crazy and people ask, "why didn't she turn around?" I did not have a malicious thought about the drug. I figured, "eh I'll bring it back to work when I go." Obviously the fact that I was so far away and hadn't slept probably played a role in that. Once again though shoulda, woulda, coulda!
The cops that found my purse were from a small town (not the same area my husband is a cop in) and I told them the truth. They were satisfied and they are done with this as far as they are concerned. No charges will be pressed. My manager also believes that it was an honest mistake, and they have checked into records in pyxis, my locker and things like that finding absolutely nothing fishy. The medication was still in the vial. It was .5mg of morphine (not NS).
The only person that is now pushing the issue is the head of security at the hospital. To those of you that have admitted you have been an addict that is a huge and wonderful step. I am not an addict, and I am finding it incredibly frustrating to have people judge me and my situation. I welcome the prayers and suggestions, but the judgements are not needed. I feel awful to be in this situation and wish more than ever that I had just turned around. I am worried about my job and have been on suspension. Not only is this my source of income I absolutely love being a nurse! I have worked incredibly hard to become a nurse and would never jepordize it purposely! In my heart I know that this was not an error in judgement but a mistake. My only error in judgement was not turning around when I found it.
Again, thank you for your suggestions prayers and thoughts and if it makes people feel better to judge and make assertions then I guess that's what happens when we blog. We leave ourselves vulnerable. I wish everyone well and will keep you updated on the situation. Hopefully I'll know something later this week. :redpinkhe

I can't stress enough to get legal counsel. I believe you are innocent and made an error.

You are on suspension for Narcotic Diversion, which is a felony. Worst case scenario you could go to jail, loose your license and at least your reputation is damaged.

Part of making an error is dealing with the collateral damage, you are not doing everything to protect yourself. A lawyer will spin the situation to paint you in the correct light. How was the staffing that night? Where you properly inserviced how to dispose of narcotics? What is the current practice on the unit? Etc, etc, etc. This is the way the legal system works.....I don't always agree with this but it is the system.

I know in your heart you feel you did nothing wrong. But your actions by not seeking counsel is going to derail your career and any chance of you working in healthcare due to a very stupid mistake. The head of security is right pushing the issue and if you don't come up with a defense, the hospital has to support him. This is out of your manager's control and you will be reported to the BORN. The hair sample is one example on how you can protect your license.

Best of luck, I believe you did not take the narcotic for personal use, but you need to defend yourself. A lawyer could plead a deal for you, etc. Don't be naive and think that since you feel you did nothing wrong everything is ok, you need to be proactive.

Ginger's Mom, MSN, RN · Jul 25, 2009

When I changed jobs a while back I had an exit interview with one of the higher ups . . . one of the main topics I addressed with her was the hospital's pia policy about narc waste.
Our hospital's stance: the only appropriate place for a narcotic yet to be wasted is in the palm of your hand.
Suggestions from the assistant DON: grab someone while you are at the bedside to watch you draw up the pt's med, and draw the remainder into a second syringe, waste the second amount (into the sharps by expelling the med), toss the vial in, too, and do the pyxis deal later when you have the time. That way you are walking around with a NOTE in your pocket, not a VIAL of med.
Their stance about leaving the building with narc in pocket: you may EXPECT to lose your license over this.
Due to staffing issues this has obvious drawbacks, so please hold your criticisms to a minimum. It's just another idea to prevent this in the future.

I couldn't agree more with you. Good legal counsel would pick up on this. Why did the police call the hospital if they believed the story? I think they didn't want to press charges since it would create paper work and hassle. The dump the problem on the hospital security. He got a call from a police department that a nurse was taking narcotics what choice did he have?

Medic/Nurse, BSN, RN · Jul 25, 2009

Get a LAWYER. Now.

If possible get a nurse lawyer and then (this is the hard part) SHUT UP. Do not discuss this any further - do not try and defend yourself except as instructed by your LAWYER.

I believe that you got swept up in one mega CLUSTER-F&@% and it is not even close to over yet.

It may have been a mistake-you may be diverting --- it does not matter. The facts are what they are and YOU LEFT WITH A NARCOTIC - the matter seems like a "I Love Lucy" skit and and now you are in deep do-do. The best of intentions and explanations may not un-ring this bell.

At best - your reputation is near ruin

&

At worse - you may be a criminal defendant in FEDERAL COURT

THIS IS A SERIOUS SITUATION.

Regardless, I'd expect that a complaint and investigation from the BON is forthcoming.

I think many of us have "deviated" from strict narcotic rules governing waste at some time - I've given a patient a couple of doses out of a 10mg vial and wasted the remainder instead of wasting after each dose and obtaining a new vial - risky business just the same. The fact that there was only 1 other vial would not have given me a pass. I would have been on the bubble if anything had "went wrong". I have taken keys out of a facility - found 'em before I left the parking lot and returned them. I am more aware and deliberate now. Strictly by the book - I've worked too long/hard to get destroyed by this issue. As long as humans are involved mistakes will happen. Sure, hindsight is punishing and regardless of how sorry your are/reget what happened/wish you could change it the situation is what it is - you have to do what you have to do. What you have to do is - Get. A. Lawyer. Now.

I wish you the best and hope that some luck will come your way. Please do not be so blind that because you did not do anything on purpose and had no intent that you will be cleared. If this was going to be "clearable" it would have been done already. This issue seems to be getting traction - not coming to a stop.

As for the "security" officer - it may be his chance to shine and prove his worth and all that - he will be motivated to maintain his position and will most likely push this issue. It sucks that he is given any "power" in this issue - I'd suspect that this may be a chance to "lead" in his mind and that may make this horrible situation even worse (can it be possible?) for you. You can count that he will most likely "run his mouth" for all time about his role in this "investigation". Face it - there are a dangerous few in those positions that have washed out of real cop work and carry a chip on their unarmed shoulder - you have a cop husband and that may ratchet up his life of misery and envy as well. This guys means you harm - you are gonna have to let a lawyer teach him about the law.

southernbeegirl, BSN, RN · Jul 26, 2009

I can't stress enough to get legal counsel. I believe you are innocent and made an error.
You are on suspension for Narcotic Diversion, which is a felony. Worst case scenario you could go to jail, loose your license and at least your reputation is damaged.
Part of making an error is dealing with the collateral damage, you are not doing everything to protect yourself. A lawyer will spin the situation to paint you in the correct light. How was the staffing that night? Where you properly inserviced how to dispose of narcotics? What is the current practice on the unit? Etc, etc, etc. This is the way the legal system works.....I don't always agree with this but it is the system.
I know in your heart you feel you did nothing wrong. But your actions by not seeking counsel is going to derail your career and any chance of you working in healthcare due to a very stupid mistake. The head of security is right pushing the issue and if you don't come up with a defense, the hospital has to support him. This is out of your manager's control and you will be reported to the BORN. The hair sample is one example on how you can protect your license.
Best of luck, I believe you did not take the narcotic for personal use, but you need to defend yourself. A lawyer could plead a deal for you, etc. Don't be naive and think that since you feel you did nothing wrong everything is ok, you need to be proactive.

i agree with this post completely.

i wasnt accusing you of being an addict. i do hope you know that. what i was doing was looking at it from a legal point of view and saying that even tho you are telling the truth, it is still just "your" side of the story. the BON sees addicts on a daily basis trying to manipulate them with their stories of how "this is just a mistake". so knowing them like i do (for my state anyways), i know that even tho you are innocent, you will still probably have to prove your innocence. is it fair? no. and for that, as one of those addicts, i am truly sorry.

but it's just the way it is.

i can totally understand you and many other posters not thinking this such a big deal. the point is tho..if they want to make it one, the BON and or the hospital CAN make this a very big deal because what you did was illegal even tho it was a mistake.

so knowing that that is a possibility, i really can't stress how much, if i were you, i would start getting my ducks in a row and begin to build a case FOR your innocence. get copies of your pixus records, have that hair drug screen, consult with an attorney. dont just sit back and wait on them to act. if you do it might be too late for you to get the evidence you will need for yourself.

it will make a lawyer's job much easier to allready have much of the evidence they will need.

hopefully nothing will come of this but are you willing to take that chance?

chenoaspirit, ASN, RN · Jul 26, 2009

I couldnt tell you how many times I went home with narcs in my pocket by accident. Yes, I took them back the next day and wasted with someone, but what happened to you could have happened to me. The census was always so high and we were always shortstaffed, I would stick it in my pocket with plans on wasting when I had a moment to do it. I had the same attitude as you, I knew I wasnt diverting and wasnt worried. But now that I know what happened to you, Im glad I dont work in the hospital anymore (I do homehealth now). Accidents happen. Most of us have stuck a med in our pocket at some point when we were busy and didnt have time to waste at that exact moment. I hope you get this straightened out. If you are given a hard time at work, its because of the other people who ARE an addict and have diverted. Those people have made employers suspicious of everyone. So dont take it to hard, it will all be ironed out in the end. It was just an accident. But like one poster stated....placing a cup in your locker to empty pocket is a good idea.

diane227, LPN, RN · Jul 26, 2009

I have a friend this happened to. She left with a partial vial and pulled all the junk out of her pocket and threw it into the dash pocket of her car. Well her son, who drives her car who also had previously been arrested for possession of marijuana got stopped for something and while searching the car, found the vial and took him to jail. It too her quite some time to get him out of this mess. However, the hospital helped her and did not get on her about forgetting her waste. She had never had any problems with narcotic wasting before.

**canoehead, BSN, RN** · Jul 26, 2009

For those with narcotics in your pockets- it's only a matter of time before you go home with them, or go for a pen in your pocket and pull out a syringe, or have a syringe plunger depress and "waste" the narcotics in your pocket by mistake.

If you saw a cashier at Walmart put a marked $10 bill in her pocket, even if she intended to ring up the sale later when her line wasn't so busy, would you think it was appropriate? The line would move faster, but her job would be gone. What if she accidently drove home with the money? And then was caught with it in her purse (on vacation)and finally confessed to her "mistake?" Are you still calling it an honest mistake? That's where the jury is going to be in this case because that's what they understand.

Get a lawyer, get on the phone now. And by using your pocket it was INEVITABLE that you would forget and go home with it some day. And your plan was to bring it back days later, and try and get someone to sign for the waste? Who in their right mind would sign that piece of paper, and as a late entry as well?? Craziness.

Virgo_RN, BSN, RN · Jul 26, 2009

For those with narcotics in your pockets- it's only a matter of time before you go home with them, or go for a pen in your pocket and pull out a syringe, or have a syringe plunger depress and "waste" the narcotics in your pocket by mistake.

Sometimes it's a matter of the lesser of two evils. If I'm pulling a sheath, I'm stuck in that patient's room for at least thirty minutes. Our smallest vials of Fentanyl are 100mcg. If I'm going to give 25mcg for pain control around the sheath pull, then I have a vial with 75mcg left in it. Leaving it on the table is not an option, since I could easily forget and walk away, leaving the med there on the table. What if someone else finds it and walks away with it? Wasting the unused portion at the Pyxis is impractical, because the patient may need more of the medicine, and I won't be able to leave the room to go get it. I can't keep it in my palm, because my hands are busy pulling the sheath. The safest place for it is in my pocket, until I can waste the remainder later on. I do not prefill a syringe with the whole vial, on the off chance that my brain will shut off and I give the whole syringe, so no danger of the syringe plunger depressing in my pocket.

The way I have avoided leaving the building with narcotics in my pocket is by emptying my pockets at my locker at the end of each and every shift. If I find a vial in my pocket, all I have to do is find another nurse to waste with me before I leave.

Is it best practice? Probably not. Best practice would be to waste promptly, at the Pyxis, in the med room, at the time you remove the med. Unfortunately, best practice can be extremely cumbersome and inefficient at times, and just downright impractical.

I know a nurse who almost lost her license for going home with a Vicodin in her pocket after one of those particularly busy shifts. She didn't remember it was in there, and had washed her scrub top and found the pill, still in the package, in the washer. She brought it in to waste on her next work day, but by then the discrepancy had already been noticed, and she was called in to the NM's office, and the chain of events was set into play.

pagandeva2000, LPN · Jul 26, 2009

Bottom line, to me is that nurses are constantly distracted with CRAP. Sorry, but it is the truth. No one seems to respect that nurses have rules to follow as well, and it seems that the providers and others forget that we have licenses that we worked hard for, also. The reason why the right way is usually impractical is because we are expected to have the eyes of spiders and several arms like an octopus. This is why I can see a situation like this can happen to anyone.

However, the discipline is arbitrary, from what I see. I remember once, an LPN mistakenly took home the narcatic keys and instead of returning herself, she sent a popular cab driver to return the keys (this man is known to all of us because we take his taxi often, so he hangs around). Can you imagine that?? I *knew* she was in hot water! Well, the next day, she came in cussing up a storm and told them she dared them to write her up after that bad day she had, and what happened? Nothing. Now, to me, if she had the nerve to send a non staff member to return the keys rather than do it herself, I believed she should have at least been written up. But, nope...she probably scared them.