Giving meds you did not pour

[mindymanders]

I oriented in a facility where an LPN pours all the medications then the RNs are expected to pass the medications. I'm uncomfortable with this; not that she is an LPN but that I would be expected to pass medications someone else poured. I don't think I will accept the position because of this situation. Is this common practice? Am I way off base?

[caliotter3]

No, you are not off base. You are correct and wise for not accepting this position. Nobody should administer meds that they have not prepared.

[amoLucia]

Just curious - for what kind of facility do you work? I doubt that any hosp or NH would permit this method of med pass. Now I have heard of corrections units where meds get set up by 1 person, and then someone else administers them.

[JustBeachyNurse, LPN]

The only"per-pour" Id consider is when the individually labeled blister tablet (has drug, dose, expiration date/lot) still sealed or the unit dose (labeled by manufacturer) sealed dose cops & syringes and just portioned out into little med cups not random pills in a cup.

The juvenile detention center has the night nurse portion out the packaged pills into cups and locks the med cart after checking vs the MAR and ordered by administration. The day nurse picks the labeled cup, verifies med & patient against MAR then opens the package right before administering. (In case of refusal or not present).

[NICUismylife, ADN, BSN, RN]

Oh hell no! I would not administer anything I didn't draw up myself. I don't care who is doing it, how qualified they are. Too much room for error.

[NICUismylife, ADN, BSN, RN]

The juvenile detention center has the night nurse portion out the packaged pills into cups and locks the med cart after checking vs the MAR and ordered by administration. The day nurse picks the labeled cup, verifies med & patient against MAR then opens the package right before administering. (In case of refusal or not present).

This would be fine. As long as the nurse administering the med can check it. That is not the impression I got from OP though....

[klone, MSN, RN]

It would be impossible for the administering nurse to perform the 5 rights if it was pre-poured by someone else. I can only guess that TJC or whoever does their inspections/surveys is not aware of this practice, because it totally would not fly.

[mindymanders]

This is a small geripsych hospital. I was told one nurse pours the meds then a different nurse administers the meds on each of the 12 hour shifts. The DON with whom I interviewed is a former state inspector and this fact made me wonder if this procedure has become acceptable. I witnessed the nurse writing the patients name on the med cups then placing the cup on a table in the nurses station. She pulled up insulins but did not label the syringes. The nurse assigned to the patient will then collect the meds and administer the meds without verification. Common nursing sense tells me this cannot be the correct way to do things! I oriented on day shift last week and am orienting on night shift tonight (which is my shift of choice). If I see that this is the procedure on night shift I will not accept the position.

[ThePsychWhisperer, BSN, MSN, APRN, NP]

Sounds like you're on the base to me. Unless the person pouring was someone I trusted with my life, kids, bank account info, etc, I'm not putting my name behind it if I didn't pour it. I've even gone so far as to not put my name behind IV fluids hung by someone else. Ya just never know...

[anangelsmommy, ADN, BSN, RN]

Oh hell no! I would not administer anything I didn't draw up myself. I don't care who is doing it, how qualified they are. Too much room for error.

AGREED!!

I worked a PDN case where mom was an ER nurse, first day mom had drawn up the meds and I told her I couldn't give meds that had been drawn up by someone else. Doesn't matter who they are, I drew up my own meds, set hers aside, she gave at a different time. She totally understood and never drew them up again when I was coming. Its my license and I am responsible for everything I give. I agree with Justbeachynurse, if they were in blister packs, and portioned into cups, and I could still check against the MAR, that is the only way I would administer the medication, its the only way to insure its the right med, right dose etc.

[Meriwhen, ASN, BSN, MSN, RN]

The only way I might pass a pre-pulled or pre-poured med is if I first verified the medication with the other nurse, then directly witnessed the other nurse taking/pouring/drawing the correct amount of medication, double-checked all the medication rights, AND that the medication never left my possession the entire time since we started. But since I would insist on being there for the entire process, I may as well just pull it myself and save us both the time and effort, or let her pass the meds that she pulled herself.

Sealed unit dose packs, I'd be more comfortable with passing pre-pulled, because I'm going to be double-checking each med before I open it.

Otherwise, if I didn't pull it, I'm not giving it.

[Been there,done that, ASN, RN]

Are you saying, there is a cup of unidentifiable pills.. that YOU are expected to administer?

No way in hades.. decline the position AND report the facility's practice.