Pulling Meds for Multiple Patients

[trustsupplyguy]

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 patient's name into the bag and them zip it shut. Then I'll do the same for patient #2. So ultimately I have 2 or 3 ziplock bags containing meds and the related Pyxis receipt.

Several nurses have told me this is "bad" and not to do it. But I don't get what the problem is. When I get to the patient's room, I pull his ziplock and check everything against the MAR before giving the meds. The receipt is in the bag so anyone can see whose meds these are and what meds were taken from the Pyxis.

Will the meds from bag #1 jump into bag #2 by magic and change what's written on the Pyxis receipt? Seriously, am I missing something (I am pretty new)? Is there a Joint Commission ruling on this? I have never had a problem doing this, and it does save time.

[Spidey's mom, ADN, BSN, RN]

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

[pagandeva2000, LPN]

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.

[Spidey's mom, ADN, BSN, RN]

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

[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?

[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.

[clee1]

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.

[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.

[Agnus]

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.

[Agnus]

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.

[Valerie Salva, BSN, RN]

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.

[lil' girl, LPN]

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?

[EmmaG, RN]

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.