Wasting non-narcotics?

[emmafrancis]

Every story starts off with..I was floated. I got report on a patient, then went to hang a med that was due at shift change. I pulled it, mixed it, and when I went to hang it on the pole, found a full bag hanging. I rechecked that the shift change dose had not been given, and it was not scanned. I pulled the full bag down and hung the fresh bag. I assumed the nurse leaving meant to "do me a favor" and forgot to tell me.

Two weeks later I get the email asking about the "incident" of 2 pulls from the machine for the same medication. I explained my part of it and got another email asking why I did not waste the med that was not a narcotic.

Um? Because I was not aware of a requirement to waste a non-narcotic med. I was so mad at the second email that I told them the simple solution was to not schedule meds for shift change.

Of course my boss has asked to see me. I fail to see how anything here is my fault. *sick of the bull*

ps: when we did shift change, the bag the previous nurse had pulled was behind an old bag, so I didnt see it until I actually went to clean up and get rid of some things up there.

[Rose_Queen, BSN, MSN, RN]

First, refer back to the policy. If the policy states that all meds have to be wasted, then all meds have to be wasted. Second, why is a nurse pulling a med that he/she isn't going to give when it's not an emergent/urgent situation? That's how these kinds of things happen. But if you responded to the email the way you've written it here, that may be the bigger issue that you're being called on the carpet. It could be just to ask questions, it could be something related how you responded. I work with someone who once hit "reply all" on an email and sent a snarky response to every single person who had facility based email. Came very close to being unemployed. Always be professional in communication.

[emmafrancis]

First, refer back to the policy. If the policy states that all meds have to be wasted, then all meds have to be wasted. Second, why is a nurse pulling a med that he/she isn't going to give when it's not an emergent/urgent situation? That's how these kinds of things happen. But if you responded to the email the way you've written it here, that may be the bigger issue that you're being called on the carpet. It could be just to ask questions, it could be something related how you responded. I work with someone who once hit "reply all" on an email and sent a snarky response to every single person who had facility based email. Came very close to being unemployed. Always be professional in communication.

Probablymyattitudehaha

[AceOfHearts<3]

It also could be so the patient isn't double charged.

[MunoRN, RN]

I think maybe you're getting more worked up than the situation merits, and that may be more the source of the problem from the managers perspective.

That doesn't mean you can't make a reasoned response, I would point out that this isn't something you had heard of before, and from the sounds of it this isn't an expectation on the other units you work on, and that having unit specific oddball policies such as this are going to be likely to have less than perfect compliance. I would also question whether this is really the best use of a nurse's valuable patient care time.

As for the logic behind it, this probably isn't it:

It also could be so the patient isn't double charged.

All inpatient reimbursement is bundled these days, except for chemo drugs, medications given to an inpatient can't be billed for individually. And in outpatient settings where you can bill individually you can't bill based on what was pulled from the Pyxis since that would often result in fraudulent billing.

[TheCommuter, BSN, RN]

It also could be so the patient isn't double charged.

You hit the nail on the head.

For instance, a patient has an order for Benadryl 12.5mg, but the pyxis only carries 25mg scored caplets. To ensure the patient is not charged for the full 25mg caplet, we utilize the pyxis to record a 12.5mg wastage.

[Meriwhen, ASN, BSN, MSN, RN]

Probablymyattitudehaha

Yeah, probably. Telling the boss not to schedule meds at the shift change, even if you said it with the utmost politeness, wasn't your smartest move.

Two reasons you have to waste non-narcotics:

1. Financial: as others said, so the patient doesn't get double-charged for a medication they didn't receive.

2. Diversion: it's not just narcotics that get diverted by staff. Common meds that tend to be taken by staff are ibuprofen, acetaminophen, loperamide, Zofran and other N/V meds, nicotine lozenges and nicotine patches, just to name a few. Just because the word "Schedule" isn't anywhere to be found on the label doesn't mean it's not diversion.

So if the facility policy is to waste all meds, drop the attitude, say "sorry, it won't happen again" and follow that policy from here on out. Or continue as you are and you can look forward to more meetings with your boss that may or may not result in disciplinary action. Your choice.