Access to medications during Callbacks

sharann, BSN, RN · Nov 29, 2003

I'm not sure if you are asking this, but we have an automated system for dispensing meds called a Pyxis. It needs to be accessed like a computer to open the drwers. We are often alone on off hours on call so we may have no nurse to "witness" our wastes. We need to call the house sup or we have to toss the narc then waste it "on paper" with another nurse later. We have the leftover locked up, but we may toss it. We have no choice or we are stuck there for an hour or more. Thsi of course is not legal or approved but it is reality. Until they staff us with a backup nurse. Sometimes we can catch the OR nurse before they disappear to wate the meds. It is inconvinient at best.

ckalston · Dec 2, 2003

We also have the Pyxis system. Prior to the new arrangement, we had recovery pouches inside the Pyxis. We would take the pouch out, use the medications (documenting on paper), have the drug waste witnessed by the nurse accepting the patient on the floor, and then we would put the tie back onto the kit and return it. Only required one nurse getting it out and putting it back and the floor nurse could witness the waste on arrival. But now it's a mess.

wildwood · Dec 2, 2003

Hi,

At our hospital we have a system similar to Pyxis, called Omnicell. You have to have a password to access it. Each medication is signed out to the patient as it is needed. Getting a witness for waste is not a problem because we (OR nurses) do not leave our PACU nurses by themselves until the patient is ready to be discharged to the floor.

We aren't physically in the room with them all the time, because on callbacks we have to do our own cleaning of OR suite and instruments, but we are available closeby in case they need us. I think is is a matter of safety to have someone else there in the department, and not be left alone. That way if the patient becomes unstable or codes, there is another nurse there.

ckalston · Dec 2, 2003

Thanks for the response. I totally agree with not being left alone with recovery patients, and the argument that has been given to us is the fact that the ICU nurses "are available" as needed. As you may know, being available is not always the same as actually been there when needed. I don't like having to depend on maybe's when I am taking care of my patient. In other words, "Maybe someone can bring me more medication if needed", or "Maybe someone will come down and check on me if I call for help." I like to have what I need at bedside, and to me that means having a recovery pouch with an assortment of the most commonly used medications (MS, Demerol, Phenergan, Versed) and in a large enough amount not to run out in the middle of the recovery.

sharann, BSN, RN · Dec 3, 2003

Ha! Our ICU nurses are just around the corner and UP 4 floors. Good luck getting any help during an emergency. Some of our OR nurses are great and will offer to stay as needed or if requested(these are the ones with common sense). The others run out and don't even give us a chance to ask for help. The prob you have is an access problem, but what do you do during the day hours? Do you use a pack then, or is this just for on-call afterhours? If you want a change, you need to go as a group and ask for change (which is a problem among nurses.....)

ckalston · Dec 3, 2003

During the day we have a Pyxis in the same area that we recover patients. We also have nurses working with us so if we can't leave the side of the patient, someone else will get us the medication. However, the Pyxis is within view of all the patient beds. This problem is only after hours. The problem with getting it changed, the boss changed it without talking to us, but now won't listen to us as a group about what we would like to see happen.

wildwood · Dec 3, 2003

Sounds like an issue to be taken to risk management. If your boss is not concerned with patient safety and your liability in case of an emergency, then I'd pursue other ways to get your problem taken care of NOW. It shouldn't even be left up to the OR nurse as to whether they want to stay or not. I am an OR nurse, and I totally understand what you are saying. I can't believe that your facility (even the surgeons) or anesthesiologists would consider this a safe practice! Janet

ckalston · Dec 4, 2003

Thank you Janet. I had not really looked at this as a risk managment issue, but can see that your correct. I will look into things from this angle.

Scififan · Dec 22, 2003

I work in a relatively small hospital, we have four operating theatres and our PACU can handle up to 6 pts (whether we have the staff for six pts at once is another issue). On Call backs and afternoons and the weekends when we are here by ourselves we have the keys to access the drug cupboard, which is exactly the same drug cupboard we use during the day.

By the way my first enty!

wildwood · Dec 23, 2003

Hi!

Congratulations on your first post. I love being able to hear from OR nurses far away.

We used to use that system of having "keys" that were supposedly hidden, but everybody who worked in the OR or PACU had to know how to get them. The problem arose when there were narcotics missing, and nobody knew who took them.

Then we started keeping a set of keys in the hospital pharmacy and had to sign them out when we went in to do cases on call back.

The system we have now Omnicell, similar to Pyxis, is much better. The drugs are signed out in the computer before the drawer opens, and your password is used so there is no question as to who is responsible.

Do you think that your system works well for you? I didn't trust everybody (even housekeeping could have been in the area and could see where we got the keys when we needed them). Just something to think about.

Scififan · Dec 24, 2003

Thanks for the reply, this system certainly is open to abuse and if and when it does occur, its a truely horrendous situation, if you're having to look at your friends and co-workers wondering until the culprit is found.

When I was still working in the ward about two years ago they were talking about the computerised systems, we were to expect them very soon.......still no sign of them!!!!!

I hoping soon in the next decade or two we'll make it into the 21st Century. (Maybe that's a little harsh)

Merry X-mas everybody I"ve actually got the next 4 days off, see Miracles can happen.