All patients coming through front door are quick registered (previous patients) and immediately name is linked in computers to charting, pyxis and main data base. In the event, a patient comes by ambulance, we are able to enter name in pyxis without MR # to retrieve meds. Any true emergencies where code cart is used-all meds usually needed are in locked in pre-stocked cart. If sedation meds are required for intubation, they are taken from pyxis and later charted.
Medications ordered by ER docs are in computer and are received and available in pharmacy. Any admit orders on hold patients are scanned to pharmacy and cross checked and their own meds are taken out or changed to our formulary stock. Allergies and weight must be included on our physician orders sheets for daily med administration or meds will not be sent.
We do not keep typical daily meds in stock, however, we keep many iv premixed and vials that need to be reconstitued. During this past year we have had a daytime ER pharmacist and she has been wonderful! One problem we do have is that narcotic medications are not always given in the dose released from the pyxis-and we require another nurse to waste medications with us. This is a problem in an emergency-if you forget to have someone come back and waste with you-it appears as someone has taken medicine because amounts will not match between what was taken and what was given.
As another poster mentioned, we are nurses and ultimately responsible for med administration. If not comfortable with amounts, or circumstances we always have the right to question or withhold a medication. In the event of an emergency-we might not know about a person's allergy, however, if a person is being coded a "side effect or reaction" is the least of their problems. I always have my nursing med book, will call the pharmacy or if during regular hours make use of our pharmacist. In many cases, she will join us in an emergency and be the "runner" for meds.
Either way, it is not prudent or realistic to have every med order overseen. Physicians are supposed to know their meds and nurses need to check prior to administering to make sure they are doing the right thing.