Question regarding nurses wasting narcs with city paramedics in the ER????????

[austin heart]

Does anyone know about any rules and regulations regarding nurses wasting narcotics with medics when the bring a patient into the ER? Do yall do it your ER?

Thanks!

[chip193]

This is the reason that the nurses in my ED, including myself, refuse to do it (we are small, 9 beds). Most of theses medics I don't know from Adam and there are a few that I do know that I don't really trust. Now there is a big hub bub going on because the city paramedics are complaining about us because we will not waste with them.

I don't understand why they can not waste with their partner.

If there is a medic that happens to read this.......Can two medics or a medic and an EMT waste narcs together or does there have to be a nurse?

In my EMS system in NY, an EMT isn't even listed in the plan, even though he is my partner. He cannot waste, draw-up, have anything to do with, or even acknowledge the existance of CS in our system. We do wastes with the nurses in the ER and there hasn't been a problem.

How often do you do wastes in the ER where you simply watch another nurse toss something into the sharps box? It's pretty frequent in my ER.

Chip

[austin heart, BSN, RN]

I think that my issue is I do not trust some of the medics that come in, not all but some.

As far as wasting with fellow nurses, I work in a VERY tight nit group now (there are only 6 of us that rotate through on days) and I trust them all. I know these people and I know what kind of nurse they are so I do not hesitate to waste narcs with them. I have worked places where I did have issue. Back in the day I worked on a very busy medical floor. Turns out several of my co-workers where stealing narcs and a few of them had been ones I refused to waste with. Sometimes you can just pick up a vibe from someone.

I just feel uncomfortable wasting narcs with someone I do not know.

[Aliakey]

In our area, an EMT can witness and sign to a waste sheet, but the witnessing and signature by the receiving RN or MD is preferred whenever possible. I don't know about the Austin area's requirements.

I can understand hesitation with some paramedics; in years past when I worked with another company, I was partnered up with a few I wouldn't even trust with a cockroach. Thankfully, there are many, many more I wouldn't hesitate to trust with my own life. But sadly, the few sour ones tend to ruin everything.

As an EMS Director (*finally* ;-) ), all of our controlled substances are ordered using the Carpuject design whenever possible. Although not failsafe on tampering, it takes more work to do so and in addition, we are very careful with our CS inventory, followups, etc. Last thing I want is for the DEA and DPS certificates to be yanked (yikes). You may start seeing more of these in the future, as it is becoming increasingly difficult to order vials and other drawable containers through usual vendors due to needleless requirements.

As a thought to why some of the EMT-Ps are drawing up a full vial of morphine or other CS when using standand vials... I could only guess to prevent the loss of the original vial while rolling down city roadways. Kind of like losing the remote to the invisible couch creature at home; always happens at the worst time. Usually, if a medic is using a CS (and pt is not normally receiving the CS for a terminal condition, like hospice pts), then there's usually a lot of action going on in the patient compartment, which can result in the "where the friggin' 'bleep' is that vial?!?" exclamations when it falls off the counter and rolls under the stretcher, chocked hidden against the wheel and maybe sitting in a pool of that "nasty wet stuff". Just no time to look for the vial, but the filled syringe is right there with the flush and is less likely to roll by its design.

Now as a Director, I simply do not keep medics if I can't trust them, or if the nurses at the hospital offer evidence to the medic's blatent incompentancy or dishonesty. I still "work on the truck" myself, and when off the unit, visit with the hospital nurses and ask them if they are having any problems with our crews or have questions. It's not a PR thing, it's information I need to know and hopefully given as honestly as possible. It's in the patient's best interest to have a good working relationship between the ambulance service crews and nurses. If the local Service Director is not actively making rounds, maybe giving him/her a call with a "heads up" on your professional opinion about a particular medic might work. The Director won't know if a medic requires more time under the supervision of a FTO unless somehow informed.

IMHO, I really don't think it would be out of line to ask the medic's partner to sign the waste sheet if you feel you can't trust the medic, as long as the EMS protocols for that area do not prohibit it. A quick look through Austin EMS' latest protocol does not say one way or the other (unless I missed it somewhere), but the Medical Director will know for certain.

Just my two cents worth from north of you ;-)

[ED RN 911]

In our ER the only ones that are allowed to waste Narcs with Street Medics are the in-house ER Medics and the MD. This goes along with the report also, when a medic brings in a Pt they can only give report to the MD, due to working under their License. They have to give care to a equal or higher level-of-care, ie: the MD. It sucks but thats the way they do it here.

[Aliakey]

Geez, if I was in your position, my first rants would be, "Hey, what am I? Chopped liver???" {grin}

In our area, many of us actually prefer to give pt care and report to the RN rather than the MD; we know you, we like working with you, and we know you'll be the one providing most of the patient care. Here, the RN *is* a higher level of care without a doubt, and as far as working under a physician's license, it is under our Medical Director only. Not the other docs who we'll end up giving report to when the nurses are already busy as it is.

I have a lot of respect and admiration for what you folks do, and doubt I could do it myself. If I couldn't have my tinture of diesel, that thick 3 am Sleazy Mart coffee, a flirtin' drunk on the asphalt just needing a line, and cold rain pouring down my uniform, I'd go nuts. More so than usual. ;-)

[paphgrl]

If you suspect NS, you can tell if there is no smell. MS has such a distinctive smell.