Very little witnessing going on with drug wastes on my floor!

[Nurse ABC]

I'm new to this med-surg floor. When we get a drug like morphine out of the Pyxis it asks if we are going to give the whole amount. If we say no it asks for a witness. The "witness" will come in and scan their badge and leave. The pyxis will then open the drawer for you to remove the narcotic. We then take it to the room, scan the pt and med, draw it up, waste the proper amt and give the rest. No one witnesses this. I first tried leaving the extra med in the bottle so I could prove what I gave and was told this was wrong-that we withdraw all of it and squirt out in the trash what we don't need. No one will stand at the Pyxis and wait until the med is drawn up and wasted because their ID is needed before the med is even taken out of the Pyxis and no one has time to watch. No one follows you to the room to actually witness. Once it's drawn up, no one could prove it's really the narcotic. I'm not sure what to do. Everyone just says I trust you and if anyone has a concern they'll just drug test you anyway. Is this common? I'm a little concerned because I don't want to be someone's witness and it come back that they were abusing drugs or selling them or giving the wrong amt or whatever with my name beside theirs. Am I worrying too much or should I talk to the manager?

[halfpast]

If you want to find whose using on your unit, it's not that hard to find 'em if you KNOW what you're looking for. Most every unit has at least one. Why don't people think about the rules and why they're there? We went to school for how long to get our licenses? We could easily be supplying our friend for their death.

What should we be looking for?

[FurBabyMom, MSN, RN]

Its a policy thing. You need to follow your facility's policy. Bottom line. It's the only way you'll be covered under their malpractice insurance for any claim. When I worked med surg I didn't have bio access to the Pyxis (my fingers didn't pick up on the sensor)... So there was that. My facility had video surveillance in the med rooms. I always just drew everything up completely with a blunt fill needle or with a filter needle (if ampule), wasted the correct amount in the sink in the med room and took the vial/bottle with me to scan than put everything in the room sharps. The nurses I worked with who wasted correctly did it this way.

If I was witnessing for someone else - I made them do it my way. I worked too darn hard for my license to lose it over narcotics. I was also the nurse that checked vitals (respiratory rate/quality/SPO2, HR and BP etc) before hauling out the IV narcotics. Cause sometimes it is contraindicated to give narcotics depending on a patient and their status. And, most of the time I put my patients narcs in 5 ml of saline because well how else can you push 0.25 mL of a narcotic over the recommended IVP time?

[FORTHELOVEOF!!!!]

Not all nurses hang around to witness the waste, but your system sounds a little flawed. Ours lets you take out what you want and will show a variance if the amount given is different than dispensed and then you take another nurse in to waste with you to get rid of the variance after you administer the medication, or the end of your shift. Either way you don't know if someone replaced the narc with NS unless you witness the whole ordeal and that isn't realistic.

[DroogieRN]

I didn't read all the replies, so feel free to ignore. Most don't stick around to waste and don't expect you to, either -- and often there just isn't the time. Don't ever witness for someone you don't trust implicitly. Probably you can count those who qualify on one hand, if not one finger...

[brandy1017, ASN, RN]

How about the doctor orders a standard dose Ie 2mg MSO4 or 2mg of dilaudid, etc. Problem solved! Instead we waste medicine the patient could use and is paying for and the patient doesn't get the full pain relief they deserve! I think that's what ridiculous about it all!

[Indy, LPN, LVN]

For what it's worth, I wish all of y'all that are squirting the waste in the sink would just stop, take two seconds, think about it, then squirt it at the trash can. The trash, particularly the paper trash, will absorb the stuff, and it won't go into the water supply. Ok? Ok. My second thought is that if you're in such a bind with the scanner doohickey then draw your drug, waste, tape the vial to the syringe, go do your thing and scan the thing near the patient. No problem unless it's one of those ampule things, then I have to say I just waste and throw the ampule in the sharps. I will do the long way of documenting in the computer without scanning because I don't want to haul around a piece of sharp glass in my hand or pocket.

Also, it's pretty easy to pick out who is unstable by who trusts you quickest, without knowing you from Adam's housecat, and if you need to prioritize what things to really watch the waste on, it would probably be the pills that have to be cut in half, etc. Make sure you see where the other half went. (also if you see some fool trying to eat the napkins out of the trash...)

Also you can note whose patients actually sleep versus whose patients are on the call light constantly for pain med. Hmm. And docs don't write standard orders for all of what's in a vial all the time, because that stuff is supposed to be based on weight, situation, and tolerance... not on what's convenient for the nurse. Not all patients are huge and addicted. Some are little and delicate.

[Sugarcoma, RN]

This is pretty common practice. On both units I have worked in my career. Very few nurses actually eyeball your wastes. The first unit we were so crazy busy that we would wait until the end of the shift to meet in the med room and waste all medications at once for each nurse. Not ideal I admit.

I do know that some facilities monitor pyxis access. I was told twice that I had been flagged as someone who pulled a large amount of narcotics. This was usually after a 3 day stretch of several Q2 Dilaudid patients. I am the nurse who will medicate you per order as long as your vitals are WDL. I would have been required to have a drug test if I had forgotten to chart any one of the doses.

The bottom line is that it is frighteningly easy to divert medications if one were so inclined. We have to trust each other a little bit. Honestly if you witness for a coworker who is later found to be diverting,how can that be linked back to you? How could anyone prove that they diverted the dose/s YOU witnessed for as opposed to those some other nurse had witnessed?

[Greenkji]

Wow! Interesting discussion. I am a new grad (no job yet), but I am shocked that drugs are so often wasted without a true witness. In all of my clinical and preceptor experience, the drug was always drawn up, wasted (with a witness) and then brought to the patient. Always. I would be extremely uncomfortable signing off on anything that I did not actually see with my own eyes. Another point, even though it sounds like all of the nurses are practicing this, I highly doubt it is written that way in the hospital's policy and procedure.

[Nurse ABC]

If most people aren't truly witnessing then it's a flawed system and a waste of time to have to find another nurse to scan their badge/fingerprint to get the med out of the machine. Just another way for the hospital to cover themselves while not really protecting the nurses it seems. It would be nice to just have a camera and forgo the whole witnessing thing! Thanks for all the honest responses!

[MN-Nurse, ASN, RN]

Occupational cultures differ, but on my med surg floor, we witness in the med room then go administer.

[evolvingrn, BSN, RN]

for some people i stick around...........for some people i don't

[anotherone, BSN, RN]

This happens where I work too. Someone has to get the med out, then go to the med cart, draw it up, and then waste it. Some people watch, very few do. The reality is that there are times , I stand around waiting 10minutes OR MORE for someone to even ask to witness, especially on night shift when the number of licensed staff is pretty low. That person is usually on his/her way to do something else and doesn't want to stand there watching. I like to take the med out, bring the order up on the MAR again, then draw it up while looking at the order and the vial/ampule/ whatever a few more times. I don't like to bring the needle in the med room and draw it up there in a rush without checking the order again while drawing up.