Pulling Meds for Multiple Patients - page 5

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   littlepeach
    If working on the floor, sure use the ziplocks. As if you have time to do it any other way. If you want to use the bathroom and actually eat during your shift, you have to cluster your care and prioritize.
  2. by   clee1
    Quote from Emmanuel Goldstein
    If an error occurs and you weren't following policy, you're screwed.

    Our pyxis does not give a receipt, btw. I haven't used one yet that does. I guess that must be something set up by each individual hospital.

    I'm curious as to why those who pull for multiple patients at once won't pull narcs too. If the practice is kosher, what difference would it make?
    I do pull narc's with the other meds... always have.
  3. by   Agnus
    Best practice says pull meds for only one patient at a time and administer them before pulling meds for another patient. Those of you who pull meds for multiple patients do not even think of doing that with any type of surveyer watching you. Not only will your tush be grass but so will your facility's.
  4. by   Agnus
    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.
    Then you need more than one Pyxis. This is unsafe, and goes against Best practice. When this hospital gets fined for this they will find the $ to buy another pyxis. It would be cheaper and smarter not to waite to be fined and or risk loosing accreditation.
  5. by   Agnus
    Quote from clee1
    While working on med/surg, I used a similar system all the time - without error, I might add. All meds are scanned at bedside along with the pt bracelet to ensure no errors are made.

    This practice may violate someone's cockamamie policy or regulation, but then again, let the azzhats that create such foolishness in the name of "safety" walk the halls in repeated trips to the med room - I just DON'T have the extra time! :angryfire
    I work on a med sug floor. I do walk the halls. I would be terrified to pull meds for more than one person at a time. I did not make the policy or regulation. It can be done.
  6. by   Valerie Salva
    Quote from katnursep
    I'm a new grad with no experience but in school we did learn to never pull meds for more than one pt. at a time, because of the possibility of mixing them up. Your system seems mix up proof to me. I did see nurses during clinicals pulling meds for multiple pts. at a time.

    Every nurse was taught in school never to pull meds for more than one pt at a time. In reality, things just do not, and often can not, work the way we were taught.

    I think the OP's system is a good idea. I would not tell mgmt about it, though. They most certainly will tell her she can't do it.
  7. by   lil' girl
    Quote from Valerie Salva
    Every nurse was taught in school never to pull meds for more than one pt at a time. In reality, things just do not, and often can not, work the way we were taught.

    I think the OP's system is a good idea. I would not tell mgmt about it, though. They most certainly will tell her she can't do it.

    I'm sorry but what is wrong with this picture? First it's okay to pull multiple meds. Next don't tell mgmt cos they will tell her she can't do it. SO okay whats next?
  8. by   EmmaG
    Quote from Valerie Salva
    I think the OP's system is a good idea. I would not tell mgmt about it, though. They most certainly will tell her she can't do it.
    And why would that be?

    Just to reiterate... with a computerized system such as a pyxis, there are records that can be accessed telling the manager (and auditors/surveyors) exactly what each nurse pulled and when.

    If you are not following safe practice and hospital policy, you are going to be hung out to dry when an error occurs.
  9. by   elthia
    Quote from Emmanuel Goldstein
    If an error occurs and you weren't following policy, you're screwed.

    Our pyxis does not give a receipt, btw. I haven't used one yet that does. I guess that must be something set up by each individual hospital.

    I'm curious as to why those who pull for multiple patients at once won't pull narcs too. If the practice is kosher, what difference would it make?
    I don't pull narcs because because even though I can lock my med cart, every employee on the floor knows the code to the med cart. That is why are computers are set up as mini med carts with lockable drawers
    In the days of unit dosing when everything was in the real med cart, and you didn't have to log in to the pyxis to get po zantac and po lopressor was the pt's scheduled morphine kept in the med cart???

    I really don't see the difference from pushing my med cart from room to room, and locking it between pt's with how meds are administered at a long term care facility.

    My nurse director and my nurse manager are well aware that this is how I and many other nurses on the floors administer our meds, that is why they advocated for the mini med carts with lockable drawers to upper management.

    I do not "pop" my pills out of their packaging before scanning and telling the pt what they are, I do not draw up meds out of vials before scanning them at the doorway, I do not spike IV bags before scanning. And I always compare the label to the MAR regardless of what the barcode scanner says, the barcode scanner has been wrong before.

    Some people are saying this is against JCAHO, but I've been searching their website for the past half hour, and haven't found anything about pulling meds from the pyxis on multiple patients at once and then locking them in a med cart in separate drawers being unsafe practice.

    http://www.macoalition.org/documents...ion_Errors.pdf
    I followed this link from JCAHO's website, it mentions unit dose machines, but doesn't mention pulling meds for multiple pt's.

    http://www.jcipatientsafety.org/fpdf...4-PS-02-03.pdf
    This definitely mentions reconciling meds against the MAR and securing meds safely by locking them up.

    http://www.jcipatientsafety.org/22818/
    and heres a link to JCAHO's long list of links of med error stuff if you have the time.
    Last edit by elthia on Dec 15, '07 : Reason: more info
  10. by   Spidey's mom
    Quote from Valerie Salva
    Every nurse was taught in school never to pull meds for more than one pt at a time. In reality, things just do not, and often can not, work the way we were taught.

    I think the OP's system is a good idea. I would not tell mgmt about it, though. They most certainly will tell her she can't do it.
    Boy, I just have to say it .. .it is not a good idea to lie to your employer .


    steph
  11. by   leslie :-D
    Quote from stevielynn
    Boy, I just have to say it .. .it is not a good idea to lie to your employer .


    steph
    you don't have to tell me twice.
    already, this is the beginnings of a very, slippery slope.

    leslie
  12. by   RN1989
    I am wondering if the "time saving" that many people are talking about is related to many nurse's inherent "me first" attitude when it comes to taking turns at the med cart. Every facility that I have worked at has had several people on each shift/floor that is SOOOOO slow getting their meds out of the machine that they cause others to be behind. So then the staff feels like they need to be hogging the machine to get all the pt's meds out at once because they don't like waiting around for the slow pokes. I've seen nurses literally stand for 20 minutes waiting for their chance at the med machine instead of finding something else to do like charting, checking labs, etc. So maybe they feel like if they get all the meds out at once, that is where they are saving time instead of using their time wisely in the first place. I've even had to chew nurse's butts on this matter because meds for pain and urgent issues take priority and I've had nurses try to tell me to "wait till I'm finished" and then want to spend another 10 minutes getting meds out. I don't put up with that stuff whether I am working as staff or management. But I think I am more than a little concerned about having unsecured meds, narcs or not, being pulled out with the possibility of someone taking stuff from your baggies to use on their pts or the possible contamination by taking them from room to room. Guess that just shows I'm old school.
  13. by   EmmaG
    Quote from elthia
    I don't pull narcs because because even though I can lock my med cart, every employee on the floor knows the code to the med cart. That is why are computers are set up as mini med carts with lockable drawers
    That is different than what is described in the OP.

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