Dilaudid anyone?

[PintheD]

Let's just say the following is a hypothetical....

An RN needs to access the Pyxis controlled refrigerated meds for a specific patient. When the RN discovers the needed med is not in the fridge she changes the number of "meds removed" to "0", shuts the fridge door and low and behold a Pyxis drawer shoots open containing DILAUDID! Yes. Eight vials of Dilaudid sitting in the drawer with unfettered access. Could never happen, right?

Now, for fun, lets say the RN grabs the charge immediately and beckons her to the med room to experience the unbelievable. The same sequence of events are repeated with the same outcome - a free for all of the tightest of controlled narcotics.

Pharmacy is called, arrives immediately and denies very arrogantly and defiantly the possibility of said hypothetical Pyxis malfunction. Again, the same sequence of events are repeated by RN with same outcome - Dilaudid drawer access, no paper trail!

Persistent in defiance, pharmacy rep demands RN repeat sequence two more times, each outcome the same as the original. At this point the pharmacy rep, holding fast to his original responses of arrogance and defiance, insinuates the RN "broke" the machine, and verbally berates her for leaving Dilaudid vials in their box in Pyxis drawer(!) Just an example of "if you can't blame the nurse at least give her a kick".

Thank God in this situation Pharmacy has ownership of the Pyxis. Can you imagine the field day a hospital would have if they could pin faulty Pyxis programming(*) on nursing? I can assure you the RN that discovered the malfunction would be punished severly and not a stretch to assume reported to the BON.

I don't know what happened, if anything, from a pharmacy standpoint regarding this scenario. Do any of you know what the legal implications are for an institution not adequately controlling a controlled substance?

(*) Let's also assume Pyxis had very recently been reprogrammed to allow Pyxis- only access to refrigerated meds.

[Asystole RN]

From a legal standpoint, nothing. The requirement to keep narcs locked is a DEA guideline, not a law.. There is no "legal" requirement to ensure a Pyxis is working correctly. This is a facility issue, not a DEA issue. Besides, in fact the narcs were still technically locked behind two locks at all times.

[netglow, ASN, RN]

Wow, OP.

I'd be sure there was an investigation. Write the situation up, who what where... I feel that the way pharm had so deftly turned "the blame" onto you is highly suspicious. You may have someone who was setting up a diversion route (reason for the extreme anger reaction on pharm's part). This is serious.

[seeIseeyou]

I vote that this was a discovered "diversion route" as well. It is totally possible with a little bit of programming know how. Very serious indeed.

[AJPV]

Apart from a signed confession, an eye-witness, a positive drug test, or a trail of pyxis discrepancies on your pyxis login, I don't think the state BON can punish you simply based on speculative accusations and shoddy circumstancial evidence. That would leave the BON and your facility open to some very large financial liabilities in the event that you sued for lost wages. To cover your own posterior, you could always pay for your own drug test and have it ready in case an accusation comes your way.

[PintheD]

AJPV - I'm not so sure. I've heard of countless circumstances where nurses have been guilty until proven innocent, and given no opportunity to prove said innocents. Twisting the facts is common practice for nursing administration everywhere. Numerous posts on allnurses alone are testament to that fact.

Having said that I am not fearful of retribution here specifically, as stated the malfunction is clearly a reflection of pharmacy.

[MrChicagoRN, RN]

The problem is too many meds, not missing ones. Pharmacy probably refilled but didn't reset the count.

I'd suggest filling out an incident report repeating what's in the first paragraph, adding pharmacy notified. Joe Jones Pharm tech came to unit, accused nurse of "breaking the pyxis." Joe Jones handed the excess medications for resolution of problem.

I'd also go up the chain of command to report the unwillingness of the pharmacy rep to accept responsibility & work to resolve the issue.

[AJPV]

Remember to use Joe Jones' direct quotes in the incident report instead of simply saying "Joe Jones accused..."

[RNLaborNurse4U]

This is why I get a nurse witness immediately when I go to pull a controlled substance (ampule) and find the amp in the drawer - broken and spilled of it's contents. Happens more often than I would like!! (I would like to get rid of all glass amps.....but that's beside the point.)

It's always about covering your butt. I would never want to be accused of diversion of drugs. Ever.

[nerdtonurse?, BSN, RN]

This actually happened to me, but it was a dibold machine. I was pulling out something harmless--protonix PO, I think, I mean, something nobody'd want to divert, yet something we don't use that often -- and two drawers popped open, one with a LOT of Vicodin in it. I screeched like a scared cat, touched NOTHING, and got the nearest nurse (who happened to be my charge nurse) to stand in the room with me until the house supervisor could arrive. Showed her the scene, reset it, and bingo, it did it again. We didn't have a pharmacy tech in house (it was the middle of the night) so the house sup had us put the meds into the "waste" slot, and she wrote something up for all 3 of us to sign. The head of pharmacy was there an hour early and took custody of the meds.

I don't know what happened, but I know they were hiring some new pharmacy techs the following week. Diversion? Stupidity? Don't know. But it scared me to death when it happened.

[Sugarcoma, RN]

I experienced something similar also with Dilaudid. While pulling heparin the drawer opened and way in the back of the drawer were 5 vials of dilaudid. The dilaudid drawer was just above the heparin and somehow they must have fallen through. I immediately called pharmacy and grabbed my RN friend to witness. The guy who came up told us he was impressed with our honesty. I worried for a while afterward that they were going to somehow blame it on me. Dilaudid is such a coveted substance for abuse and diversion. It is scary anytime you are on the end of an error involving it!!!