Pulling Meds for Multiple Patients - page 4

In order to save time, I will often pull meds from the Pyxis for more than one patient. For example, I'll get patient #1's meds, put them in a little zip-lock bag, put the Pyxis receipt with the... Read More

  1. by   pagandeva2000
    I think that pulling them out and placing them in zip lock bags are almost the same as pulling from a pyxis and placing the medications in individual drawers in a med cart, which I have seen done frequently.

    I have seen a floor where the friction was so bad between nurses, that carts were stolen right under their noses, and one nurse decided to do something similar just to stay out of the mess. I have to honestly say to each his own license. I can't and won't judge.
  2. by   Spidey's mom
    Quote from kmcnelly
    I think it is also being missed that most of the people doing this are saying that they are doing it PER HOSPITAL POLICY! They've been taught to do it this way in school (if they were using a pyxis) and the hospitals policy is to do it this way (if they have a pyxis). Please realize that this is a new machine, and it may be 'safer' to do it this way than it has been before. The meds are disbursed in their package, so there is no possibility for cross-contamination if they aren't removed from that package. The meds have a receipt which is checked when they're disbursed against the mar, and then checked again against the mar before giving the med to the last pt. All rights are still checked in order, and this way just saves a shade of time. (again, per hospital and school policy)
    Actually, I haven't read that this was policy - many people are saying that they would revert to one patient at a time if JHACO showed up.

    When I first started working acute care, there were times we did LTC in the event of staff shortage. I never understood the theory that pre-pouring saves time. You still spend the exact same time pulling the meds all at once as you spend pulling them one at a time.

    We had a med cart that went from room to room. So, you could pull the meds for each individual patient at the patient's door. Without pre-pouring. But nurses spend 1/2 hour first thing in the morning pre-pouring all the meds, putting them in cups in the patients' individual drawers.

    If there isn't time to pass meds in a timely manner, then your hospital is short-staffed. It kind of drove the bosses crazy when I passed meds because if I was late with a med I would write why . . . it took 2 hours to pass meds to 40 patients with only one nurse.

    I'm not putting my license on the line for a place that understaffs. They don't float me to LTC anymore.

    Also, in acute, with only 5 patients some nurses still pre-poured. 5 patients.

    If this is an ok policy with your hospital and with JHACO and pharmacy then I guess it is ok with me.

    But I'd never do it. One time I brought both patients' meds into a room and one patient was in the bathroom and fell. I put the meds on the bedside table of the other patient as I sprinted by to help him (the covered and identified cups were in my hands). When I came back, the patient had taken both cups of meds.

    Never again.

    steph
    Last edit by Spidey's mom on Dec 14, '07
  3. by   EmmaG
    Quote from stevielynn
    Actually, I haven't read that this was policy - many people are saying that they would revert to one patient at a time if JHACO showed up.
    Which tells me it isn't policy...

    For those who think that they can get away with this, consider that JCAHO now makes unannounced visits, and that many hospitals have their own internal investigators who anonymously monitor staff for JCAHO (and hospital) policy violations. And I hope they realize that JCAHO or management can also pull the computerized record in the pyxis and see that nurses were taking meds for multiple patients at once; it doesn't have to happen while they're doing a survey for it to be a violation.

    Quote from stevielynn
    If there isn't time to pass meds in a timely manner, then your hospital is short-staffed.

    <snip>

    I'm not putting my license on the line for a place that understaffs.
    Yep. And again, if an error occurs and you aren't following policy and safe practice, you're on your own...
    Last edit by EmmaG on Dec 14, '07
  4. by   MAISY, RN-ER
    It's interesting, not sure what the policy in our facility is for pulling meds for multi patients on the floor.

    Someone mentioned narcotics, are they routinely ordered as daily meds? I wouldn't think so because they require a pain rating and reevaluation. Personally, I wouldn't pull them with dailys. That's just me.

    ER is so different...nothing we do seems to be like anywhere else. I learn alot from all of you.

    Thanks...

    Maisy
  5. by   EmmaG
    Quote from MAISY, RN-ER
    Someone mentioned narcotics, are they routinely ordered as daily meds? I wouldn't think so because they require a pain rating and reevaluation.
    Quite a few people are on routine narcs or other Schedule meds.
  6. by   Spidey's mom
    Quote from Emmanuel Goldstein
    Quite a few people are on routine narcs or other Schedule meds.
    Yes, that is very true.

    And in the ER, I medicate one patient at a time too. What a mess it would be if I grabbed the Toradol in one hand and the Rocephin IM in another.

    steph
  7. by   Blee O'Myacin
    Quote from kmcnelly
    I'm really confused about this quote. In my school we have 2 patients. Our instructor watches us pull the meds, makes sure we do our 7 rights, and will follow us (never leave our side) until we pass the meds. Trust has nothing to do with this. We have never used a pyxis, so we haven't been taught the multiple-pull, but those that have been taught I would assume are taught the same way.
    Sorry that wasn't all that clear on the re-read. But what I meant was that instructor seems to be taking on a lot more than I would in his or her position. So all of you have two patients - so say that's 20 patients worth of meds if there are 10 in your group. That's way more patients than the average assignment. A 1700 med pass must take at least 2 hours! No wonder some instructors are having students pull meds on both patients!

    I wouldn't want to take the risk - as an instructor or as the nurse in charge of the patient. Frankly, if I saw a nursing instructor pull meds with a student on multiple patients on my assignment, I'd take issue with it. Ultimately, it is my responsibility that the patients get properly medicated - even if a student "has" my patient under the watchful eye of an instructor. (Who really can't be in 10 or 20 places at once!)

    I'm not trying to flame anyone who pulls their meds in this fashion, just presenting an alternate point of view. Extra steps to and from the pixis aren't going to make much of a difference in the long term - I find that the least strenuous of my activities on any given shift involve my walking to and from the pixis! :spin:

    Blee
  8. by   sailornurse
    Sounds like many of you are not familiar with the Pyxis brand of computerized medication dispensing.
    Hospitals that have these machines that are kept in a med room. This has done away with the "Unit Dose' dispensing that pharmacy used to do, where all the meds for each patient where placed in a small drawer/box. These med boxes were then placed into medcarts that could be rolled down the hall, or the med boxes were locked in each patient room.
    Now you the nurse now have to pick each individual pill/tablet/med from this computerized system, one by one. It is very time consumming. Yes, there is a line of nurse waiting to get to the pyxis to pull morning meds. It has created more work for nurses. One hospital I have recently worked at as an agency kep their old med carts so the nurses use them to create a unit dose system for each patient. Another that I am prn at, the nurses carry tackle boxes with dividers & pad locks to pull all the meds for patients. For example: You pull 0800 & 0900 meds at the same time.

    When you have up 8 patients, You have to pull meds for all your patients or you would never finish, all your meds would be late, some by as much as hours, which are also med errors. If you tried to pull the meds for each patient then administer those, then come back for the next pt. you would be done in time for the noon med pass. Many of you have confused the OP with the pre-pouring of meds, which is not a good practice if you are referring to opening the med packets & placing the pills into med cups, then traipsing down the hall with open med cups full of various colorful pills. Even with the tackle box, we do not open the individual pill until at the bedside, with the MAR, armband & 6 rights.

    I teach nursing & I see nothing wrong with the OP with the exception that the meds need to be secured with a locking mechanism. Not sure carrying zip-lock bags in my pocket is the best we can do.The computerized med cart that is rolled to each room seems to be the best way to deal with Pyxis type dispensing systems.
  9. by   Spidey's mom
    Quote from Blee O'Myacin
    an instructor. (Who really can't be in 10 or 20 places at once!)

    I'm not trying to flame anyone who pulls their meds in this fashion, just presenting an alternate point of view. Extra steps to and from the pixis aren't going to make much of a difference in the long term - I find that the least strenuous of my activities on any given shift involve my walking to and from the pixis! :spin:

    Blee
    I think this is like the admonition to people who drive over the speed limit. It saves you, what, a minute or two but increases your risk of an accident greatly.

    Someone needs to do a study - find out how much real time is saved by doing this.

    I doubt it is very much . . .my hypothesis is no significant time is saved. (Stats class - sorry)

    steph
  10. by   Spidey's mom
    Quote from sailornurse

    When you have up 8 patients, You have to pull meds for all your patients or you would never finish, all your meds would be late, some by as much as hours, which are also med errors. If you tried to pull the meds for each patient then administer those, then come back for the next pt. you would be done in time for the noon med pass.
    Again - why are nurses saving the hospital's tush here? Why are we putting our licenses on the line for the hospital's decision to short-staff?

    I would take until noon to pass meds and let the chips fall where they may. And then find another job.

    Safety and patient advocacy first. To heck with the hospital's idea of staffing.

    steph
  11. by   pagandeva2000
    One of the issues with the pyxis at my job is that there is ONLY ONE and all of the nurses fight to get to it like it is the last glass of water in the desert. And, it is set up that if you are earlier or later than 1/2 hour, then, it will not open at all, and it will be documented as a medication error. Therefore, most of the nurses on the floors set up their medications this way, meaning that they take the meds still wrapped in their plastic with the name and dosage on it, set them up in their individual drawers with the client's name on each drawer, and check them against the MAR before administering them.

    I work in the clinic, so, we do not deal with pyxis, but from what I am hearing from my friends, this system has made things worse for them. I think that in may cases, once more, some of the systems that are in place are not in the best interests of nurses.
  12. by   Spidey's mom
    Quote from pagandeva2000
    One of the issues with the pyxis at my job is that there is ONLY ONE and all of the nurses fight to get to it like it is the last glass of water in the desert. And, it is set up that if you are earlier or later than 1/2 hour, then, it will not open at all, and it will be documented as a medication error. Therefore, most of the nurses on the floors set up their medications this way, meaning that they take the meds still wrapped in their plastic with the name and dosage on it, set them up in their individual drawers with the client's name on each drawer, and check them against the MAR before administering them.

    I work in the clinic, so, we do not deal with pyxis, but from what I am hearing from my friends, this system has made things worse for them. I think that in may cases, once more, some of the systems that are in place are not in the best interests of nurses.
    Well, that is a bad system. Let's get rid of Pyxis.

    steph
  13. by   kpyers32!
    Pyxis is like a computerized receptical for meds on the floor/unit. The nurse logs in, and selects her pt. & then selects the meds due for that pt. Making the process systematic. It has various drawers & slots & won't let you move on till the drawers are closed etc. It's a computerized way to dispense medication.

    'Pulling meds' is just lingo for getting medications from the pyxis for your patient. To my knowledge there is no other reference. I think it's b/c it's a bit more involved then say grabbing meds off a shelf. You know? Am I wrong?

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