By Shelby Petrie, Clinical Nurse Manager
All nurses must practice safe narcotic handling, which protects both patients and nurses themselves. A common question from new nurses and even veteran travel nurses at new facilities is, “Who can witness narcotic waste?” This query is especially important for travelers as they move between facilities, and specific narcotic wasting policies may vary at different locations.
Narcotic Waste Witnessing at Healthcare Facilities
First and foremost, you should familiarize yourself with your current facility’s narcotic wasting policy and follow it accordingly. Just like everything else — from parking rules to policies that protect patient outcomes — perm nurses and travel nurses alike must always be fully versed and in total compliance with each hospital’s standards and rules. If you haven’t already been provided with a facility’s narcotic wasting policy in your employee handbook, at orientation, or during training, be sure to ask your supervisor where you can find it.
Since travelers switch facilities several times per year, it can be an extra challenge to stay up to date and keep your clinical care aligned with all policies. This is especially true at the beginning of a new travel nurse assignment, and narcotic wasting is particularly important to master. Don’t sweat it though — come prepared and you’ll do just fine. We recommend travelers review narcotic waste policies — and all such policies — when starting at a new travel nursing assignment. Continue reviewing them until you feel completely confident in your new role and the new protocol there.
The Five Rights of Medication Administration
When narcotics are pulled from the medication dispensing unit, it is now our job as nurses to make sure The Five Rights are followed to get the correct medication and dose to the correct patient.
As a reminder, The Five Rights are:
- The right patient
- The right drug
- The right dose
- The right route
- The right time
Despite The Five Rights and honest attempts to do everything right, there are times when the amount of medication pulled is more than the dose ordered. This is where nurses need to be diligent in verifying and giving the correct dose, plus ensuring that we waste any portion of the dose that’s not administered to a patient.
You should immediately waste or return any narcotics that are not given. Keeping narcotics in an unsecure place, such as a pocket or in a patient’s room, can increase the risk of them being lost or stolen, which will create major issues in documentation and raise red flags to the facility.
It is important to always waste narcotics with another licensed professional per policy. In most states, any licensed nurse or pharmacist can be a witness to narcotic waste. However, you may find variance in state law and/or internal facility protocol. So again, always be sure you know the local laws and hospital policies everywhere you go!
On the other hand, if you are witnessing narcotic waste you should always watch the disposal of narcotics and personally verify they’re being correctly disposed. Never put your license and career in jeopardy by taking someone’s word for it — no matter how much you think you can trust them!
Narcotic Waste Documentation
Of course, documentation is everything in nursing! The best practice is documentation of the medication, dose, and route given using barcode scan (or alternate facility procedure/policy) at the time of administration. Try not to say, “Oh, I’ll remember to jot this down later.” You may think you can manage to remember, but it’s dangerous and opens another door for human error. Additionally, you should always document the waste or return of narcotics in real time. Hospitals and pharmacies constantly monitor narcotics, and you don’t want to find yourself in an investigation.
Narcotic Waste Red Flags and What to Do
If you feel uncomfortable wasting another nurse’s medication or have any red flags about the waste, you should immediately notify the appropriate chain of command to protect yourself, the patient, and potentially your fellow nurse from unsafe behavior.
Also, if you’re ever on a travel nursing assignment and find yourself in a precarious or negative situation that might put your license in jeopardy and/or harm a patient, you can contact your recruiter. They’re always here to support you and have your back. If for some reason you can’t connect with them and need help right away, you can call our 24-hour Customer Care Line. Even better, at Medical Solutions you and your recruiter are backed up by our internal Clinical Team. This team of experienced nurses has been there themselves, speaks your language, and is always an available resource for you on clinical matters and questions.