Yes, I read the original issue. I understand what you're saying; on first read I didn't follow through the instances of present situation vs. future.
But I'm still going to ask for clarification:
Quote from rx3500
Documenting your waste in the medical record is an important step because it will show the path of the narcotics use. Make sure that you have a witness and have them document witnessing the actual waste.
I will ask again. Are you suggesting that, as a matter of routine every time a medication is wasted, I should document in the medical record that I wasted something and that the waste was witnessed by Jane Doe, RN? And Jane Doe should also enter that patient's medical record and write a note that they witnessed the waste of X mg of this med?
That makes sense and I'd go along with it. However, it's a step that largely fell by the wayside once everyone began using medication dispensing cabinets and there existed the functionality to witness at the machine. So it would be a great big "roll-back" in lots of places, to revert back to documenting a waste in the record itself/eMAR. Especially since the advent of being incentivized to do everything as fast as humanly possible.
I can see in thinking through this that pyxis' record of transactions has sort of been allowed to stand in for proper legal documentation, when in reality the pyxis transaction record is simply an administrative tool associated with pharmacy. Hmm.
Quote from rx3500
In this situation I would have the charge nurse or supervisor be your witness. Writing a memo on the situation, and having the witnessing party sign as well is a good way to prove the transaction. Keep a copy. In pyxis the option is there to document waste when pulling the med to avoid having to remember it later. Definitely remember to document this in the patient chart for tracking purposes. Additionally reach out to your pyxis administrator for guidance. They will be able to help. Never be afraid to admit the mistake, supervisory awareness, self volunteered looks better than not mentioning it at all.
Okay, yes, I see what you meant. It may be wise for anyone who realizes they have forgotten to waste, to approach their manager ASAP and write out a memo about the forgotten waste documentation, noting that it was indeed witnessed and the name of the RN who witnessed it. And yes, the manager can witness someone writing all of this on a piece of paper. By "prove the transaction" you were referring to the transaction of writing the statement, not the transaction of having wasted anything or witnessed any waste.
Quote from rx3500
In pyxis the option is there to document waste when pulling the med to avoid having to remember it later. Definitely remember to document this in the patient chart for tracking purposes.
I understand now you are saying to "waste" at the pyxis and then also document wastes in the medical record.
Everyone should utilize the pyxis waste function in real time - right then when removing the med and prior to administering it or even leaving the area with it. Actually I think it is the only way the pyxis waste function can be used legitimately, since, if the witness is not present for the whole removal/prep/waste procedure then the witness really can't be sure of what they're witnessing.
It bothers me the way nurses are threatened (not just suspicious actors but entire staffs) and treated because of something someone did somewhere sometime in the past - meanwhile the actions that management suggests or puts into policy most certainly aren't foolproof in plenty of places.
The right way to do this these days would be to call witness to the med cabinet. Remove med, draw up correct amount, label it, remove remainder, verify amount, waste it, and have the second person sign the waste in pyxis. (plus the added step being suggested here of both then going separately into the medical record and documenting the waste). Remember not to properly dispose of empty vial because it is still needed for scanning at the bedside.
What is totally accepted and advised in many places, instead, is: RN removes med, goes to patient room, administers med and documents that. Starts looking for someone with whom to waste the remainder. Once someone is flagged down, go to pyxis together, perform a "witnessed waste" [of whatever liquid substance
in whatever amount is in the vial]. Kinda funny that it would upset an apple cart if this procedure wasn't followed. I mean, it is
actually meaningless and proves nothing.
So. Option 1 is what is prudent and complete. But it's not what most places advise or would want because it hogs nursing time. So. Do it the second way, and if you don't you will find yourself the subject of a witch hunt.