Wasting Procedures

JMH · Sep 4, 2003

P_RN -

A specific hospital procedure manual won't do me too much good at this point. I'm hoping to show it's a wide spread, well-known principle. Ideally, I could have found it in a nursing text book! I will ask the board of nursing, though; thanks!

allnurses Guide · Sep 4, 2003

Ahhh . . . .but there is a problem. A couple of years ago we were told it was inappropriate to waste liquid meds into a sink. Not sure where the info came from - some stupid government regulation most likely.

I remember being taught how to waste meds in school. And the guiding principle is that it needs to be wasted so no one can get to it. Pills are wasted in our sharps containers . . . .but really, if someone is desperate, they might go for it.

I wouldn't put a pill in a trash can. At home, I flush old meds in the toilet.

steph

ktwlpn, LPN · Sep 4, 2003

Originally posted by JMH
P-RN -
Nope, not a school paper. It's for a legal brief. I'm an attorney, hoping to show that throwing a pill in a trash can is not the best way to waste a narcotic...

Well-this is one of those posts that make you go"hmmm" I would never just drop a pill in an open trash can...Dish,please....someone must have and their must have been a negative outcome of some sort...Without compromising anyone's privacy can you tell us more?

JMH · Sep 4, 2003

Steph -

You say you remember being taught how to waste meds in school... was it a clinical experience? Just verbal instruction? Or can I find this principle in a text book somewhere?

ktwlpn -

Employee was terminated, and isn't happy about it.

Edward,IL · Sep 4, 2003

I have an additional question/comment.

We have always been told and adhere to very strict narcotics counts and accountability via documentation, having a witness watch and document wasted meds, counting narcastics between shifts, etc.

I've heard that these strict rules only apply to nurses. MD's stock meds in their offices, pharmacists stock narcotics in drug stores. My understsnding is that they are not required to have a witness when they waste expired meds or have to have near the documentation that nurse require. Is this true?

Edward, IL

ceecel.dee, MSN, RN · Sep 4, 2003

I have thrown a pill in a trash can...an aspirin, a Senokot...that has fallen on the floor, or patient can't swallow it and it's partially dissolved, or whatever.

Not a narcotic. That would go back to the med room for "witnessing" and then down the hopper or in the sharps.

I don't think this was taught in school...I think I learned it in orientation on the job (I believe via the med test prepared by the pharmacist's).

After any ER experience at all, I think the "school of Hard Knocks" teaches nurses to REALLY, PERMANENTLY get rid of wasted narcs (see enough drug seekers that you know they would go so far as to dig it out of the trash can)...not just "throw them away".

It may not be such common sense knowledge in a different practice setting.

allnurses Guide · Sep 4, 2003

I learned how to waste meds in our lab time with our instructors and I do remember handout with instructions but I'm sorry, I don't remember if it was in a textbook.

I would not throw any kind of pill in the trash . . narc or not. Someone could still dig it out and we are supposed to watch them swallow their pills so as not to choke. If the pill is in the trash and they fish it out later and take it and choke because there was no nurse there, "that would not be good" as my 2 year old says.

And don't doubt that people do strange things . . . there is a discussion going on right now on the OB thread about putting part of the placenta that you just delivered under your tongue to keep you from bleeding, instead of using pitocin. So, life is full of odd things.

steph

ktwlpn, LPN · Sep 4, 2003

Originally posted by JMH
ktwlpn -
Employee was terminated, and isn't happy about it.

Seems harsh-I am betting that this person has a history of problems.There must be more to the story. I don't know if this is something the Board of Nursing would want to be involved in unless something happened to a patient or the employee is suspected of drug diversion.If that is the case then I think the employer has an obligation to report it and try to get the nurse into treatment.I can't see a nurse loosing her license for this but I would consider it an unsafe practice.It would make me wonder what other policies and procedures this nurse has a problem with-it is a red flag.I don't care how busy and in a hurry you are there are certain things that you just do not do......Chucking around narcs would be near the top of the list for me....or sharps...

snoogans · Sep 4, 2003

In our LTC facility pills are disolved and flushed, injectables are squirted into a cup of water, and flushed, patches are cut up and put in sharps container, liquids are poured into a cup of water and flushed. All witnessed by the DON or her designee, which is the supervisor, mds coordinator, nurse manager, or the staff develpment nurse. This is the policy for when we have to waste a lot. Our residents usually have a 30 day supply at a time and if they die, are discharged, or have a change in med.

Another nurse is fine if the med is dropped. Because having something hang around from Friday night until Monday morning just isn't cool.

All I know is somedays the fishes are real happy.

grneyes676 · Sep 5, 2003

I do not remember where I learned to waste meds...I dont think I haver ever seen a written rule anywhere....I always put the meds in the sharps container, wether it is a pill, in a syringe, or if I squirt it in there....if someone wants to go dig in the sharps container to get an oxycodone they can be my guest!!

crissyb · Sep 5, 2003

Was taught in school, during clinical to waste - sink for liquids (or hopper) pills into the sharps container or down the sink. Nothing was ever in a textbbok about appropriate forms of disposal.

chris

Long Term Care Columnist / Guide · Sep 5, 2003

Where I work, the injectables go into the sink or the sharps container (although the carpet has been known to soak up wastes from time to time, and we kid each other about NOT licking the sink!) and liquids/pills go straight down the hopper or the toilet. Once when I'd just started working in assisted living, I found an entire trash bag full of discarded pills---narcs, antipsychotics and tranquilizers---in a janitor's closet, along with another bag that had probably 400 used syringes in it!! The med aide had tried to dispose of these properly, but no one in the upper management had been willing to take responsibility for them, and so they'd sat there for months....I shudder to think what the state surveyors (who came to inspect the facility shortly thereafter) would have done if they'd found them before I did. There must have been two or three thousand pills in that bag.....well, the med aide and I took a couple of hours to destroy all the drugs and document everything, and let me tell you we probably KILLED a bunch of fish that day. But at least the drugs and syringes were out of the facility........!