Big Trouble

Specialties MICU

Published

Hello Nurses,

This might be long so bare with me!! I am quite distraught at the moment and need your help. I am a relatively new nurse that works in the Medical ICU. Working in the ICU as a new grad has been a huge learning curve but exciting.

When it comes to the ICU you administer a lot of medications specifically pain medications. I was recently pulled into my managers office with concerns of my documentation with one specific IV pain med. The most prevalent pain med we give. The problem was that some how some way it had come up in my documentation that I had scanned the pain med as if I had given it in our e-chart (Prism), then later on it saying I pulled that med from the Med station making a time stamp. So Me documenting at 0400 that I gave the med, and then at 0430 it showing I took it from the med station.

My manager has put me on leave because this has come up in my charting almost 5 times on different patients. I get very busy and caught up in my pt care but she wants an explanation of why I did this. The problem is I honestly don't know why I would scan a med before pulling it.

If there is anyone out there that would have a reasonable / any explanation I really need your help!! I love my job and my pts and I would hate myself if I lost it over this.

Thank you for all the help!

Are you clicking it off on the EMR at the nurses station then pulling it after to go give it physically in the room?

... After reading all the replies the most logical explanation to me was that I must of had an empty vial or manually entered the med in anticipation of giving it later. ...

So this happened 5 times and you think this is the "most logical explination? Either you scanned an empty vial or bypassed the scan. Which was it? I know in our system it shows if you scanned or bypassed. If you did not bypass, then what did you scan?

Something here is not adding up.

Specializes in M/S, LTC, Corrections, PDN & drug rehab.
So this happened 5 times and you think this is the "most logical explination? Either you scanned an empty vial or bypassed the scan. Which was it? I know in our system it shows if you scanned or bypassed. If you did not bypass, then what did you scan?

Something here is not adding up.

Exactly! It happened to *the OP* 5 (FIVE) separate times!!! No one else, just the OP, & the OP has *no idea* how it happened. What??? I only worked with a Pyxis during nursing school but I know you have to pull it out first & then scan it so what the OP is describing makes no sense. I understand computers can be off but if computers are gonna be off they will be off for *everyone* not just *one* person.

I'm having such a hard time wrapping my head around this situation because it makes no sense whatsoever. There *have* to be details left out. I don't expect the OP to ever tell us the whole truth but I find it odd that only the OP got in trouble & it was ironically the same med every time.

Most likely had an empty vial scanned 1st.

Specializes in Critical Care.
Most likely had an empty vial scanned 1st.

Either that, or they weren't scanning. If you just click on the box in epic, it defaults to the top of the hour.

Either that, or they weren't scanning. If you just click on the box in epic, it defaults to the top of the hour.

Does Epic mark it as bypassed then?

I know in Cerner if you just check it it flags it as not scanned (but does chart it at the time clicked, defaulting to the top of the hour sounds dumb).

Specializes in Psych ICU, addictions.
Does Epic mark it as bypassed then?

I know in Cerner if you just check it it flags it as not scanned (but does chart it at the time clicked, defaulting to the top of the hour sounds dumb).

My Cerner defaults to the time the dose was/is due.

Specializes in Critical Care.
Does Epic mark it as bypassed then?

I know in Cerner if you just check it it flags it as not scanned (but does chart it at the time clicked, defaulting to the top of the hour sounds dumb).

I haven't seen it with a "bypassed" or "not scanned" in the MAR, which is what I have access to, but I have no doubt that the lack of scanning is recorded. Part of our performance review was % of the time we scanned meds. I would think that would be a logical first step for an investigation by pharmacy as well.

My Cerner defaults to the time the dose was/is due.

Hmm, when in Care4 (the floor nursing software) I can say I never bypassed it, so no idea what it does there for scheduled meds.

In the ER I have had a few that I have bypassed in emergent situations, but they were Stat meds, not scheduled, and they show given at time I clicked it.

It may just be dependent on if it was a reoutine order or stat order as to how it is logged time wise.

But I agree, it is sounding like the OP may have just bypassed the scanning so it defaulted to the top of the hour/scheduled time, even if it was actually given at another time.

That would explain the documentation of given at 4:00 (the scheduled time/top of the hour time) but a pulled timestamp @ 4:30.

The OP needs to post back to clear this up. Not nice to post this without a resolution. :)

Specializes in Critical Care Nursing.

The only logical explanations I can come up with is that you are either consistently bypassing the scanning step to clear the task before you actually pull the med, that you are scanning some sort of label instead of the actual medication, or that you consistently scanned leftover meds that were not wasted. I apologize for my bluntness but I do not believe that you do not know how this could happen for a total of five times. I'd also like to add that you could be easily recognized from the information you have given and should act with caution on this, and for your sake OP I hope it was not narcotics :/

Specializes in NICU, ICU, PICU, Academia.
The only logical explanations I can come up with is that you are either consistently bypassing the scanning step to clear the task before you actually pull the med, that you are scanning some sort of label instead of the actual medication, or that you consistently scanned leftover meds that were not wasted. I apologize for my bluntness but I do not believe that you do not know how this could happen for a total of five times. I'd also like to add that you could be easily recognized from the information you have given and should act with caution on this, and for your sake OP I hope it was not narcotics :/

It was fentanyl and only fentanyl. No other drug. Hence our suspicions....

It was fentanyl and only fentanyl. No other drug. Hence our suspicions....

Where do you get that from? I see no mention from anyone that it was Fentanyl.

All the OP said was it was "The most prevalent pain med we give".

It probably is fentanyl (I am guessing as a drip to go along with versed for sedation), but could be morphine or even toradol (but I don't see a stink happening for toradol). I do agree it is probably a controlled substance.

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