sorry if this is in the wrong thread it's been a while since i've been on here. So a month ago, I took out morphine and had to waste. My preceptor didn't waste with me, and my pixus allows us to "waste later" which is stupid and creates problems. I wasn't approached about it to this day, but what would happen?
2nd scenario: Sometimes during morning rush before i see my patient for all their AM meds, i will anticipate my patient needing a vicodin or whatever, and will pull it out (as PRN rx) before asking pt if they want it-this avoids me going back and forth to the pixus. I recall on a couple different occasions where they were too sedated or sleepy, and i would return it. When i return the pill, how will they know I returned it? what if another nurse says she returned hers, (BUT really DIDN'T), and I actually return mine. I don't like how you don't return it to the original box but into a drop box kind of thing, where the pharm tech picks it up later.
Also, is it okay for you to sign in pixus to get something for another nurse ? This happened to me yesterday my coworker couldn't log in with her fingerprint.
I once worked with a nurse that diverted narcs for herself, was high as a kite one night, that's how she was discovered. Ironically, she was on her last night of orientation too! Don't know how the termination occurred, but I do know her license was never suspended, and I have a big problem with that!
I once worked with a nurse that diverted narcs for herself, was high as a kite one night, that's how she was discovered. Ironically, she was on her last night of orientation too! Don't know how the termination occurred, but I do know her license was never suspended, and I have a big problem with that!
My best friend's sister-in-law's license was revoked for narcotic diversion. Her whole family thought she was still a nurse until a few years ago I happened upon this information. When I met her I didn't believe she was a nurse, did a 2 second search on the state's website and the license came up revoked. Entire disciplinary document available on Nursys. Her brother still thinks she's working as a nurse and doesn't understand why she can't find a new job.
When it comes to drugs of any sort it is best to treat the pyxis like a cash register. You would not get cash out of the company till and put it in your pocket anticipating that a customer might need change (well, maybe in a periop environment). You would not take cash from a customer only to ring it up later (Wasting).
The way nurses act towards drugs can lead to diversion activities. In my unit it was part of the culture that nurses would get ibuprofen or zofran out of the pyxis and use it for themselves. There was also the culture of too busy to waste together, so one nurse would sign in and leave another alone to waste the medications.
Here is my slippery slope: I was being treated for migraines with oxycodone (not a good treatment) and told by the medical establishment at the time I had the right to be pain free... now put someone with impaired thinking in the situation where the waste of narcotics is not taken seriously, and the respect for medications is lacking.
If its OK for Cindy to take Zofran, and I'm prescribed narcotics, what is the harm in taking the waste narcotics? Soon this devolved into full blown diversion of narcotics and a drug problem that was leading to certain death.
Do not cross any line when it comes to the handling of drugs of any type. You might not start taking narcotics, but blurring of the rules might give some other poor sap the idea that there really aren't any rules.
As far as the person who thinks a nurse did not get sanctioned for narcotic diversion, she could have been sanctioned in a non-disciplinary program (As I am).
Specializes in Mental Health, Emergency, Surgical.
When it comes to drugs of any sort it is best to treat the pyxis like a cash register. You would not get cash out of the company till and put it in your pocket anticipating that a customer might need change (well, maybe in a periop environment). You would not take cash from a customer only to ring it up later (Wasting).
That's a good analogy and thank you for having the courage to share your story.
I would never take a medication out for another nurse to give. EVER. If she is tied up and has a patient in pain, I would certainly pull the med, but always give it myself. I never blindly waste with another nurse. I wouldn't care if it were my manager. At the end of the day it's YOUR license. Are you willing to jeopardize that in order to try to "fit in" and not make waves as the new hire? If someone is diverting drugs, they're not going to have your back. Just be careful.
I don't know what to tell you about the Morphine not being wasted. This could come back later during an audit of the system and it's been too late to pee in a cup to prove you did or didn't use it because it would be out of your system within less than a week if I remember correctly. In the future, just make sure that you waste it immediately. I know we all get busy but narcotics are nothing to play with as they can cause you a lot of unnecessary headaches later.
As for pre-pulling the Vicodin, I would not do this either. I know it saves time going back and forth to the pixis (especially if its on the other end of the unit) but pharmacy can see how often it is returned and with electronic med pass, exactly what time it was given is very easy to look up without searching down the old paper chart like the old days. If there is one missing from the drop box and two nurses "returned" one, the only thing I can think is a urine drug screen for both and then close monitoring of your log in activity.
Pulling meds for another nurse under your log in....I would want to be the one administering the medication if I pulled it, especially if a controlled substance. We probably did more of this before the advent of computerized med pass, but so many reports can be ran now to see if we are following protocol that even so much as a Tylenol can be tracked as to who pulled it from the pixis and who administered it to the patient. Obviously in an emergency policies may be eased, but most of the times a code is called by that point and the code cart is utilized (have only had one time where it was not but was in the ICU with one other nurse and the patient was on a vent already but having cardiac issues. The ICU resident and RT were there and the pixis was literally right next to the patients door. One of us was pulling, the other administering, and in the end we cosigned the med sheet (again, paper). It probably wasn't the best practice but the code cart wasn't utilized since the patient wasn't a true code, but we had to administer the meds fast or they would have been.
If we return a med, it ups the count in the drawer - that's how they know if the med was truly returned. I don't take out narcs before I need them, because with my luck I know I would end up taking them home with me in my pocket. :)
If we return a med, it ups the count in the drawer - that's how they know if the med was truly returned. I don't take out narcs before I need them, because with my luck I know I would end up taking them home with me in my pocket. :)
Or worse yet you could be like me, where your scrub top pocket keeps getting caught on the door handle on the way in/out of a room and things get dumped out without being noticed. I've lost money and a lot of pens but thankfully, I haven't placed meds in them because I knew this could happen since I've been latching onto the doors since I was a nurse tech waiting to get my license.
When I used a Pyxis--and now with an Omnicell--all returns needed a witness.
Any time you waste--either immediately or later--you need a witness.
If you're pulling meds and just throwing the extra into the trash or shooting it down the sink w/ no witness, you're going to get yourself into trouble.
I'll pull meds for another RN's patient, if I am giving the meds myself. Like she's busy w/o her other pt, so I'm going to give them for her.
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?
Follow protocol EVERY TIME. Yes, some nurses break it. Some break it every day. Do not follow these poor examples.
You've learned proper medication protocol. Stick to it. You'll be fine.
They will call you at home to waste your meds if you forget at the end of the night. I would not personally let other nurses get narcs out under my name. If you return a narc, you should have another RN with you because it will ask for a witness password.
We have to have a witness to return any narcotic, and of course the computer keeps close track of all that was pulled, administered, and/or returned/wasted, and it will flag any discrepancy by the end of the shift which the charge nurse supposed to address and correct before shift change. I don't know if other facilities are like that, but it seems to work pretty well at keeping up with all that stuff.
I think the "waste later" thing is intended to mean "document the waste later". In other words, I may pull a 1mg/1mL vial of dilaudid, waste 0.5mL and show the nurse sitting at the computer behind me and rush to go give it to my patient screaming about their pain medicine then come back a bit later, log in, and get the nurse to document that she witnessed it with me. I always try to document my waste immediately, but I have been in many situations that didn't allow for it right away.
The other couple of things the OP brought up are really just nurse discretion. If I have a patient that I know has been watching the time to be sure they get their PRN norco every 4 hours and I have to go in there to do something else, then yes I may go ahead and pull it and have it on hand because I know they will likely ask for it when I go in. Some nurses aren't comfortable doing that. It's up to you.
Lastly, pulling meds for another nurse to administer.......I'm pretty comfortable doing this in certain situations if it's not a narcotic. I've pulled many IV bags, zofran, antibiotics, etc for coworkers that were super busy or in an isolation room or whatever. I have done it once or twice for narcotics when I was actually present to see it scanned in and given to the patient, but again, this is all up to your personal discretion. It's your job and your license.
PacoUSA, BSN, RN
3,450 Posts
I once worked with a nurse that diverted narcs for herself, was high as a kite one night, that's how she was discovered. Ironically, she was on her last night of orientation too! Don't know how the termination occurred, but I do know her license was never suspended, and I have a big problem with that!