Pixus waste never witnessed

jadelpn, LPN, EMT-B · Mar 24, 2015

Yikes!! First off, most med areas have cameras. Therefore, you are being recorded.

Secondly, do not ever, ever, EVER anticipate narcotics and grab them--you need to assess your patient before you pull meds. And not just for a narcotic reason--if the patient I not within a range for a med would also be a reason to assess first.

Thirdly, do not EVER sign your name/fingerprint for another nurse. Ever. If the nurse in question has an issue with the pyxis, then they need to approach pharmacy about that, not you.

And finally--the waste later icon is crazy, as who is going to witness a non-existent waste?

And because a pyxis is a computer, it records everything. So just because it hasn't caught up with you yet, doesn't mean it won't. So be smart about it. You don't want to be accused of diversion due to foolishness. That is career ruining.

KelRN215, BSN, RN · Mar 24, 2015

When you return something what do you do? When I worked in the hospital, you had to select in the pyxis which patient you were returning the med for, therefore they know it was you. You sign in with your fingerprint and select that you are returning the medication for John Doe.

Pulling a PRN narcotic from the pyxis without knowing if the patient wants it is a BAD idea. Get out of this habit now.

onedayitllbeme · Mar 25, 2015

Never pull narcotics "just in case." You are asking for trouble. Waste later is ok if you pull the med go to a nurse have her watch you waste then go back and sign off. But don't physically waste without anyone watching.

bella14k · Mar 25, 2015

I agree with you guys but the nurses act like it's okay. I did this twice already. I am a new hire, i've been there for 5 months. I did it for a nurse who's last day of work was that day, and then the other day with another nurse. I don't want to piss anyone off when I say I don't want to use my name to get their narcs, but if this is serious i definitely won't. And good,i'm glad there's cameras bc that's my backup if for w/e reason i get in trouble. I haven't seen any cameras , are they in the pixus? What is being accused of diversion? And if i'm accused of that, what happens next?

bella14k · Mar 25, 2015

Also, a week went by since I took out that unwitnessed morphine that i needed to waste. The person who precepted me at the time said she would waste, but i guess we both forgot, and usually there's a cue when you sign into pixus that says, "waste needed", you know, as a reminder that you still need to waste. But it's not there anymore. How can I solve this? Should i call pharmacy and ask? Over the last 5 months i have not been approached about anything. I take it that i work with other nurses who don't use drugs, so all drugs returned (unopened pills and unopened vials of course) by all nurses are all in the return box of the pixus. I will never take out a med without assessing, and i will not take out other rn's drugs under my name, since everyone seems to think that's a terrible idea. Thanks for your advice.,

please get back to me about my other concerns

LakeEmerald · Mar 25, 2015

I suggest you bring up the unwasted morphine with your preceptor, and ask her to help you waste it. It may come back to bite you in an audit later on if you don't. Do you recall the patient's name and info to waste with? You may have to ask pharmacy for help, but better to catch it now and address it proactively than to have someone have to question you about it later.

Pulling narcs for a nurse on her last day and not witnessing them being given? It would make me nervous. Protect yourself a little better.

bella14k · Mar 25, 2015

When i had to go down to pharmacy I even asked if taking out a med for another nurses patient (bc her fingerprint wouldn't scan) was okay, and the guy said "yeah" (don't know if he was a tech or pharmacist or what). I will confirm this again when I ask about the previous waste. Luckily I do have my old schedule which has the name of my preceptor (I had 3-4 diff preceptors throughout), so hopefully i'll be able to narrow it down and find the right day this occurred, and then go from there. And no i do not remember the patient name, i recall looking in the pixus one day for this guys name (at THAT time i did remember) and i guess the waste reminder was gone when i logged in. Probably b/c he was discharged, so i had no1 to waste on, you know? It's my fault for not doing a thing about this,even though the days following this i was thinking about it,and i either got busy or my preceptor for that day wasn't there to witness.

jadelpn, LPN, EMT-B · Mar 25, 2015

I agree with you guys but the nurses act like it's okay. I did this twice already. I am a new hire, i've been there for 5 months. I did it for a nurse who's last day of work was that day, and then the other day with another nurse. I don't want to piss anyone off when I say I don't want to use my name to get their narcs, but if this is serious i definitely won't. And good,i'm glad there's cameras bc that's my backup if for w/e reason i get in trouble. I haven't seen any cameras , are they in the pixus? What is being accused of diversion? And if i'm accused of that, what happens next?

And be mindful of the fact that there are some nurses who may or may not be diverting who will in fact use the new nurse to get narcs for them, believing them to not question it.

And most experienced nurses know better, especially with narcs. And if someone gets po'ed about it, it would be more than likely due to the fact you are on to them, and they have to figure out how to get their own narcotics. Narcotics are so highly regulated, that this more than likely is against your facility policy. Which can be held against you.

Most every pyxis I have worked with has the option of a password as opposed to a fingerprint--so I am not sure why pharmacy is so cavalier about the whole thing. And cameras capture images--most are in the area pointed at the pyxis--so the only thing it will verify is Yup. you took narcs out on someone...who, wait, wasn't even your patient--see where this is going?

Get your own malpractice insurance. Be sure that you say "I am sorry, but I can not pull narcs for you, it just isn't great practice I want to get into"

Fact is YOU would be held responsible for anything that you pull--regardless of a "but I did it to help another nurse" And there has been nurses who are put on monitoring who have done what you are describing.

And if for some reason that you are wondering how to get narcs for you--realizing you may have a problem with dependence is something only you can answer, and some of your questioning is a bit off to me. Historically, you are not wasting, and you are pulling all kinds of narcs for other nurses. Perhaps you need to self report to the BON or your employer will----

SEE how easy it is to turn all of what you said around? And I am just an outsider looking in. The practice habits that you portray are just not good ones. And can land you in the hot seat.

Always waste immediately--make sure that you have your order in front of you so that the wasting nurse can see it. And expect the same when you waste with another nurse. And again, should you be asked to pull narcs, just say no.

PacoUSA, BSN, RN · Mar 25, 2015

NEVER waste later! Good practice is to always waste when you pull from the Pyxis. Never leave the med room with more narcs than you need to give right away! You never know what can happen once you leave the med room with unwasted meds, you could possibly get involved in a code and forget you even pulled a narc that's sitting in your pocket.

KelRN215, BSN, RN · Mar 25, 2015

I agree with you guys but the nurses act like it's okay. I did this twice already. I am a new hire, i've been there for 5 months. I did it for a nurse who's last day of work was that day, and then the other day with another nurse. I don't want to piss anyone off when I say I don't want to use my name to get their narcs, but if this is serious i definitely won't. And good,i'm glad there's cameras bc that's my backup if for w/e reason i get in trouble. I haven't seen any cameras , are they in the pixus? What is being accused of diversion? And if i'm accused of that, what happens next?

Being accused of diversion means that your floor notices that bella14k removes a lot of narcotics from the pyxis for John Doe but John Doe hasn't taken any narcs in days. No other nurses who care for this patient pull narcotics for him. Bella14k also has several undocumented wastes. Therefore they say "bella14k might be taking these narcs for herself", tell you to submit to a drug test and report you to the BoN. Then there's a likely suspension from work and an investigation into your license.

psu_213, BSN, RN · Mar 25, 2015

The only time I would go with the "waste later" is the case of an emergency. For example, in the ED if a patient is seizing, a nurse (not necessarily that patient's nurse) will go to the Pyxis and pull out Ativan--at the time not knowing exactly how much will be given. That nurse will go back later with another nurse to waste. Even that scenario carries a risk of a missed waste, so be careful.

If, however, a PRN is being given, and requires a waste, waste it right away! For example, if a patient get Dilaudid 0.5 mg PRN, and you only have Dilaudid 1 mg--pull it, waste it right then, and know there won't be an issue. If you forget to have a waste witnessed, it can still come back on you if you originally pulled the med.

Never pull out a PRN narc (or anything else controlled) unless you are certain the patient wants it. It is going to look really, really bad for you if such narc is pulled, the patient refuses, you forget to return the narc in the Pyxis. It is not difficult for the pharmacy, your manager, the DEA, etc. to correlate the narcs you pull with the narcs you have charted. Even if you pass a urine test, you can still be accused of diversion--from the point of view of management, how do they know that you did not take the narcotic for a friend or took a narc to sell it? I'm not accusing you of that, but someone might.

Finally, I will always witness another nurse give the narc if I pull it for him/her. If a nurse for some reason cannot get into the Pyxis, I will tell them "I will help you this time, but you have to call the pharmacy and get the squared away." (again, I will still witness them give the narc.) I worked with a nurse who diverted narcs. After the fact, almost everyone said "I never would have though she would be the one to divert." Point is, you cannot blindly trust anyone when it comes to wastes. It may seem "rude" to not trust someone, but you cannot assume that a given nurse will not just pocket the narc or that he/she actually did waste that extra Morphine, Valium, etc.