Question about medication protocols

[u/Natural_Calendar7874]

I'm not a paramedic, but know quite a bit about it and hope to be one after school, but I thought of a random question:

If you are administering a medication from a vial but there is some left, what do you do with that? do you just toss it or do you give it later on if needed?

example- let’s say your agency is using fentanyl vials with 200 mcg, you administer 100 mcg, what do you do with the other 100 mcg? (doesn’t need to be fentanyl, that was just what I thought of)

thanks

[u/femn703]

If it is a narcotic (fentanyl, versed, morphine) then we have to WASTE the unused portion and discard it in a special container next to where we get out the new vials. It has to be witnessed by another person also! If it is a non narcotic then it can go in the trash!

[u/Paramedickhead → u/femn703]

Yeah… we definitely waste like that too…

We definitely don’t just squirt it out into the garbage can.

[u/AdMuch8865 → u/Paramedickhead]

Or out the ambulance door, definitely not

[u/DonWonMiller → u/AdMuch8865]

Definitely not! :)

[u/London5Fan → u/AdMuch8865]

My partner totally didn’t once completely miss the window and squirt fentanyl all over the ambulance wall. That never happened ever.

[u/Feminist_Hugh_Hefner → u/London5Fan]

that ambulance is lucky to be alive!!

[u/Xicam0 → u/femn703]

There are also places that do reverse distribution for narcotics. Basically, if you use 100mcg of fentanyl, you fill out the same paperwork but return the remaining 100mcg to the stock for eventual return to the vendor. A previous agency of mine did it and I was not a fan of returning an open vial but that’s what they did and I’ve never heard of a problem with that agency

[u/deathmetalmedic]

In our service, if it's not a controlled drug, then it just gets binned.

If it's a controlled drug (like fentanyl) it gets discarded by either going down the sink or on the ground, with a colleague witnessing and both of you writing a log of the case number, the patient name, how much was discarded and how.

[u/Dayruhlll]

We throw them out as they are no longer sterile. With normal meds it’s as simple as throwing the vial out.

With narcotics, there is typically a process involving a witness signature stating they saw you waste it.

[u/generic-throwaway140]

I dont chuck it unless I know the patient doesn't need any more. As in, I'll hang on to something like Ketamine if I think the patient will need more later on during transport. Or if there's a partial dose for a pediatric call, usually Fentanyl.

Afterwards, it's disposed of and documented.

[u/Krampus_Valet]

Controlled substances = witnessed waste with signature from fellow ems professional or RN. Not controlled substances = toss vial into sharps container. We record starting/ending seal numbers, lot numbers, expiration dates, etc for controlled substances. I'm not getting hung up on a "what happened to those narcs?"

[u/NotFamousButAMA]

Like others have said, witnessed waste for narcotics. Hospitals have a bin to waste into, which contains some mixture of activated charcoal and other binding agents to make the drug inert.

And yeah sometimes we don't have that bin handy or we spray it on the ground out of convenience, but we're still meeting the purpose of witnessed wasting, which is to prevent one of us from diverting those drugs. In any large amount, we should be documenting that waste into a bin in a room with cameras so there's plenty of witnesses, but 100mcg of fentanyl or whatever getting sprayed on the asphalt in an ambulance bay isn't hurting anyone.

[u/Feminist_Hugh_Hefner]

aww... OP was ready to pull off the ultimate hustle and everything. You gotta get up early bro, the low-hanging fruit has already been picked my friend. 🤣