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Discussion

question about wasting

Hey everybody. I am a new nurse, just started a job at the hospital about 3 weeks ago and I am still learning in orientation. Last night I had a patient who was going down, brought to my floor with no oxygen, was supposed to be on 2L (ER SENT HER up without it on, in report said she was fine without it, but her O2 on ABG WAS 65) came in with asthma, pneumonia. When she arrived she was not in good shape. We were going to have to call a rapid, but the physician was there luckily. She had me give Ativan, solumedrol, stat breathing treatments, and fluids. Se instructede to to give half the Ativan. Nothing was scanned and these were one time orders. I put the Ativan in her med drawer in my cart to waste later, but as I was about to waste it (end of shift) I got a call from lab to do something so I forgot and then never did waste it before clocking out. So basically it's sitting in my med cart for someone else to find. I'm freaking out wondering what I should do. It was just 1mg but still I'm worried. Our policy is to waste all narcs or meda u count with another nurse and enter in pixis. I thought about calling to tell them that I left it there, but I sidnt remember until this afternoon(went straight to sleep when I got home). Anybody have advice as to what I should do? Thanks for any help. I don't want to lose my job. I am just getting started there and really like it. Come to think of it, since the med was one time order I'm not sure that it would have been on the pixis so I don't know how I would have even wasted it.

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    • Featured Replies

    Call them immediately. As nurses, we have a lot of things on our minds, and though sometimes we are required to be superhuman, we are merely just humans, so mistakes are inevitable. With that said, it is very important that you own your mistake, report it to your supervisor, tell he or she the truth, just as you explained, and learn from it. Next time, put it in your pocket or write down on your brain 'WASTE ATIVAN.' I have to do these things because I can be forgetful. You will learn things like this with experience. A lot of nursing is learning the hard way, this may be one of those times. Being scared is normal, they may ask you to pee on a stick, and guess what?! You will pass, because, after all, you did not shoot up the Ativan.

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    I will second the "call them" sentiment. It will be in the Pyxis unless there is some way to do an override. However, as far as I know, you can't pull anything unless you pull it under a patient's name. Someone correct me if I'm wrong. There will be a record of anything pulled so it can be wasted. You just started and unless your supervisor is an absolute jerk, they should not ding you too badly. It happens more than you would think. Try not to get in the habit of putting half used controlled drugs in your cart. Put them in your pocket and at the end of the shift, empty out your pockets. I have caught many a med that I almost went home without wasting by getting into the habit of ALWAYS doing that :-) Take a deep breath. It will be o.k. Keep us updated.

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    • Experts

    1. Call them and report the incident immediately. Be appropriately contrite, be honest about what happened, ask what you need to do to fix it, and stress that it will not happen again.

    2. Take any drug test offered, or request to take one. Bear in mind that a negative UDS doesn't guarantee that you're completely off the hook, as facilities know nurses often divert drugs not for their own use but to supply to others or to sell...and yes, this includes partial/single pills as well as full bubble cards. Still, offering/taking a UDS without complaint looks a hell of lot better for your situation than your complaining about having to take one.

    3. Learn the habit of wasting as soon as possible after giving the med, and not save wasting for later. Like tomorrow, later never comes. If you have a problem with wasting a drug, let your charge/manager know ASAP.

    Best of luck.

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    • Author

    Thanks guys. I'll let u know when I get in touch with my boss. So question, if u find something in a cart like that then what are u required to do?

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    If you are the one to find a med like that in your cart, notify your charge or manager immediately and follow facility policy regarding the issue.

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    • Author

    I'm just wondering how much trouble I caused whoever took my cart. As a new person there I feel terrible for being an annoyance by messing up like that. I already have to ask a million questions

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    3. Learn the habit of wasting as soon as possible after giving the med, and not save wasting for later. Like tomorrow, later never comes. If you have a problem with wasting a drug, let your charge/manager know ASAP.

    Excellent advice. I always try to waste in the medication room whenever possible.

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    Call and tell someone, like the charge nurse or the nurse who took over the cart (if he/she is still there) and tell them. I can't even count how many times I've found meds meant to be wasted in my cart. If I have the time I usually will call or text the off-going nurse and will verify what the med was for and after hearing the story I'll waste it myself with a co-worker or charge nurse. Just don't make a habit of it.

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    • Experts

    At my place of employment, the policy is that all wasted medications must be addressed within 30 minutes of the retrieval from Pyxis. Our pharmacy department staff does not want nurses hanging onto wasted medications all shift.

    There's a reason for this. A clever diverter can withdraw the wasted medication from vials, pocket it, and fill the vial to be wasted with saline. Clever diverters and thiefs can also pocket wasted half-tabs of Hydrocodone or Percocet and replace the packages to be wasted with regular Tylenol.

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    I've done this myself on occasion. I just called work and spoke to the nurse working the cart, verified the drug was still there and then asked the nurse that was working to please waste it. Not sure what I would've done if the drug ended up missing after I left though, scary thought that!

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    Next time, dont put down the narcs , always keep them on you in case you were lose them or they are stolen and you cant waste them.

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    • Author

    So all went well. I called and the nurse who got my cart already wasted it with someone else. They hadn't planned on calling because I guess they didn't know who pulled it. But if it had come up missing I would ha e been in trouble obviously. Never putting them in my cart again. I've been putting a piece of tape on narcs to return or waste with my pts room # and pocketing to get rid of later. Thanks guys!

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