I have been doing my final clinical rotation in nursing school in a SICU and have observed what I view as questionable practices, so I wanted some SICU RN's to weigh in on these things:
I had a patient on dialysis, and my preceptor told me to empty the effluent drainage bags into the sink. Shouldn't these go in the red bin, as it is technically human waste? Similarly, shouldn't empty bags and tubing for the following things go in the red bin as they are also human products: cryo, PRBC, albumin, platelets?
We have to change the propofol drips q12h. My preceptor told me to just throw the old bottle (half full) and tubing into the regular trash can -- should I waste the propofol since it is a highly abused substance instead of just throwing it in the trash where anyone could fish it out and divert it?
My patient needed PRN Fentanyl IV for pain. The vial had 2 mL, we only administered 0.5 mL. Instead of wasting the other 1.5 mL on the spot, my preceptor drew it all into a syringe, labeled the syringe and put it in her pocket "in case the patient needs more later" -- there is not a Fentanyl shortage, so I don't think this was appropriate...especially because I didn't see her waste it before we left for the day.
As a nursing student being evaluated solely by this preceptor, I am not willing to directly confront her and jeopardize my graduation, but I do not think these actions are the "right" way. Then again, I am a student, so maybe I just don't know. Any feedback would be appreciated.
I guess I should specify when I take the drugs out, when the Pyxis asks me "are you administering the full dose of ____", I specify "yes", so I'm not carrying around drugs that have been wasted. The Pyxis thinks it's all been given, so no discrepancies. Then, if I haven't used however much, I go back in w a nurse at end of shift and waste what I didn't use! :)
PEritoneal dialysis fluid can be disposed of in the toilet. It is considered waste products and can be disposed of in the toilet or in a hopper. Not usually in a sink.
The issue has more to do with disposing of waste where we wash our hands, not so much where the drain leads to (like if you give a bed bath with a basin of water, you're supposed to use the toilet not the sink).
The issue has more to do with disposing of waste where we wash our hands, not so much where the drain leads to (like if you give a bed bath with a basin of water, you're supposed to use the toilet not the sink).
Peritoneal dialysis fluid should be sterile. Pouring it down the sink contaminates the sink far less than washing your hands in the sink does.
Just because there is not a national shortage of a medication, does not mean there is not a temporary facility/system shortage of a medication for whatever reason. Either way follow your hospital procedures regarding narcotics to protect the license you worked so hard to get. If a policy is outdated or is not very functional on your unit, work with your unit/hospital leadership to effect change for the better. Always look to improve workflow. More and more is being added to your already busy day. Take that opportunity to make it better for everybody. Some policies that work on the floor, clearly do to work in the ICUs.
BellionRN
117 Posts
I guess I should specify when I take the drugs out, when the Pyxis asks me "are you administering the full dose of ____", I specify "yes", so I'm not carrying around drugs that have been wasted. The Pyxis thinks it's all been given, so no discrepancies. Then, if I haven't used however much, I go back in w a nurse at end of shift and waste what I didn't use! :)