Being accused?

[RachelLeeRN]

Hi everyone. I am a new GN nurse, on my 5th week of orientation. I take 3 patients on my own so far, doing well... although at times my head is spinning and I question my ability :) But thats normal .. .right?

Anyways, I worked yesterday 7a-7p. I get a call from the nurse supervisor at 7am today ( my day off!! ) as I see the phone ringing, im thinking OMG i was supposed to work today!!! Oh no.... i messed up my schedule..THINK AGAIN.

SHe says, " Did you remember giving a oxycotin to your patient yesterday?" I said...as i try to wake up and my heart starts beating 1000 x a min. Yes, My patient is on Oxycotin 10 Q12H, 12pm and 12am is her scheduled time. I am familiar with this order b/c it is new and the doctor wrote it while I was on shift yesterday. I also remember b/c I have never seen that pilll before until yesterday. So I said yes, I remember distinctly giving her 1 pill at noontime. She said are you sure you didnt accidently grab two from the pixis when you got hers? I was like....umm NO. I am a new nurse and the reason im so slow is b/c i check, double check, triple check everything im doing.

So, she says okay, just wanted to check.

So thanks, its 7am my day off and im about to throw up. I called her again at 11am, I just couldnt get my mind straight. I asked her if everything had been cleared up? She states that she has to talk to one more person, but there is 1 pill missing and it has to be held accountable to someone. So instead of getting a better feeling from calling... it got even worse. I dont understand...we have a pyxis, i remember the count matching, and taking out one for her. The only time it was accessed again for the oxycotin was at midnight when the night nurse went in to pull her dose for that patient , and thats when "the count didnt match". Could she of taken it herself? I have no idea what to do.

Whats going to happen to me? I know i didnt make a mistake, and not in a MILLION years would I take any medication, I have a hard enough time taking tylenol.

Has this happened to anyone? Is my license gonna get taken away from someone else setting me up? I dont know what to do..im so confused...

Thanks guys.

[Altra, BSN, RN]

I know this is upsetting.

But until you have reason to do otherwise, take a deep breath and relax!

I can't say what the outcome of this will be. I don't know how often your Pyxis is physically counted by the charge nurse, pharmacy, or whoever to make sure the counts match. There are many options for action on the part of your department manager and/or facility administration -- it will depend on your facility's policies. You and the night nurse or your entire department may be subject to a temporary or permanent change in procedures for accessing controlled meds. But you need to remember that this is in response to an unacceptable situation (being unable to account for controlled substances) and nothing against you personally.

Make sure you log out completely and correctly after every time that you access the Pyxis. Continue to carefully check yourself as you have been. Other than that ... this is out of your hands.

Take care.

[clee1]

Meds go missing (at least "on paper") often. There is a great audit trail on these machines, so the error is usually found quickly.

Don't sweat it. The worst that can happen is you'll have to drug screen. No big deal, right?

[RachelLeeRN]

Meds go missing (at least "on paper") often. There is a great audit trail on these machines, so the error is usually found quickly.

Don't sweat it. The worst that can happen is you'll have to drug screen. No big deal, right?

At this point I'd be willing to do anything to prove. The sad thing is i feel like...why am i being stressed out and so worried when I didnt DO anything wrong?

[Tweety, BSN, RN]

Try to relax for now. It's common to retrace their steps when meds go missing, it doesn't mean you're being accused. They were asking because you might have said "yes, I gave her 20 mg" or any number of things that would have explained the missing dose....and then they would have realized a mistake was made, so don't jump to conclusiosn that you're going to be set up or lose your license.

[mom2michael, MSN, RN, NP]

Our med machine automatically goes back 2 people who have accessed the machine regardless of who made the mistake when our count is off - so it's common for our supervisor and/or Pharm to call us both and question if our count was right when we accessed X drug. No big deal - we answer honestly - and they go on to the next.

We have several agency nurses that have a hard time with our machine because the way our machine counts is different than most facilities. Our PRN staff has a hard time too. Full time staff is used to it - so we usually do OK. But about once or twice a week we get a count off and we have to wrack our brains to figure out what happened.

As long as it's not a continued chain of events for you - I would just relax and not worry. She probably had to contact everyone who accessed the machine to get out the drug w/in X period of time, you were one of them. You answered honestly and she has moved on.

[NotReady4PrimeTime, RN]

Our Pyxis is programmed to automatically flag any discrepancies. If I take 5 mL of phenobarb elixir out and forget to record that on the bottle, there will be a discrepancy the very next time someone goes to take phenobarb elixir out. The last person who accessed it will be named on the screen, along with what the initial count was, what was supposed to have been taken and who it was being taken for. It's also possible to pull up a list of all the people who have accessed that drug in the recent past. Some controlled drugs are dispensed by divided drawers; for example our 2 mg morphine is in a divided drawer, and only the number of vials requested will be available. Others are in multi-vial drawers and have to be counted. If the count I enter doesn't match what the machine is expecting it tells me to recount, and if it's still wrong then there's a discrepancy created, along with a strip of paper for me to deal with. This happens a lot with phenobarb elixir, codeine and morphine syrups; often there are two bottles in the drawer and it's easy enough to only enter what's on the label of the open bottle and forget about the other 100 mL. All of our tablets are in unit dose packaging, so counting is simple. The system isn't perfect, but there has to be some sort of checks and balances in place. I hope this situation is resolved easily for you, RachelLee.

[dangRN]

I would not worry. They would have to prove that you are guilty of taking the medication. Worse case, they would ask you to submit a drug screen. Medications get missing all of the time. Sometimes we never get an answer. Don't worry about it.

[Tait, MSN, RN]

We use an Accudose which is very similar to Pixis. Do not sweat it. I would have been more upset, as you were too, when they called questioning my dosing to my PATIENT. Screw the Pixis and a discrepancy that wasn't caught by your supervisor, and be aware of "poentially" being pinned as a scapegoat. There are a lot of shady folks out there who might be testing the waters to see if they can get someone else in trouble for their urge to steal meds.

Before I started at my hospital there was a nurse who used to go into the med room claiming to do a "count" on narcs. She would siphon the morphine out of the syringes and replace them with water during this time. You never can tell.

*hugs* ^^

Tait