Very little witnessing going on with drug wastes on my floor! - page 3

I'm new to this med-surg floor. When we get a drug like morphine out of the Pyxis it asks if we are going to give the whole amount. If we say no it asks for a witness. The "witness" will come in and... Read More

  1. by   FORTHELOVEOF!!!!
    Not all nurses hang around to witness the waste, but your system sounds a little flawed. Ours lets you take out what you want and will show a variance if the amount given is different than dispensed and then you take another nurse in to waste with you to get rid of the variance after you administer the medication, or the end of your shift. Either way you don't know if someone replaced the narc with NS unless you witness the whole ordeal and that isn't realistic.
  2. by   DroogieRN
    I didn't read all the replies, so feel free to ignore. Most don't stick around to waste and don't expect you to, either -- and often there just isn't the time. Don't ever witness for someone you don't trust implicitly. Probably you can count those who qualify on one hand, if not one finger...
  3. by   brandy1017
    How about the doctor orders a standard dose Ie 2mg MSO4 or 2mg of dilaudid, etc. Problem solved! Instead we waste medicine the patient could use and is paying for and the patient doesn't get the full pain relief they deserve! I think that's what ridiculous about it all!
  4. by   Indy
    For what it's worth, I wish all of y'all that are squirting the waste in the sink would just stop, take two seconds, think about it, then squirt it at the trash can. The trash, particularly the paper trash, will absorb the stuff, and it won't go into the water supply. Ok? Ok. My second thought is that if you're in such a bind with the scanner doohickey then draw your drug, waste, tape the vial to the syringe, go do your thing and scan the thing near the patient. No problem unless it's one of those ampule things, then I have to say I just waste and throw the ampule in the sharps. I will do the long way of documenting in the computer without scanning because I don't want to haul around a piece of sharp glass in my hand or pocket.

    Also, it's pretty easy to pick out who is unstable by who trusts you quickest, without knowing you from Adam's housecat, and if you need to prioritize what things to really watch the waste on, it would probably be the pills that have to be cut in half, etc. Make sure you see where the other half went. (also if you see some fool trying to eat the napkins out of the trash...)

    Also you can note whose patients actually sleep versus whose patients are on the call light constantly for pain med. Hmm. And docs don't write standard orders for all of what's in a vial all the time, because that stuff is supposed to be based on weight, situation, and tolerance... not on what's convenient for the nurse. Not all patients are huge and addicted. Some are little and delicate.
    Last edit by Indy on Oct 14, '12 : Reason: left out words
  5. by   Sugarcoma
    This is pretty common practice. On both units I have worked in my career. Very few nurses actually eyeball your wastes. The first unit we were so crazy busy that we would wait until the end of the shift to meet in the med room and waste all medications at once for each nurse. Not ideal I admit.

    I do know that some facilities monitor pyxis access. I was told twice that I had been flagged as someone who pulled a large amount of narcotics. This was usually after a 3 day stretch of several Q2 Dilaudid patients. I am the nurse who will medicate you per order as long as your vitals are WDL. I would have been required to have a drug test if I had forgotten to chart any one of the doses.

    The bottom line is that it is frighteningly easy to divert medications if one were so inclined. We have to trust each other a little bit. Honestly if you witness for a coworker who is later found to be diverting,how can that be linked back to you? How could anyone prove that they diverted the dose/s YOU witnessed for as opposed to those some other nurse had witnessed?
  6. by   Greenkji
    Wow! Interesting discussion. I am a new grad (no job yet), but I am shocked that drugs are so often wasted without a true witness. In all of my clinical and preceptor experience, the drug was always drawn up, wasted (with a witness) and then brought to the patient. Always. I would be extremely uncomfortable signing off on anything that I did not actually see with my own eyes. Another point, even though it sounds like all of the nurses are practicing this, I highly doubt it is written that way in the hospital's policy and procedure.
  7. by   Nurse ABC
    If most people aren't truly witnessing then it's a flawed system and a waste of time to have to find another nurse to scan their badge/fingerprint to get the med out of the machine. Just another way for the hospital to cover themselves while not really protecting the nurses it seems. It would be nice to just have a camera and forgo the whole witnessing thing! Thanks for all the honest responses!
  8. by   MN-Nurse
    Occupational cultures differ, but on my med surg floor, we witness in the med room then go administer.
  9. by   evolvingrn
    for some people i stick around...........for some people i don't
  10. by   anotherone
    This happens where I work too. Someone has to get the med out, then go to the med cart, draw it up, and then waste it. Some people watch, very few do. The reality is that there are times , I stand around waiting 10minutes OR MORE for someone to even ask to witness, especially on night shift when the number of licensed staff is pretty low. That person is usually on his/her way to do something else and doesn't want to stand there watching. I like to take the med out, bring the order up on the MAR again, then draw it up while looking at the order and the vial/ampule/ whatever a few more times. I don't like to bring the needle in the med room and draw it up there in a rush without checking the order again while drawing up.
  11. by   anotherone
    Quote from Jessy_RN
    At our facility, we have to 'waste' at the pyxis and have that person witness at the pt's bedside by entering their credentials into the charting system and their password.

    When we are going to give the narcotic, one of us grabs the syringe and needle that are next to the pyxis while other pulls the drug. It is quickly drawn up and wasted in the sink by the pyxis. Then both scan go it, scan the pt and witnesses in the computer.

    It does take a little bit of extra time but for the most part it doesn't because you are mindful of how busy the other person is and have the caremobile (scanner) logged in and ready to go, plus all the 'waste' supplies are readily available where the pyxis is located.

    I don't feel comfortable not making sure someone actually witnesses my waste the moment I pull it out of the pyxis.
    Ugh, we don't have the supplies where the pyxis is. Also we often have a few pts on q1-3 hr morphine/dilaudid etc. What about when pts ask for meds, you draw it up, waste the right amount, go in the room and the pt refuses? in your unit, it's helpful that the other nurse is actually there to witness this also. This happens often enough where I work. (no, i don't want the dilaudid, now I want oxy, no now i want percocets etc) Unless you go and ask the pt if it true who knows whether it is or not.
  12. by   anotherone
    Quote from Indy
    Also you can note whose patients actually sleep versus whose patients are on the call light constantly for pain med. Hmm. And docs don't write standard orders for all of what's in a vial all the time, because that stuff is supposed to be based on weight, situation, and tolerance... not on what's convenient for the nurse. Not all patients are huge and addicted. Some are little and delicate.
    I don't know where you work or what type of diverters where there but on my unit we get many pts who ring nonstop for pain meds, we get A LOT OF post op pts or pts with chronic pain issues now with acute pain issues. I would never think it suscpicous that one nurse's pt is not sleeping but " in pain" sicne most of the other pts aren't asleep either.
  13. by   sbostonRN
    Most people at my job do not witness wastes. I am one of the few that do. We have carpets in our hallways (where the Pyxis is), so the nurse usually draws the whole vial of med, then squirts out the unneeded amount onto the carpet (of course this is for small amounts like 1/2 mL).

    However I have never gone into the room to witness the nurse give the med to the patient. Yes, the nurse could chart that she gave it while she pocketed the dose. But that's a possibility ANY time a narcotic is given, even when a waste isn't entered. I don't watch nurse #1 give her patient 2 Percocets, so why would I witness her give 1.5 tabs?