Pixus waste never witnessed

sorry if this is in the wrong thread it's been a while since i've been on here. So a month ago, I took out morphine and had to waste. My preceptor didn't waste with me, and my pixus allows us to "waste later" which is stupid and creates problems. I wasn't approached about it to this day, but what would happen?
2nd scenario: Sometimes during morning rush before i see my patient for all their AM meds, i will anticipate my patient needing a vicodin or whatever, and will pull it out (as PRN rx) before asking pt if they want it-this avoids me going back and forth to the pixus. I recall on a couple different occasions where they were too sedated or sleepy, and i would return it. When i return the pill, how will they know I returned it? what if another nurse says she returned hers, (BUT really DIDN'T), and I actually return mine. I don't like how you don't return it to the original box but into a drop box kind of thing, where the pharm tech picks it up later.
Also, is it okay for you to sign in pixus to get something for another nurse ? This happened to me yesterday my coworker couldn't log in with her fingerprint. Last edit by bella14k on Mar 24 : Reason: Want to supplement
Yikes!! First off, most med areas have cameras. Therefore, you are being recorded. Secondly, do not ever, ever, EVER anticipate narcotics and grab them--you need to assess your patient before you pull meds. And not just for a narcotic reason--if the patient I not within a range for a med would also be a reason to assess first.Thirdly, do not EVER sign your name/fingerprint for another nurse. Ever. If the nurse in question has an issue with the pyxis, then they need to approach pharmacy about that, not you.And finally--the waste later icon is crazy, as who is going to witness a non-existent waste? And because a pyxis is a computer, it records everything. So just because it hasn't caught up with you yet, doesn't mean it won't. So be smart about it. You don't want to be accused of diversion due to foolishness. That is career ruining.

When you return something what do you do? When I worked in the hospital, you had to select in the pyxis which patient you were returning the med for, therefore they know it was you. You sign in with your fingerprint and select that you are returning the medication for John Doe.Pulling a PRN narcotic from the pyxis without knowing if the patient wants it is a BAD idea. Get out of this habit now.

Never pull narcotics "just in case." You are asking for trouble. Waste later is ok if you pull the med go to a nurse have her watch you waste then go back and sign off. But don't physically waste without anyone watching.

I agree with you guys but the nurses act like it's okay. I did this twice already. I am a new hire, i've been there for 5 months. I did it for a nurse who's last day of work was that day, and then the other day with another nurse. I don't want to piss anyone off when I say I don't want to use my name to get their narcs, but if this is serious i definitely won't. And good,i'm glad there's cameras bc that's my backup if for w/e reason i get in trouble. I haven't seen any cameras , are they in the pixus? What is being accused of diversion? And if i'm accused of that, what happens next?

Also, a week went by since I took out that unwitnessed morphine that i needed to waste. The person who precepted me at the time said she would waste, but i guess we both forgot, and usually there's a cue when you sign into pixus that says, "waste needed", you know, as a reminder that you still need to waste. But it's not there anymore. How can I solve this? Should i call pharmacy and ask? Over the last 5 months i have not been approached about anything. I take it that i work with other nurses who don't use drugs, so all drugs returned (unopened pills and unopened vials of course) by all nurses are all in the return box of the pixus. I will never take out a med without assessing, and i will not take out other rn's drugs under my name, since everyone seems to think that's a terrible idea. Thanks for your advice., please get back to me about my other concerns

I suggest you bring up the unwasted morphine with your preceptor, and ask her to help you waste it. It may come back to bite you in an audit later on if you don't. Do you recall the patient's name and info to waste with? You may have to ask pharmacy for help, but better to catch it now and address it proactively than to have someone have to question you about it later.Pulling narcs for a nurse on her last day and not witnessing them being given? It would make me nervous. Protect yourself a little better.

When i had to go down to pharmacy I even asked if taking out a med for another nurses patient (bc her fingerprint wouldn't scan) was okay, and the guy said "yeah" (don't know if he was a tech or pharmacist or what). I will confirm this again when I ask about the previous waste. Luckily I do have my old schedule which has the name of my preceptor (I had 3-4 diff preceptors throughout), so hopefully i'll be able to narrow it down and find the right day this occurred, and then go from there. And no i do not remember the patient name, i recall looking in the pixus one day for this guys name (at THAT time i did remember) and i guess the waste reminder was gone when i logged in. Probably b/c he was discharged, so i had no1 to waste on, you know? It's my fault for not doing a thing about this,even though the days following this i was thinking about it,and i either got busy or my preceptor for that day wasn't there to witness.

Quote from bella14kI agree with you guys but the nurses act like it's okay. I did this twice already. I am a new hire, i've been there for 5 months. I did it for a nurse who's last day of work was that day, and then the other day with another nurse. I don't want to piss anyone off when I say I don't want to use my name to get their narcs, but if this is serious i definitely won't. And good,i'm glad there's cameras bc that's my backup if for w/e reason i get in trouble. I haven't seen any cameras , are they in the pixus? What is being accused of diversion? And if i'm accused of that, what happens next?

NEVER waste later! Good practice is to always waste when you pull from the Pyxis. Never leave the med room with more narcs than you need to give right away! You never know what can happen once you leave the med room with unwasted meds, you could possibly get involved in a code and forget you even pulled a narc that's sitting in your pocket.

Quote from bella14kI agree with you guys but the nurses act like it's okay. I did this twice already. I am a new hire, i've been there for 5 months. I did it for a nurse who's last day of work was that day, and then the other day with another nurse. I don't want to piss anyone off when I say I don't want to use my name to get their narcs, but if this is serious i definitely won't. And good,i'm glad there's cameras bc that's my backup if for w/e reason i get in trouble. I haven't seen any cameras , are they in the pixus? What is being accused of diversion? And if i'm accused of that, what happens next?

The only time I would go with the "waste later" is the case of an emergency. For example, in the ED if a patient is seizing, a nurse (not necessarily that patient's nurse) will go to the Pyxis and pull out Ativan--at the time not knowing exactly how much will be given. That nurse will go back later with another nurse to waste. Even that scenario carries a risk of a missed waste, so be careful.If, however, a PRN is being given, and requires a waste, waste it right away! For example, if a patient get Dilaudid 0.5 mg PRN, and you only have Dilaudid 1 mg--pull it, waste it right then, and know there won't be an issue. If you forget to have a waste witnessed, it can still come back on you if you originally pulled the med.Never pull out a PRN narc (or anything else controlled) unless you are certain the patient wants it. It is going to look really, really bad for you if such narc is pulled, the patient refuses, you forget to return the narc in the Pyxis. It is not difficult for the pharmacy, your manager, the DEA, etc. to correlate the narcs you pull with the narcs you have charted. Even if you pass a urine test, you can still be accused of diversion--from the point of view of management, how do they know that you did not take the narcotic for a friend or took a narc to sell it? I'm not accusing you of that, but someone might.Finally, I will always witness another nurse give the narc if I pull it for him/her. If a nurse for some reason cannot get into the Pyxis, I will tell them "I will help you this time, but you have to call the pharmacy and get the squared away." (again, I will still witness them give the narc.) I worked with a nurse who diverted narcs. After the fact, almost everyone said "I never would have though she would be the one to divert." Point is, you cannot blindly trust anyone when it comes to wastes. It may seem "rude" to not trust someone, but you cannot assume that a given nurse will not just pocket the narc or that he/she actually did waste that extra Morphine, Valium, etc.

I once worked with a nurse that diverted narcs for herself, was high as a kite one night, that's how she was discovered. Ironically, she was on her last night of orientation too! Don't know how the termination occurred, but I do know her license was never suspended, and I have a big problem with that!