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Wasting meds AFTER admin?

Medications   (275 Views 6 Comments)
by haunani haunani, BSN, RN (Member)

haunani has 8 years experience as a BSN, RN and specializes in Ortho/Neuro (2yrs); Mother/Baby (6yrs).

4,921 Profile Views; 121 Posts

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What is the reasoning for wasting meds AFTER administration and not before?  Like, if I pull out 1mg Dilaudid, but I'm only going to give 0.5mg.  It's probably something simple that's escaping me.

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3,107 Posts; 23,312 Profile Views

Your best bet is to waste at the time the medication is removed from the dispensing machine if you will not be administering the full amount removed. Also, it's best if you don't serve as a witness when you can't verify what is being wasted.

The reasoning for wasting afterward, though, is indeed something simple: It is because in the immediate short term it is often easier and faster than waiting for a witness at the time of removal. Have you not experienced this in your years as a nurse? 🙂 [I'm not saying it's right or acceptable, just that people are under a lot of pressure and there aren't people just standing around waiting to witness].

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haunani has 8 years experience as a BSN, RN and specializes in Ortho/Neuro (2yrs); Mother/Baby (6yrs).

121 Posts; 4,921 Profile Views

The reason I ask is that we just got some education/training at work, and it included the following:

■ NEVER waste at the time of removal from the Pyxis machine

■ Wasting should always occur after the medication has been given (partially) to the patient

I've never been told this or heard this before and was curious as to possibilities for why they stress this.

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3,107 Posts; 23,312 Profile Views

I would most certainly ask these “educators” for their rationale. 

After the fact there is no way for witnesses to verify what exactly they are witnessing. You know, someone takes a vial of med to the patient room, gives some of it (or doesn’t give any of it) and comes back with some unidentifiable liquid in a vial wanting someone else to witness it being wasted. Nope. I have moved away from involving myself in that, and I think it’s in our best interests to avoid it because that process easily allows for accusations. 

(Not to mention the other real problem which is the problem of getting a quick witness after you’ve given the partial dose. This is when people put the vial in their pocket or some other unsecured place because there isn’t a second RN in the immediate vicinity, then they instantly get busy with something else and forget about it. And people who never care for patients but do have the responsibility of monitoring med cabinet activity have a really hard time understanding why anyone would ever pocket or stash medication other than for nefarious purposes.  So no.)

Please report back with the rationale they give you! I would love to know it. 

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marienm, RN, CCRN specializes in Burn, ICU.

204 Posts; 3,949 Profile Views

Yeah, other than an emergency or a procedure, I would always waste/witness at the time of removal from the Pyxis. This is how our machine is set up and we'd definitely get flagged if we had an excessive number of "waste laters". 

I did have to waste a med after scanning it for administration the other day (and thus had to waste with a witness at the Pyxis, and also "not admin" the med in the MAR)...because I dropped the tablet on the floor.  But I'm not usually that fumble-fingered, so that's an exception & not the rule.  (Yes, I did pull and re-scan a new tablet.)

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AlwaysLearning247 has 4 years experience as a BSN.

333 Posts; 6,177 Profile Views

I always draw up all of the medication in the syringe and waste the excess right there with another nurse prior to administration. It doesn’t matter how busy I am, I always make time to waste prior so I don’t forget!

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