I just finished orientation classes at a new job. It's been going really good and I am pleased with how thorough and professional the educating trainers have been. Yesterday we went over medication administration. We were told that at this facility a narcotics waste can be witnessed by anyone, even non-nursing staff. It was clearly stated that housekeeping, dietary, maintenance staff, "anyone you can grab" can witness a waste and sign the reconciliation sheet. I guess this could even mean family or visitors if no one else is available (they didn't clarify if it had to be a facility employee).
You should have seen the look on the new orientee's faces! One of the RN's doubled checked what had been said, the trainer repeated "wastes can be witnessed by anyone". One of the STNA's said, "I feel really uncomfortable about this, at my other job only RN's can witness a waste".
I agree. At my previous job in a metropolitan ICU we were told that another RN had to witness a waste. Now, that floor was staffed by all RN's and a CTA. This new job is more of a mixture of STNA's, LPN's and RN's.
The reason cited for this rule was that in some areas of the facility (like the Alzheimer's Unit) there are no RN's employed, yet narcotics are given.
Wow! Help me out with this one . . .Is it true that "anyone" can witness a waste???
It was clearly stated that housekeeping, dietary, maintenance staff, "anyone you can grab" can witness a waste and sign the reconciliation sheet. I guess this could even mean family or visitors if no one else is available (they didn't clarify if it had to be a facility employee).
Wow, there's a lawsuit waiting to happen.
I'd never risk my license like that, wasting meds with people who may or may not have a clue on how dosages are.
Where i work, it has to be an RN or LPN that helps another RN, LPN, or MDA waste (our anesthesiologists are mainly the ones who waste drugs on our floor).
Where I work, we also just have a rolling cart with a lock box and sign out sheet for narcs. A waste must be witnessed by someone with a license. It doesn't seem like good company policy to allow a waste to be witnessed by someone not familiar with the drugs. For your own protection, I would seek out another nurse to witness for you. You might want to ask your DON or someone else to clarify this policy for you.
only licensed here. we use pyxis, and you "witness" by typing in your user name and scanning your fingerprint, and only licensed nurses have pyxis access. so no getting around it. it won't let you waste without having a witness
Specializes in Education, Acute, Med/Surg, Tele, etc.
Licensed personnel only. I think your trainer should doublecheck on that. Since only licensed personnel can give meds, it only makes sense that only licensed personnel can witness wastes.
Tazzi hon, in ALF's around the US a CNA or unlicensed person can be delegated to do medication adminitration now. I worked for a facility that did this. However...a waste had to be witnessed by RN!
In my facility it states that either LPN or RN can give narcs and anyone with a professional license can cosign the narc and the waste. I have always used another nurse (RN or LPN_) but I have used MD's in the past.
We use pyxis too, it has to be another RN to witness (not sure about LPNs, as we don't have any on our unit).
But what gets me is that when you witness with someone, you don't even see them physically waste it. Is this how other units do it? Or are you guys witnessing the waste (by signing or entering your code in pyxis), and then following them to watch them draw it up and waste the amount?
We always have to have ALL of our meds double-checked with someone else anyway, so if it's a narcotic or anything else that I'm not using the whole dose of, I always show the other person that I'm checking with that I'm dumping the rest of it.
But what gets me is that when you witness with someone, you don't even see them physically waste it. Is this how other units do it?
In my previous job on a small neuro ICU we were all reallly lax about this and I witnessed wastes many times (that I didn't actually see) for other nurses.
Part of the orientation for this new job was a video training session where an RN investigator for our state board of nursing told some stories about drug stealing and abuse cases he has investigated. After watching that video I will never again be lax in witnessing a waste! Here's one of the stories he told that really shocked me:
An agency nurse came to work at a facility for night shift. She wanted to go off campus (to Taco Bell) for her lunch. She asked one of the staff nurses to hold her drug cart keys until she returned (each of the nurses at this facility had individual drug carts/keys). The staff nurse obliged. The agency nurse returned and took back the keys. At shift end there were 3 oxycontin missing from the agency nurse's cart. She blamed it on the staff nurse who she had given the keys to while she went to lunch. It was hard for the investigators to determine who actually stole the drugs. But in the end the agency gal was indicted because her live in boyfriend was found to be a drug abuser. The RN investigator said that a drug count should have been done before the agency nurse went off campus and then again when she returned and the keys where returned. Wow! I would have been just as "nice" and "gullible" to keep the keys for someone who wanted to go to Taco Bell and never think of insisting on a narc count before she left.
Another thing this investigator said was to always ask to see the tubex (prefilled syringe) if someone has drawn up a liquid narc in a regular syringe and is wasting some of it. One of the biggest tricks is for thieves and abusers to fill a syringe with nacl and waste some, give the rest to the patient and pocket the tubex. If the tubex has been disposed of, then he suggested that the witness actually feel the consistency of the fluid in the sink (with their fingers), if it's not slippery/oily and feels just like water, question what is going on.
I have definitely made up my mind to only have licensed personnel witness my wastes at the new job, and even though I might get some slack, I am going to be picky about details in witnessing wastes for others!
Part of the orientation for this new job was a video training session where an RN investigator for our state board of nursing told some stories about drug stealing and abuse cases he has investigated. After watching that video I will never again be lax in witnessing a waste!
This is so important. Fresh out of nursing school, my first supervisor was diverting drugs. Into her leg. I refused to sign for wastes that I had not seen. The gaps in the documentation led to her being caught. She was injecting herself and giving the children saline.
On another job, I insisted on accountability with narcotics and everyone laughed at me. A few years later when I left, they threw out my protocol. 2 diverting nurses later, they called me at home and asked if I had kept a copy of the protocol...any by the way...."sorry".
crb613, BSN, RN
1,632 Posts
We too have a pyxis so it has to be an RN,or LPN.