When something goes wrong with a patient or a med

Charting controlled substance waste clearly

A clean way to chart partial controlled doses before the cabinet, MAR, and audit trail start arguing.

8 min read built on 4 full opinions updated 2026-09-16

Written by a med-surg RN, ten years, day shift. Why there is no name on it · How this guide is made

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When the vial, syringe, cup, or tablet has more than the ordered dose, your note has to do two things: show what the patient got, and show where the rest went. That’s it. The cabinet, the MAR, and the waste or return record should line up.

Key points

  • Chart what you actually gave: medication, dose, route, time, and the patient assessment or response when your unit requires it.
  • Deal with the leftover amount right away: wasted or returned, exact amount, where it went, and who witnessed it.
  • Spell out the math: amount removed minus amount given equals amount wasted or returned.
  • Don’t chart the full dose as given if the patient only received part of it.
  • If the scan, Pyxis, Omnicell, or waste entry goes sideways, correct it with facts per facility policy and notify the right person. Don’t guess.

What to write

Use your facility’s required fields first. If you add a nursing note, make sure it matches the MAR and the dispensing-cabinet record.

Less helpful charting Better charting
Morphine given. Waste witnessed.2310 Morphine sulfate 2 mg IV given via L forearm PIV for pain 8/10. Medication removed as 4 mg/1 mL vial. 2 mg administered; 2 mg wasted immediately in approved controlled-substance waste container with J. Smith, RN witness in Omnicell. Pain reassessed 2340, 4/10.
Dilaudid 0.5 mg given, rest wasted.0145 Hydromorphone 0.5 mg IV slow push given via R hand PIV per order. Vial contained 1 mg/1 mL. Remaining 0.5 mg wasted at time of administration with M. Lopez, RN witness; waste documented in Pyxis. RR 16, patient awake and reports pain decreased from 9/10 to 5/10 at 0215.
Fentanyl wasted with nurse.1022 Fentanyl 25 mcg IV administered for dressing change per order. 50 mcg/1 mL vial removed. 25 mcg administered; 25 mcg wasted in approved controlled-substance waste container with K. Patel, RN witness and ADC waste entry completed.
Oxy wasted later.2040 Oxycodone oral solution 5 mg PO administered from 10 mg/10 mL unit-dose cup. Remaining 5 mg/5 mL wasted per unit controlled-substance waste process with A. Green, RN witness. Waste documented in MAR and ADC.
Returned unused med.1335 Order changed before administration. Lorazepam 2 mg/mL vial removed but not opened and not administered. Intact vial returned to ADC return bin with transaction documented; charge RN notified per unit process.
Forgot to waste.Late entry 0320 for 0110 medication administration: Hydromorphone 0.4 mg IV administered from 1 mg/mL vial. 0.6 mg was wasted at 0112 in approved controlled-substance waste container with T. Brown, RN witness, but ADC waste entry was not completed at that time. Charge RN and pharmacy notified at 0315; discrepancy correction completed per policy.
Barcode did not work, narc given.0905 Barcode scan unsuccessful after two attempts; medication and patient verified per downtime scanning process. Morphine sulfate 1 mg IV given from 2 mg/1 mL syringe. Remaining 1 mg wasted immediately with L. Chen, RN witness; manual MAR entry and ADC waste documentation completed.

Words to avoid

Word or phrase Why it causes trouble Use instead
WastedToo vague by itself2 mg wasted in approved controlled-substance waste container with witness name
Rest wastedDoes not show the math4 mg removed, 2 mg administered, 2 mg wasted
Full dose givenWrong if the patient received only partActual dose administered: 2 mg IV
NarcSloppy and nonspecificMedication name and dose, such as morphine sulfate 2 mg
WitnessedWeak if it does not say who and what was witnessedWaste witnessed by J. Smith, RN at time of disposal
ReturnedUnsafe wording if the package was opened or drawn upIntact unopened vial returned, or remaining dose wasted
Fixed in PyxisDoes not explain the eventADC waste entry corrected at 0320; charge RN and pharmacy notified
Probably wastedGuessing languageIf not verified, document facts and follow discrepancy process
Scanner failedIncomplete without alternate processBarcode scan unsuccessful; patient and medication verified per downtime process

The MAR says one thing, the cabinet another

The usual problem is simple: the MAR says one thing, and the dispensing cabinet says another. A nurse pulls morphine 4 mg, gives 2 mg, but the MAR looks like 4 mg was given. Or the cabinet has no matching waste entry.

That gap matters. Controlled-substance tracking is built from separate steps: removal, administration, waste, return, and witness documentation. If one step is vague or missing, the chart no longer explains where the unused medication went.

The partial dose usually isn’t the problem. The missing trail is.

Bottom line

Chart the math: amount removed, amount given, amount wasted or returned, witness, and time.

Official guidance

  • Document the medication administration promptly in the MAR or EHR. Include the actual dose and route. Use barcode scanning when that is your facility’s process. (Medical Solutions, OpenStax)
  • When you give only part of a controlled substance dose, document the leftover amount as waste through the automated dispensing cabinet or EHR with a witness. Follow your facility workflow. (AHRQ PSNet, WTCS Pressbooks)
  • Use your facility’s approved controlled-substance disposal or return process. Don’t make up a workaround. (Practice Greenhealth, eCFR)
  • Keep controlled-substance records consistent. Bad or mismatched charting can create medication-safety problems and diversion-monitoring concerns. (NursingCenter, NCHA)

In court, 2017–2025

What happened in 4 court cases
  • Commonwealth v. Amanda K. Berube, Massachusetts Appeals Court, 2025, link

If the entire contents of a vial were not used, the nurse was supposed to empty the unused contents into a secure container and submit a waste report witnessed by another nurse.

The opinion described an automated dispenser, a morphine vial, charted administration, and no waste report for unused morphine. The court affirmed the conviction for possession of a class A substance.

  • Henning v. Avera McKennan, South Dakota Supreme Court, 2020, link

Avera McKennan Hospital terminated Stephanie Henning, a nurse in its intensive care unit, after it discovered errors in Henning’s documentation of controlled substances.

The record described automated dispensing reports, scanning issues, and controlled substances that could not be accounted for. The court affirmed summary judgment for the hospital on the employment claims.

  • Laura Lee Demastus v. University Health System, Inc., Court of Appeals of Tennessee, 2017, link

She, however, could not explain the suspicious transactions.

The medication review compared Omnicell removals with patient charting and looked for doses that were not documented as administered or wasted. The court affirmed summary judgment for the employer.

  • Dana Casnocha-Jones v. State Board of Nursing, Missouri Court of Appeals, 2024, link

She would re-fill the vial with an identical amount of a saline solution, and would show the vial to another nurse, who would confirm that it contained the appropriate amount of residual liquid.

The record shows why the waste witness needs to see the actual waste process, not just look at a container afterward.

Court decisions

Published decisions, linked to CourtListener.

All decisions behind this guide

From nurses online

Quoted as written. Opinion, not a source.

Other guides

Advice, not law.