Fired for Pyxis discrepancy

[Kristen75]

I was terminated from a position because 5mg of Valium was ordered and I removed 10mg of Valium from the pyxis. I gave the 5mg of Valium and went to waste the other 5. The nurse that went with me signed into the pyxis, selected the patient, selected waste and then had me log in under my info. I selected the waste amount and then hit accept and went on about my day. A few days later I was terminated because they said I didn't waste the med. I know it was wasted but was told that the pyxis doesn't show a waste. How does this happen? I know it was done. I requested a drug test but was not given one, just terminated. Any advice?

[cdsavannah59, CNA]

Regarding my previous post, when med is wasted, is it put in the Pyxis, or elsewhere? Remember I'm a PCT and I don't even touch that machine so I hope that's not a silly question to ya'll

[Here.I.Stand, BSN, RN]

Regarding my previous post, when med is wasted, is it put in the Pyxis, or elsewhere? Remember I'm a PCT and I don't even touch that machine so I hope that's not a silly question to ya'll

Do you mean the actual non-administered portion of the meds? They are squirted or crushed and flushed down the sink in the presence of the witnessing nurse. "Wasting" it in the Pyxis is simply the documentation process; Nurse 1 logs in, clicks waste meds, selects the med that was wasted, and enters the amount of waste and reason for waste (generally it is because only part of the drug was given--0.4 mg of a 1 mg syringe of Dilaudid was given per the Rx--but can also be if the nurse dropped the drug on the floor, or the pt decided he/she didn't want it after the nurse removed it from the packaging.) Then Nurse 2 enters his/her login info as the electronic signature.

If a med is returned--say the pt decided he didn't want his pain med, and the nurse hadn't yet opened the prefilled syringe/blister pack--the two nurses document the same as for a waste, except you select "return med" from the menu. I can't remember what exactly the Pyxis does, but the Omnicell (another electronic med cabinet) has a locked box that opens up. Nurse puts the unopened drug into the box, and then it locks automatically when the box is closed. It's a drop-down box kind of like a sharps container, so another nurse coming along can't just pretent to return a med but then steal meds from the box. The pharmacy staff then handles the disposition of the meds--they either dispose of them or re-stock them into the cabinet.

[B,RN]

While I do agree they should have at least asked the other nurse to verify if you wasted together, ultimately it is your responsibility to ensure the waste goes through the machine. There have been times where are machine wasn't "capturing" the waste appropriately. Each time, I had the charge nurse or manager waste with me to show that it was done correctly. Also, you have to waste before you leave the med room. How am I supposed to know that it really is still Valium and not saline or something else? If you do this as you pull it from machine, it will make you waste in same time slot and fingerprints as the removal of the medication.

I am not sure why you were fired without at least consulting the other nurse or a drug test. Let this be a lesson to always double check your documentation! Good luck to you!!

[PacoUSA, BSN, RN]

Depends on the Pyxis setup how meds are returned. One hospital I worked in had a locked box in the drawer under the keyboard where all returned meds withdrawn from Pyxis go. The hospital I'm in now allows you to return the narc back with the original supply provided the count is verified before returning.

[Jory, MSN, APRN, CNM]

I've never heard of anyone getting fired for a first offense. But yes, the nurse needing to document the waste signs in first, then the witness.

[calivianya, BSN, RN]

That's ridiculous. I have wasted things under my name for other people, other people have wasted for me, I have wasted like we're supposed to (i.e. get a coworker when I'm first pulling it), and I have wasted in the Pyxis with a coworker after the fact because there was no one available to waste when I was first pulling the med. All of those are perfectly valid ways to waste.

It sucks that you got fired.

[lindarn]

Isn't there a paper receipt that prints up, when the Pyxis is accessed? I seem to remember a paper receipt that would print up, and if I had wasted a narc, I would ALWAYS KEEP THE RECEIPT FOR FUTURE REFERENCE.

Lindarn, RN, BSN, CCRN (ret)

Somewhere in the PACNW

[xoemmylouox, ASN, RN]

Wow.. I doubt this was the real reason you were fired - they were just looking for an excuse. Make sure you follow up with a lawyer in case something should come of it.

[misslindzee]

If an investigation comes about from the nursing board, I don't think they would discipline you for it. It seems odd the facility would fire you for a first offense. Get your "evidence" ready, write down a timeline for your own records (log the phone calls etc) and if the board needs a response, you tell them exactly what happened. If they ask you about any prescription meds, DO NOT DISCLOSE ANYTHING but what pertains to the unaccounted med.

[misslindzee]

OR if they ask you about your drinking habits, do not say anything. Do not say I have a drink once and a while.. only answer questions related to the 5mg waste. The board is not your friend.

[Kristen75]

I have everything written down and already have an attorney. It was the first thing I did once I calmed down. The attorney's I did interview all said that this wasn't about 5mg waste and feel that this can be fought. It makes me feel better but I am crushed and feel so scared about what is going to happen. It makes me question going on with nursing.

[PacoUSA, BSN, RN]

I hope you're suing for damages and not your job back. I wouldn't go back to that place at double pay.