Refuse the cart

Specialties Geriatric

Published

I have a friend working in a skilled nursing and rehab facility. She has only been working there one month. On her unit, in the narcotic boxes on each cart and in the narcotic fridge, there are at LEAST 20 expired, discontinued,and inactive narcotics (liquid and pill forms). Some of these have been discontinued since last year. Some of them are from patients that have long since passed away or went home. My friend made a medication error and gave a patient a discontinued narcotic (right patient, wrong narc).

My friend felt awful but was short staffed and therefore distracted and being pulled from the cart. She got a write up for this. Others have made the same error at this place and continued to make it after she did. Admin has been verbally told about the danger of those narcotics not being wasted, and they have also been emailed regarding the matter, to no avail. Here is the advice I gave her.

I told her to call the unit manager/charge and make a complaint about the matter. Next, if nothing gets done, send an email to admin about the matter. If nothing is done after that, refuse to take the cart on her next shift. She thinks this is extreme. What do you all think?

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Specializes in retired LTC.
I told her to call the unit manager/charge and make a complaint about the matter. Next, if nothing gets done, send an email to admin about the matter. If nothing is done after that, refuse to take the cart on her next shift. She thinks this is extreme. What do you all think?
Registering her complaints are fine, but her REFUSAL to take on the cart will prob result in INSUBORDINATION or a REFUSAL to carry out duties as assigned.

We're talking about severe disciplinary reax possible, possibly her termination.

What's the facility's protocol for wasting narcs? That's the first thing to know.

If the pharm consultant be brought into the loop, it should be done. They usually review med errors.

Since a med error was made, was an incident report filed that identified the outdated meds as CONTRIBUTING to the error? And that data could have been added to the write-up.

Anywhere you can document contributing factors such as this, aids a root cause analysis.

However, final note - a med error was made. A failure of one of the 5 rights. No getting around that fact.

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Specializes in Case Manager/Administrator.

I would let my supervisor know these medication need to be destroyed, find out when the pharmacist comes in you need to band together with the other nurses to get this pharmacists to destroy/take away those DC narcs. I would also place those narc in an area where they are only counted (make sure you do count), perhaps in a zip baggie in the locked area. . I am surprised the state has not found those meds. You are out of compliance.

F Tag 329 Unnecessary Drugs, F Tag 332/333 Medication Error, F Tag 425 Pharmacy Services clearly show why those medication need to be disposed of.

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Specializes in Geriatrics, Dialysis.

What is the facilities protocol for wasting narcs? Where I work any 2 nurses can do this. Even if the nurses can't waste, the med error was a failure of not following the 5 rights. If multiple nurses are making the same error I'm thinking that they should probably be paying a little more attention to what they are doing.

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Specializes in LTC, Hospice, Case Management.
What is the facilities protocol for wasting narcs? Where I work any 2 nurses can do this. Even if the nurses can't waste, the med error was a failure of not following the 5 rights. If multiple nurses are making the same error I'm thinking that they should probably be paying a little more attention to what they are doing.

My thoughts exactly - 2 nurses can also waste narcs in my facility. I'm also curious if you still actually count all these discontinued narcs each shift change? (I would certainly think you should be).

We have 2 residents with very similar names that both take same narc. Our narcs come in a count card - we colored the one card with a highlighter just to make it harder to mix up - can you use a highlighter on the discontinued narcs & find a way to separate from the rest.

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In my state the DON removes DCd narcs off the cart with another nurse and we send them into the state for destruction. Either way, you need to find out your facility protocol. Go to you DON and ask her what the steps are for removal. If the meds are still on the cart when you Pharmacy Consultant comes in let him know. He will put that in his report. Those reports go to the DON and Admin and in some cases cooperate. That info being added to his report will light a fire under someone. If they are still there when he comes back, tell him again. The consultant will light a fire under someone to get them off.

And as the others have said. Giving the wrong med is a nursing error, no matter the situation. Yes the meds should be taken off the cart, but if nurses are giving them, they are NOT reading their MAR. Almost all med errors can be prevented by regain the MAR and reading the med label, which is a part of your 5 rights and a requirement, but often times either not done or just skimmed over when a med error happens.

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