How to count and waste controlled substances
Other platforms explain it with text and video. In VMS you practice it on the patient.
Opioids and other controlled drugs are tracked by law to prevent diversion and harm. Clear counting and wasting habits protect patients and your license.
Step by step
Count with two nurses
At shift change or as policy states, the outgoing and incoming nurses count every controlled item together and both sign. [1]
Resolve differences at once
If the count does not match, report it right away and do not leave until it is resolved or documented per policy. [1]
Remove one patient's dose only
Take out only the dose for one patient, right before giving it. Never carry controlled drugs in a pocket. [1]
Waste with a witness
When only part of a dose is given, a second licensed person watches you waste the rest. Both of you document the amount. [1]
Witness only what you see
Witness only waste you actually watched. Pre-signing or signing later is a serious violation. [1]
Dispose correctly
Use the approved disposal container that makes the drug unusable, not the sharps bin or sink unless policy allows. [1]
Watch for diversion signs
Report patterns such as frequent wastes, patients in pain despite doses, or altered vials. [2]
Common errors
- Signing as a witness for a waste you did not see.
- Leaving the unit before a count discrepancy is resolved.
- Keeping a controlled drug in a pocket to give later.
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
- Open RN, Nursing Pharmacology 2e (CC BY 4.0)
- NCSBN 2026 NCLEX-RN Test Plan
- Open RN, Nursing Skills 2e (Chippewa Valley Technical College) (CC BY 4.0)
Steps adapted from Open RN, Nursing Pharmacology 2e and Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. VMS is not affiliated with these organizations. Updated: 2026-10-11.