errn431

Hello everyone, first time poster/long time reader here. Looking for some opinions on waste procedures in the ER. I know some of this content has been covered in other forums, but I am looking for specific info. Background: I am on a patient safety committee work group at a small community hospital in a rural area. We are a 63 bed facility with 14 ER beds. I am the representative on this committee for the ER. Right now we are working on narcotic waste. Our hospital policy states that once the ordered dose has been administered the nursing staff (LPN or RN) is to place the remaining amount in a clear plastic bag with a patient label and "immediately" take it to the Omnicell and return the waste amount with a witness. I am not advocating anyone not following the policy, but I am concerned that this is not always immediately feasible based on the patient acuity and staffing in the ER. Our ER nurses have 4:1 patient ratios. We have no CNAs or patient transporters. We have to turn over (clean) our own rooms. We do our own EKG's and nebs. Sometimes we have paramedic who functions in a ER tech role, but we are largely on our own. It is very challenging at times to have another staff member "immediately" available to witness your waste. Additionally, some times the patient is too unstable to safely leave the bedside as soon as the medication is given. The Omnicell will not allow you to return without a witness, even as a temporary measure. So the nurse has no choice, violating policy if no other waste witness is available at that moment. Even if a witness is available, the nurse often has to decide between unsafely leaving the bedside of an unstable patient or either leaving the vial unattended on the counter or placing it in her scrub pocket until it is safe to leave the bedside. Surely there must be another way that does not risk our patients safety and allows us to follow policy and reduce risk of drug loss/diversion. What does your facility do? What is your procedure for wasting narcotics in a busy ER with limited staffing. Please excuse any typos, as I am writing this quickly on my lunch break.