You must watch me!

[Emergent]

A new nurse to our unit seems slipshod with various things. Today, when I asked her to waste a narcotic she wanted to rush out of the med room without actually watching me waste. I said "No, I want you to watch me!".

She protested, saying she had things to do. It takes 10 more seconds. I think adhering to this strictly is most important.

[OyWithThePoodles, RN]

On 2/2/2019 at 8:42 PM, canoehead said:

I think a camera in the med room should be mandatory these days.

Yeah... I noticed ours about three minutes too late. After I had lifted up my shirt to adjust my constantly riding up bra... Someone got a little peep show that day.

[Ruby Vee, BSN]

Some places have a unit culture in which everyone actually witnesses the waste they're witnessing every single time. And some units have a culture that doesn't. I've actually had nurses complain because I stood around to watch the waste -- "Don't you TRUST me?" I always say, "Yeah, but I just wanted to ask you about ______". That always takes more than 10 seconds, but I find out the interesting gossip! ("Kristi got into anesthesia school? WOW!" or "I'm real sorry your car conked out. Do you need a ride to work tomorrow?" Not mean, malicious gossip, but the positive, fun kind.)

[JadedCPN, BSN, RN]

I have mixed feelings about the waste process that has changed over the years. What I will say is this - do I watch others waste and want to be watched while I waste? Absolutely. If nothing besides the fact that it is policy in every place I've worked, and I want to cover my butt. And I make no excuses or apologies for staying to watch people waste - I act nonchalant, as if it is my job, because it is.

That being said...I think the whole wasting process is not very effective in terms of preventing diversion. I can watch you pull up 1mg of morphine and waste the other 1mg of morphine, but unless I then follow you immediately to the patient's bedside and watch you administer that medication to the patient, then the potential for diversion is still there the second I leave the medication room.

I worked with a nurse early in my career who wasted all of her medications the proper way (like Ruby Vee said, that was the culture of the unit so it was no big deal), and she still ended up getting caught diverting medications because she took the half pill she was saying she was administering to the patient and pocketed it for herself instead. So sure you can stand there and watch someone waste a medication in the med room, but unless you follow them and watch the administration (which, of course, is asking way too much), is it really effective?

[kbrn2002, ADN, RN]

It doesn't bother me at all to take the time to witness a narcotic waste but since chances are pretty high that I wasn't around when the med was dispensed how do I really know what's actually being wasted? That's a rabbit hole I don't want to go down. Imagine the scenario of the power's that be realizing this reality and suddenly we have to actually verify that every med being wasted is actually the right med. Picture the time suck of verifying every pill. Picture the impossibility of verifying a half pill when not all the identifying markings are visible. Picture the utter impossibility of knowing a liquid med waste is actually the med. All this because apparently the most trusted profession can't actually be trusted after all! Seriously though, if a nurse is actually diverting the requirement to find a witness to waste isn't much of a deterrent.

[Davey Do]

7 hours ago, OyWithThePoodles said:

Yeah... I noticed ours about three minutes too late. After I had lifted up my shirt to adjust my constantly riding up bra... Someone got a little peep show that day.

[Kooky Korky, BSN, RN]

I am confused by those who say they don't know what medication they are actually witnessing.

I would not be willing or able to witness wastage of a pill or liquid that I did not actually come out of a real and present wrapper or bottle.

The waster would have to let me see the opening of the container if he/she expects me to witness it.

And the nervous Nellie Newby might need a little help. I understand her anxiety and overwhelm. I think we all do, I just wonder what help she might need. Being a new nurse is such a meat grinder these days.

[Emergent, RN]

7 minutes ago, Kooky Korky said:

I am confused by those who say they don't know what medication they are actually witnessing.

I would not be willing or able to witness wastage of a pill or liquid that I did not actually come out of a real and present wrapper or bottle.

The waster would have to let me see the opening of the container if he/she expects me to witness it.

And the nervous Nellie Newby might need a little help. I understand her anxiety and overwhelm. I think we all do, I just wonder what help she might need. Being a new nurse is such a meat grinder these days.

This nurse is not a new nurse, only new to our ER. I found out that she got fired from her previous position. She has a highly aggressive personality actually and has already gotten multiple patient complaints, probably due to her rough manner.

[subee, MSN, CRNA]

How would I know what anyone is "wasting" when they empty the syringe of water? Ridiculous waste of time....sorry about the bad pun.

[Emergent, RN]

6 minutes ago, subee said:

How would I know what anyone is "wasting" when they empty the syringe of water? Ridiculous waste of time....sorry about the bad pun.

In my ER everyone requests someone to come into the med room, and in real time watch us withdraw from the vial and waste. Thankfully, we go by the book.

The one fellow who kept requesting after the fact witnesses from me was a diverter.

[Workitinurfava, BSN, RN]

I know someone who developed a drug habit and over-dosed at home from hospital meds (crushed meds put in a syringe). The person was not giving the full syringe of meds at the bedside, was not always giving the pain pills, although the other part of the meds were wasted by verification. There are some patients that will down a full cup of pills without looking at what is in it.