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Wasting meds AFTER admin?

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Specializes in Ortho/Neuro (2yrs); Mom/Baby (6yrs); LDRP (<1yr). Has 10 years experience.

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.

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].

haunani, BSN, RN

Specializes in Ortho/Neuro (2yrs); Mom/Baby (6yrs); LDRP (<1yr). Has 10 years experience.

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.

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.

marienm, RN, CCRN

Specializes in Burn, ICU. Has 8 years experience.

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.)

AlwaysLearning247, BSN

Has 6 years experience.

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!

I usually waste when I pull from the pyxis but here's one reason some nurses may not (and this story is not the first time or pt this has happened with):

Pt was getting 0.5mg Dilaudid, which was 0.25mL. I would draw it up in the med room so I could waste right away, then take the syringe to the pt's room and administer it. 2 days into taking care of this pt, she said, "you know, I never feel it/get good pain control when you administer it, but when my night nurses do, its incredibly strong and helpful." I went over that I dilute it in NS, maybe I was pushing it slower, etc but then I told her i'd bring the unopened vial in next time and measure the dose in front of her. I did, and the pt said the same thing about not feeling it, etc even though we both saw that the correct dose was being given.

The pt was having a legitimate lot of pain, so I think the night shift nurses were giving her a "nurse's dose", possibly up to the full 2mg.

This is wrong on so many levels (call the doc so the pt can have consistent pain control since 0.5 isn't working!), so now i'm more inclined to bring the unopened vials to the pt's room and draw it up in front of them.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

One reason why some facilities encourage or even require wasting after administration is the error risk posed by drawing up the medication at the pyxis. It's less of an issue with prefilled syringes, but when the medication is pulled from a vial there are potentially issues with properly labelling the medication. Ideally the medication should still be in the original vial/package/etc when it's scanned and preparation for administration should occur at the bedside.

The other issue that in some units the pyxii are not located in an area where supplies can be legally kept, so the nurse needs to remember to bring supplies to draw up the medication with them at the pyxis.

On 9/14/2019 at 4:55 PM, t&g0913 said:

"you know, I never feel it/get good pain control when you administer it, but when my night nurses do, its incredibly strong and helpful."

On 9/14/2019 at 4:55 PM, t&g0913 said:

The pt was having a legitimate lot of pain, so I think the night shift nurses were giving her a "nurse's dose", possibly up to the full 2mg.

I suppose that's possible but there are other explanations.

4 hours ago, MunoRN said:

Ideally the medication should still be in the original vial/package/etc when it's scanned and preparation for administration should occur at the bedside.

Well, thank you for sharing the reasonable rationale.

Since there are so many concerns about patient safety, diversion, and timely/proper documentation of administrations and wastes, it would probably be best if two RNs went to the bedside each time a controlled substance (or something requiring a dose verification or witnessed waste) is to be administered. That's really the only proper solution in my mind, since patients don't deserve the risk of unlabeled medications and nurses don't deserve the risks of not crossing all Ts.

I will waste immediately and continue my preferred labeling method. And will not witness any waste I can't reasonably verify. 🤷🏽‍♀️

Edited by JKL33

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

1 minute ago, JKL33 said:

Well, thank you for sharing the reasonable rationale.

Since there are so many concerns about patient safety, diversion, and timely/proper documentation of administrations and wastes, it would probably be best if two RNs went to the bedside each time a controlled substance (or something requiring a dose verification or witnessed waste) is to be administered. That's really the only proper solution in my mind, since patients don't deserve the risk of unlabeled medications and nurses don't deserve the risks of not crossing all Ts.

I will waste immediately and continue my preferred labeling method. And will not witness any waste I can't reasonably verify. 🤷🏽‍♀️

I waste at the Pyxis when pulling the med whenever possible, you never know when over-zealous auditors might put a bullseye on your back.

"Wasting" meds from an open vial is just silly. The only thing being wasted is time. Drug addicts would steal their grandmother's food stamps. Anybody in healthcare not know that addicts will lie to them?

Amazingly, some nurses seem genuinely surprised when I point out that I have no idea what is in that vial.

In all, the whole process is a bit goofy- Even if wastes are done properly, plenty of nurses have plenty of opportunity to divert plenty of drugs. Giving half a PRN, etc... The amount that a sedated PT gets is astounding- stealing 10% would be trivial and simple.