Wasting Controlled Substances

Hi Everyone,
Melinda recently met with Ernest Thomas, our internal controlled substances auditor and between both units, we have some room for improvement when it comes to wasting drugs in the accudose.  He gave us this nice cheat sheet to help us determine when and how we "waste". 

Controlled Substance Wastage:

When you MAY WASTE:
Condition	Solution
Partial dose ordered	Waste unused portion
Patient refusal	Waste entire dose
Med dc’d after dose prepared	Waste entire dose
Blood aspirated into needle	Place syringe with dose in dirty needle box
**Each wastage must be performed by a licensed individual and witnessed by a licensed individual. Each wastage must be recorded in the Medstation.

When you MAY NOT WASTE:

Broken seal or Tamp-R-Tel Tablet crushed or dropped Liquid medication is spilled; mop up with 4x4 gauze and store with syringe (if safe) in a plastic bag

Complete Controlled Substance Discrepancy Report and fax it to 2-1204. Lock drugs in narcotics cabinet or drawer until destroyed by a Controlled Substance Auditor.

If unable to resolve discrepancy and the discrepancy is greater than three (3) dosage units call 2-4561, 2-4199, or page 11283 or 12540.

Most of the time, we are wasting unused portions of the vial or syringe, and this we typically do correctly.  Our problem is the length of time it sometimes takes to enter the waste.  We should be wasting unused portions at the time they are taken out- I know this isn't always possible with emergencies, and having only 3 nurses on 7C at night.  Just be aware, and try to waste as soon as possible after administering the medication.

Many of you may not know the policy for wasting dropped or spilled medication (I didn't).  As it states in the second box above, we can not simply throw the dropped tablet or spilled liquid in the trash/sharps.  We must place it in a bag and keep it in our locked Narc box, fill out a Controlled Substance Discrepancy Report and fax it to 2-1204.

Also- when using the same vial for more than one dose, during a procedure for instance, make sure the verbal orders are entered in the chart, for example- fentanyl 40 mcg X 2.  This way it doesn't look like you used the same vial for 2 PRN doses.

If this is confusing, or you have any questions, please see Melinda or myself.
FYI: The policy- https://www.musc.edu/medcenter/policy/Med/C168.pdf