Kaisu Posted January 4, 2009 Posted January 4, 2009 We had just started our new schedule. It's 48 hours on, 4 days off. The change has caused a lot of issues because we are a high call volume station, and a standup in the first 24 makes the second 24 less than fun. Earlier in the day, I had run on a chest pain. We had administered ASA and 3 nitro when the patient began experiencing sudden pain in the left arm. I had a fire department medic on the ambulance and I handed him the nitro for administration of the 4th dose and drew up morphine. Our medical director has a bugaboo about morphine. Although in our written protocols for use in chest pain, he has made it clear that he wants us to call for orders to administer it. I have had morphine for chest pain denied and learned my lesson. This lady was going to get it if she needed it. I was going to administer it and ask for forgiveness later. My guardian angels are on the case as the patient's pain responded immediately to the nitro. Transport time was short and I wound up wasting the morphine. I had the charge nurse witness the waste, filled out my documentation and took it to the pharmacy. It took them a long time to replace the drug but I finally got it. This is about 6 hours and several calls later. We get toned out for kidney stone pain. It's dark and the patient lives in the boonies. It took a while to find him. On arrival, he is doubled over on the floor of his residence, moaning in pain. We immediately assist/carry him to the ambulance and get moving. The patient's only medical history is hospitalization for treatment of kidney stones two months earlier. He is 35 years old, normotensive and takes no medications. He has no allergies. I immediately obtain IV access (O2 and monitor) and call for orders for morphine. (It is the only analgesic I carry. On a previous kidney stone patient, I had no option for pain as that patient had been allergic to morphine.) Med control asks me to call in on the cell. I do, and they ask for the patient's name. The medical director (on shift that night) checks the patient's history and then gives orders for 4mg of morphine. We carry morphine in 10mg/1ml vials and ampules. I pull out a 12ml syringe, attach a filter straw and draw up the morphine. The plunger draws hard - don't know why. I go to switch to a 14 gauge to draw up the saline. When I release the plunger, it pulls up into the barrel and shoots the morphine into the air. Crap!. In my surprise, I stick the 14 gauge into my thumb. Double crap!. Now I got a glove filling with blood (mine - hate that), no morphine in the syringe, and a patient moaning in pain. I pull up the second dose and administer 4 mg. The patient has immediate relief. I change gloves, we transport the patient and I get a nurse to witness the waste of the 6 mg. In pharmacy, things get very very slow. I wait and wait and wait. The pharmacy assistant comes to me and says "You know it looks a little funny - you waste 10mg earlier, now you've lost 10mg and wasted another 6. That's 30mg in one day and most paramedics never use it. Do you have an empty vial or something you can show us?" Tones are going off all over, all our crews are out, they need me to be in service and I am getting this bullshit. I get a little frustrated. "The ampule is in my sharps container, the vial is in the garbage" I tell her. I can tell that the staff is glad there is a glass wall between me and them because my BS tolerance is at an end. At that point, my supervisor shows up and wants to know what is going on? He takes it from there. The pharmacist is hard to understand because he is an East Indian gentleman with a very thick accent. Turns out he wants some sort of paperwork - not sure what but they make it up as they go along. An incident report signed by my supervisor and the medical director will be enough to replace the 10 mg. I lost. In the meantime, the 10 mg consisting of the 4 administered to the patient and the 6 witnessed wasteage can be replaced right away. My supervisor is happy because it means I can go into service. I am pissed off because it makes no sense. If I cannot be trusted with the 10 I wasted what makes them think that I can be trusted with the 10 used on the patient. Be that as it may, the pharmacist finally gives me 1 ampule. Supervisor is happy cause I can go back in service. He hands me a door card and a radio, (not sure why), I walk out the door and promptly drop the ampule on the floor, smashing it to pieces. Not as funny - large hispanic "gangsta" looking young man in the ED with a brachial artery bleed. This patient is mad at the world and makes waves. The ED doc in charge approaches the patient with a syringe and tells him it is pain medication. The patient allows him to administer it. It is sucs. The patient goes down and is intubated without amnesiatic or analgesic. I leave. When they told me it would not be like school, I didn't realize it would be this much not like school.
spenac Posted January 4, 2009 Posted January 4, 2009 It is frustrating the way days like that go. I have always wondered how they know the patient got any meds and not the medic? No one witnesses except the wasting and how do they know your not wasting NS instead of MS? I hate thinking about it because I have control of this and several other controlled substances. Yet it is my word and my reputation at stake. No way to prove anything short of piss test, I guess. Sorry for rambling.
Richard B the EMT Posted January 4, 2009 Posted January 4, 2009 Most of us groan at the mention of the urine tests for drug abuse. Has anyone ever requested it to prove innocence? Never mind, I'm starting a new string on just that topic.
Dustdevil Posted January 5, 2009 Posted January 5, 2009 Be that as it may, the pharmacist finally gives me 1 ampule. Supervisor is happy cause I can go back in service. He hands me a door card and a radio, (not sure why), I walk out the door and promptly drop the ampule on the floor, smashing it to pieces. ROFL! You can't make this shit up! The entire narcotic control system is indeed absurd. So much so, that I refuse to "witness" narcotic wastage, unless it is from an unopened vial. It's pointless. I have no way of knowing what is in that syringe that is being squirted out. None of these steps we take do anything to stop or even discourage theft, misuse, or abuse. That "most paramedics never use it", as the pharm tech said, is a sad testimony to the fact that all this red tape does nothing more than discourage medics from using narcotics when it is really indicated.
CBEMT Posted January 5, 2009 Posted January 5, 2009 We had just started our new schedule. It's 48 hours on, 4 days off. The change has caused a lot of issues because we are a high call volume station, and a standup in the first 24 makes the second 24 less than fun. 48 straight? Please tell me you're kidding. In pharmacy, things get very very slow. I wait and wait and wait. The pharmacy assistant comes to me and says "You know it looks a little funny - you waste 10mg earlier, now you've lost 10mg and wasted another 6. That's 30mg in one day and most paramedics never use it. Do you have an empty vial or something you can show us?" This is why I never dispose of vials, carpujects, or ampules of our morphine or versed until I get it replaced. :wink:
spenac Posted January 5, 2009 Posted January 5, 2009 48 straight? Please tell me you're kidding. This is why I never dispose of vials, carpujects, or ampules of our morphine or versed until I get it replaced. :wink: Only 48 wow wish I had that instead of my 120. Of course slow service here. I to always keep the vials, though still does not prove what I am actually wasting. It also serves as a reminder to restock.
Dustdevil Posted January 6, 2009 Posted January 6, 2009 This is why I never dispose of vials, carpujects, or ampules of our morphine or versed until I get it replaced. :wink: That's a good practice. In fact, I have worked for systems that required you to turn in the empty vial along with your request for replacement. Even if it is not required, it makes you look better if you do.
CBEMT Posted January 7, 2009 Posted January 7, 2009 That's a good practice. In fact, I have worked for systems that required you to turn in the empty vial along with your request for replacement. Even if it is not required, it makes you look better if you do. Thanks. There's one hospital I transport to only occasionally that I tried to get morphine from for the first time this past summer. Their pharmacy not only wanted the carpuject I used, they wanted a photo ID. :shock:
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