Medication safety what if...

klone, MSN, RN · Mar 9, 2015

What standard of care do you feel like it would be breaking?

loriangel14, RN · Mar 9, 2015

Well yeah if my hands are full or I need my hands free I have put stuff in my pocket.

brownbook · Mar 10, 2015

I don't know (or care...... :sour: ) if I am breaking some standard of care. When I draw up 100 mcg of fentanyl into a syringe (which I label with the patient's name and drug) and give 25 mcg I keep the syringe in my pocket.

I can end up giving the whole dose, or wasting it later. Later can be shortly after the patient is discharged, or the end of a busy shift. Thankfully I have the routine of giving myself a pat down :laugh: when I change out of my scrubs, so I go get the waste co-signed. (We are a smaller independent clinic, no pyxis here!)

mariebailey, MSN, RN · Mar 10, 2015

I had to go pick up Librium, a narcotic, from the pharmacy 1 dose at a time. He took it several times per day, & it wasn't in the pyxis. We do have medication drawers for patients, but narcotics cannot be left in them. I had to pick up a dose that wasn't due for 1.5 hours, & I was lost as to where to store it. Thus, I carried it in my scrub pocket until it was due.

RNNPICU, BSN, RN · Mar 10, 2015

Sorry guys, but this sounds contra to many policies regarding medication administration. Especially for narcs. Medication in your pockets can leak, get lost. For medications that need a witness, your witness needs to verify both drawing up and wasting. I would not want to witness a medication taken from someone's pocket.. how could I know that it was actually that medication?

By placing meds in your pocket you are setting yourself up for an error and potentially being accused of diverting

Just my 2 cents..

SBGangelJC · Mar 10, 2015

RNNPICU sounds like in your experience this was not an acceptable practice, but I can see why carrying medications in your pocket might be necessary under certain circumstances such as mariebailey shared. Not sure about the not wanting to waste scenario, I truly hate wasting anything, but a lot of hospitals prefer to do that. I remember working 1 shift and I pulled out morphine but the patient ended up changing their mind, policy was to waste even though it was unopened.

I've heard so many mixed reviews about meds in pockets such as it is a safety risk, infection control issue, and facilitates diversion. I tend to disagree with the concerns about safety and infection control. Bar code scanning makes it a no brainer to be safe and if meds shouldn't go in the pocket due to contamination then neither should pens, alcohol wipes, or anything else we use for patient care. Some places do not have medication carts or a place to store meds so if your hands are full then what else can you do. Nurses need to use their judgement so I imagine there are lots of scenarios where circumstances lead nurses to put meds in their pockets.

melizerd, ASN, RN · Mar 10, 2015

We pre-waste narcs with another Rn. I do put things in my pocket, often in a ziplock bag. The med room is at one end of the unit so I frequently gather several rooms at once and just label the bag with room number, if my rooms are at the opposite end.

klone, MSN, RN · Mar 10, 2015

Sorry guys, but this sounds contra to many policies regarding medication administration. Especially for narcs. Medication in your pockets can leak, get lost. For medications that need a witness, your witness needs to verify both drawing up and wasting. I would not want to witness a medication taken from someone's pocket.. how could I know that it was actually that medication?
By placing meds in your pocket you are setting yourself up for an error and potentially being accused of diverting
Just my 2 cents..

Maybe some of us are misunderstanding? I will pull a single dose vial and put it in my pocket. The medication is in its original container, unopened.

And yes, with narcotics, we always pre-waste with a witness as soon as it's pulled from Pyxis.

RNNPICU, BSN, RN · Mar 10, 2015

Klone, I can see that scenario with an unopened vial, but where I am at, you would need to either document you gave the med or waste within one hour.

We have strict narcotic rules with regards to wasting and documenting giving the med. Where I am, the RN has to witness the other RN giving the med, and disposing of the waste.

I think I was also imagining a nurse with syringe in pocket without a label on it.

IVRUS, BSN, RN · Mar 10, 2015

Never put a syringe full of any medication in your pocket, much less PO meds of any kind. What happens when a drug is in a syringe (not matter what kind is in the syringe - with some being more dangerous than others) and you're walking down the hall, trip and the cap of the syringe comes off, exposing the needle, which now is lodged in your hip and all the medication is now in you... could happen, no matter how remote it may be.

And why put PO medications in your pocket? If you are delivering them to a pt, bring them in in a medicine cup, or what I do is pop the pill out of its package in front of the pt so when they say.. "What's that pill?" I have the package right there to inform me.

Also, the post about diverting medication is so true.

K+MgSO4, BSN · Mar 10, 2015

O crikey! Im having chest pain reading this........if you need to take a syringe of meds put it in a kidney dish. Dispensing multiple patients meds in the drug room and carrying them in ziplock bags is setting yourself up for failure as well.