Reportable BRN incidents

Nurses General Nursing

Published

I had an incident recently at work. I've was supposed to give

75 mg dose of methadone to a pt which was 8 small 10 mg pills with one cut in half. I ended up giving all 80 mg and later told an another RN during a medication waste that I gave the entire dose and signed me off anyway.

The problem is I didn't waste until about 6 hours later and it raised suspicion the next day and was asked about it a few days later which I confessed about what really happened. My manager told me that we would have an investigatory meeting and to bring my union rep with me.

I'm worried about getting fired but even more worried about having this reported to the BRN. My question is if this would count as something reportable. I'm in California.

Anyone out here still giving coworkers a hard time when we insist on actually witnessing a waste - - I hope you (plural) stop that, and this kind of thing (and more) is why. Actually I don't care if people act hurt about this. Years ago someone I generally trusted innocently asked me to "witness" something they had already wasted - they were looking at it as a simple formality that they complete the "computer part" of the process. I told them I would do it that one time, and not to ever ask me again (and why). I have no problem being that nurse - and neither should anyone else reading this.

This is another one of those things that neither job/time pressures nor friendships nor anything else should get in the way of.

Anyone out here still giving coworkers a hard time when we insist on actually witnessing a waste - - I hope you (plural) stop that, and this kind of thing (and more) is why. Actually I don't care if people act hurt about this. Years ago someone I generally trusted innocently asked me to "witness" something they had already wasted - they were looking at it as a simple formality that they complete the "computer part" of the process. I told them I would do it that one time, and not to ever ask me again (and why). I have no problem being that nurse - and neither should anyone else reading this.

This is another one of those things that neither job/time pressures nor friendships nor anything else should get in the way of.

There was nothing to witness. No drugs were wasted. The extra 5 mg was, according to the OP, deposited into a patient.

OP- part of your challenge here is that your story is just what someone might say if they had taken the drugs themselves.

Good luck.

Specializes in Travel, Home Health, Med-Surg.
Anyone out here still giving coworkers a hard time when we insist on actually witnessing a waste - - I hope you (plural) stop that, and this kind of thing (and more) is why. Actually I don't care if people act hurt about this. Years ago someone I generally trusted innocently asked me to "witness" something they had already wasted - they were looking at it as a simple formality that they complete the "computer part" of the process. I told them I would do it that one time, and not to ever ask me again (and why). I have no problem being that nurse - and neither should anyone else reading this.

This is another one of those things that neither job/time pressures nor friendships nor anything else should get in the way of.

I completely agree with this and had the same experience, told the nurse just this once and made it clear to others I would not do that, it is not that hard to simply show someone the waste prior to actually disposing of it.

There was nothing to witness. No drugs were wasted. The extra 5 mg was, according to the OP, deposited into a patient.

Yeah. I get that.

Which is why, when your coworker says, "can you [pretend you watched me] waste something?" You say NO.

Yeah. I get that.

Which is why, when your coworker says, "can you [pretend you watched me] waste something?" You say NO.

I agree.

But, the practice is so ingrained in many environments. Even where people think they are being conscientious, in reality all they are doing is witnessing disposal of a certain amount of clear liquid. I work with nurses who actually think that we are doing the right thing when they have me watch them pull liquid out of a previously opened vial. In other words, if you did not personally see the vial opened, and the drug come out, you are not witnessing a waste.

In my ER, we regularly "witness" waste from paramedics who come in after giving partial vials of narcotics. I have absolutely no idea what liquid is being drawn up and disposed of. But, I like the medics in our area, and I don't buck the system because they will just get somebody else to participate in the charade, and resent me for making their jobs harder. Hopefully the diverters I facilitate use the extra 50 mcg of fenanyl once home, rather than on the drive home.

The crazy thing about the focus on wasting is that abuse of this system is probably a tiny fraction of the diversion that happens. But focusing on one small aspect gives the illusion of controlling the problem.

Nancy is addicted to opiates. Or maybe, Nancy just likes to get high a couple times a week on her days off. Maybe Nancy doesn't even use narcotics, but gives them to her boyfriend, her under medicated mother with cancer, or sells them to fund her scrap booking addiction. Nancy works in in an ER/ICU/post op or some other unit using a lot of narcotics, scheduled and or PRN. That unit is fastidious about all wastes being actually witnessed. Nancy gives IV narcotics at least 12 times daily, sometimes in really high doses, due to her PT population. Nancy, is not a cruel person, and gives most of each dose, taking only a small amount of each dose for her goody vial. Nancy really doesn't want her patients in pain, so she is right on top of those PRNs, giving them as soon as available, and right on the high end of the range. Obviously taking a bit out of each of those as well. Nancy has a butt load of narcs to take home, 3 times a week.

It is the rare unit that takes any real precautions against this type of diversions. Any nurse working in a unit that uses a lot of parenteral narcs who can't figure out how to divert without fudging a waste is profoundly stupid.

BTW, OP:

Why did you give 80 instead of 75?

Oversight, deliberate, time-saving measure?

And, how did it play out that when confronted with a late waste you told them that you gave it to the patient? Since you are already lying, why not just say you were too busy, or forgot?

This all seems weird to me, but may that is becase I don't understand your environment.

I agree.

But, the practice is so ingrained in many environments. Even where people think they are being conscientious, in reality all they are doing is witnessing disposal of a certain amount of clear liquid. I work with nurses who actually think that we are doing the right thing when they have me watch them pull liquid out of a previously opened vial. In other words, if you did not personally see the vial opened, and the drug come out, you are not witnessing a waste.

Exactly. I've pretty much moved away from getting involved in wastes of open vials. It's not to hard to help change a unit culture with regard to this - you just start by mentioning it every time you waste with one of your coworkers ("try to call at the beginning next time, if you can.") When they ask why you can explain that the current hateful environment in which we now find ourselves requires us to step it up a notch. The other reason I think it's important to have these discussions is so that nurses ourselves can stop and think - and can quit acting like someone's an axe-murdering criminal when something veers from whatever the latest policy is. For example: Some places have added policies about time-frames for wasting meds, and nurses are perfectly willing to act like someone has committed the crime of the century if someone can't waste the med in the new time-frame. Meanwhile, none of us are (or ever were) watching anything more than someone squirting an unknown liquid out of a syringe! Please.

On another thread I had a discussion with someone who claimed to be a "pyxis manager" who had all these recommendations and also a couple of "reminders" that people are always watching pyxis activity - but when I brought up these points you mention here, hherrn, there was no acknowledgment of the obvious problems.

In my ER, we regularly "witness" waste from paramedics who come in after giving partial vials of narcotics. I have absolutely no idea what liquid is being drawn up and disposed of. But, I like the medics in our area, and I don't buck the system because they will just get somebody else to participate in the charade, and resent me for making their jobs harder. Hopefully the diverters I facilitate use the extra 50 mcg of fenanyl once home, rather than on the drive home.

The paramedics' wastes never should have involved us....and yet - yep. They still do. I really thing epic rage would ensue if this issue was pressed w/ admin. Because, yes, looking like we're doing something is very important.

The crazy thing about the focus on wasting is that abuse of this system is probably a tiny fraction of the diversion that happens. But focusing on one small aspect gives the illusion of controlling the problem.

I think there are enough unthinking people out there that this is pretty widely believed to be accomplishing something good/helpful.

My issue is, I don't care how dumb/nonsensical a waste policy is. Not doing it in a way that makes actual sense or, worst case like the OP's helper - not witnessing at all when you said you did - - now you're talking about very bad consequences over things that were insane to begin with.

Specializes in Peds, School Nurse, clinical instructor.

Med errors happen but the lying and trying to cover it up...that is going to be your down fall.

Specializes in PICU.

I agree. I think the lying and trying to cover it up is the bigger issue. Had you given th 80mg of Methadone, realized it. You could have documented that 80mg were given, written an incident report. But the waste 6 hours later and trying to cover up your error is the bigger concern.

Only an attorney can answer that for you.

Good luck with this mess.

P.S. What were you thinking dude?

Specializes in Adult Internal Medicine.
I gave the entire 80 mg dose and 'wasted' 5 mg with another nurse with her knowing that I gave the entire 80 mg. I didn't confess until suspicion was raised with the waste being done so late. That's the main issue.

The main issue isn't the "late waste" (as the waste never occurred) its the willful falsification of documentation. You are in some trouble here, hope you can get a lawyer.

Your colleague is also in some significant trouble. And it sure makes it seem like this type of thing happens with some frequency..

Integrity is gained by doing integral acts. Honesty is the best and only policy. Responsible persons admit and correct their faults as soon as they realize their action. This action was dishonest, and getting someone to "cover" you was manipulation. Reporting medication errors helps correct the broken system. When narcs are involved, it's a whole different government controlled situation. You'll get into trouble, and work your way out of it; what a learning curve.

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