"Discrepancies" In Epic Documentation

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The dreaded HR meeting happened. It was brought to my attention that there were 7 incidents of Ativan pulled but not given. 7!! Something is way off here. I work in Psych (15 years). I'm not a drug abuser. This is per a pharmacy report. Totally confused. We use Epic, and if something is pulled and not given, it shows up as overdue on the mar. 

Any one have an experience like this?

By the way, do u think it could have been in the Mar "report" page??

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Specializes in Fall prevention.

We had only had Epic a few months when it started happening and it could have been the MAR reports page I’m not real sure all I remember is it was not on the actual MAR.  It was a smaller line item page.  

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Specializes in orthopedic/trauma, Informatics, diabetes.

Our org is using a 3rd party software to audit pulls vs given. I have had an issue where I pulled 2, only scanned one, or pulled and not scanned. Easy to do when there are a lot of meds being given. If there is a reasonable response, it is not an issue. I am def more careful now but it hasn't risen to the level that you are talking about. 

We have had issues in the past where a pharm tech didn't know how to properly process returned narcotics and there was a week where they said there were like 35 discrepancies (normal is like 1). All had the tech's name in the Omnicell. 

I wish people (even leadership) would use some critical thinking. To go from zero issues to that many in such a short time shows that there is def an issue with technology-not you.  

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There have been times where I've given but documented as such, with " bar code unreadable" . So some I document as given, but bar code wasn't scanned. I was never told not to do this. Is that going to get me in trouble?

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There have been times where I've given but documented as such, with " bar code unreadable" . So some I document as given, but bar code wasn't scanned. I was never told not to do this. Is that going to get me in trouble?

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Specializes in NICU; Mother-Baby.

What I've seen happen at our facility is when giving a new or PRN med EPIC creates a new administration in thr MAR instead of linking to the scheduled administration. Example: you pull the med scheduled for 1015 and scan at 1021 and EPIC will show the dose due at 1015 as Not Given with a dose given at 1021. This doesn't always happen but I've seen it often enough. These would potentially show up as missed doses on a report but easily researched to show they were actually given.

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Specializes in Burn, ICU.

Are other co-workers having the same problem?  If so, it could be a systemic issue like others have mentioned, but it would be very strange if it only applied to specific controlled substances.  If you're the only one, it sounds like you're missing a step.   

EPIC is different at each facility but at mine EPIC doesn't "know" that you pulled a med from the Pyxis.  Pharmacy can reconcile "meds removed" with "meds given" but I don't think I (as an RN user) can see if these match up.  (Exception: meds pulled using the override function in an emergency, so there's obviously a connection but it doesn't seem to apply to meds with existing orders.)  Also, benzos are often PRN medications, so there won't be a "due" time in your MAR and it won't show up as "overdue" if you pull it and don't give it.  The one time I had an issue with a controlled substance it was a PRN narcotic.  I pulled all of the patient's 20+ scheduled meds plus the pain med, scanned everything (I thought), and gave them all...except I didn't actually scan the pain med.  I didn't notice because there were no "overdue" flags on my MAR.  I got a very serious warning, had to correct the medical record, and had to write it up as a med error.  If you think this could be the case for you, you need to come up with a method ASAP to scan every med, every time. 

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OP what is your current status? Are you on suspension?

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No. Nothing  as of yet. I go in Wed to see the pharmacy report. Hopefully I can scour the records in epic and see what's going on

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14 minutes ago, Faithx14 said:

No. Nothing  as of yet. I go in Wed to see the pharmacy report. Hopefully I can scour the records in epic and see what's going on

Hmm.

Well, for lack of a more knowledgeable thing to say: Proceed with caution.

On the one hand it's going to be hard for them to maintain that they considered you a risk or that they thought you did something like divert controlled substances if they are messing around without even suspending you.

On the other hand, sometimes there is no rhyme or reason or ANY sense of ethics to their proceedings, so I would be **very** leery of being in the same room with them, and especially leery of talking and babbling too much and feeling uncomfortable and inadvertently saying the wrong things that they decide to run with.

I guess that's to say that if they seem to actually believe there's a problem on their end, rather than a problem with you, then be cautiously cooperative. For love of all that is holy do NOT make any comments that could impugn yourself, none of this, "I suppose I could have forgotten to scan once but not seven times..." etc., etc. This is strictly my opinion but as I see it you need to maintain a hard line that there IS a problem related to the mechanics on their end.

If they show you this pharmacy log and ask you to "explain yourself" or explain how this happened, there is NO WAY I would participate in that. I would say, "Pharmacy or IT needs to answer that. There is zero way that I removed controlled substance 7 times and did not deliver them to the patients." End of story. You need to look people in the eye and you need to be pleasant and professional while at the same time making it very clear that you are not wringing your hands and fretting over how to explain your poor practice or the idea that you "must have" done something wrong. Instead, be calmly and pleasantly perturbed and expect THEM to quickly get to the bottom of THEIR problem.

I hope it goes okay.

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18 hours ago, Faithx14 said:

There have been times where I've given but documented as such, with " bar code unreadable" . So some I document as given, but bar code wasn't scanned. I was never told not to do this. Is that going to get me in trouble?

It’s going to make your numbers on your unit go down,  and also it’s going to flag that it’s YOU not scanning the barcodes. I would make every effort possible to scan the barcode and if it doesn’t scan make sure you call pharmacy and let them know each and every time, and which meds aren’t scanning.  Personally I don’t even give meds that won’t scan without a call to pharmacy and I rarely if ever do override pulls. Most emergency meds are on crash cart and if it’s not that much of an emergency I stay on the phone with pharmacy like ummm yea so can you verify this med please and thank you very much.  It’s too dangerous out here and I know we like to hurry up and get er done, but in those instances when it’s not urgent call pharmacy.

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28 minutes ago, HiddenAngels said:

Personally I don’t even give meds that won’t scan without a call to pharmacy and I rarely if ever do override pulls. Most emergency meds are on crash cart and if it’s not that much of an emergency I stay on the phone with pharmacy like ummm yea so can you verify this med please and thank you very much.  It’s too dangerous out here and I know we like to hurry up and get er done, but in those instances when it’s not urgent call pharmacy.

Very excellent advice. Hope everyone reads it.

Stop doing short-cuts and work-arounds to solve other people's problems while risking yourself or your patient in some way to do so. Just stop. Those days need to be over.

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