Medication safety what if...

[SBGangelJC]

Hey all have you ever needed to carry or hold medications in your scrub pocket? If so what were the circumstances? Do you consider this to break a standard of care? Why or why not? Thanks. Peace and love you all.

[emtb2rn, BSN, RN, EMT-B]

End of a shift can find a variety of vials in my pockets - narcan, cardizem and lopressor are the most common although atropine is found fairly regularly. Which is why i check every pocket before leaving.

But never narcs. Never. Ever. Administered, wasted or returned.

[RNNPICU, BSN, RN]

We pre-waste narcs with another Rn. I do put things in my pocket, often in a ziplock bag. The med room is at one end of the unit so I frequently gather several rooms at once and just label the bag with room number, if my rooms are at the opposite end.

Is there any other identifier beside the room number? If not, how can you be certain that those are the meds for that pt?

It just sounds like having meds in the pocket sets the nurse up for potential mistakes. Many names, meds sound similar and it would be easy to bring a wrong med to a pt, and if you were in a rush to administer meds, very easy to make an error.

[icuRNmaggie, BSN, RN]

Don't carry narcotics in your pocket. You could lose it and then what.

I found a carpuject containing 10 mg of MS on the floor in the hall. I no choice after asking my coworkers about it and I had to turn it in to a supervisor.

The ER nurse who brought us a patient had to go through a lot over losing that med.

[Farawyn]

Only while going in to an isolation room with my hands full.

[cheezwizz90]

New policy in my hospital that we can no longer carry any meds in our pockets, even saline flushes. We have to carry them in our hands and if we can't give them right then, then we label it and lock it in the patient's med drawer. The reason given wasn't because of safety concernes over needle sticks, accidently taking them home, losing them or infection control. The reason is because, no kidding, they say that the body temperature of the nurse can heat up the medication and alter the drug properties. Nevermind that our hands also have heat. I am entirely skeptical of the pharmacy's reasoning, and furthermore it isn't practical. Sometimes you just have to put things into a pocket. That's why scrubs have so many pockets right? I even carry IV narcotics in my pocket, and I've never had the needle or cap come off. Even if it did poke me, I'm pretty sure that I'm not going to plunge it all into myself like another poster suggested could occur. It's going to cause pain and be removed promptly. I don't carry them for hours, just if I can't find a witness to waste with me or the patient needs another dose in an hour or less. I see zero issues with carrying PO meds in my pocket as long as I haven't opened the package yet.

Keep it real.

[TexMex22]

Never put a syringe full of any medication in your pocket, much less PO meds of any kind. What happens when a drug is in a syringe (not matter what kind is in the syringe - with some being more dangerous than others) and you're walking down the hall, trip and the cap of the syringe comes off, exposing the needle, which now is lodged in your hip and all the medication is now in you... could happen, no matter how remote it may be.

That's right 'cause everyone knows the real danger with shots is a hip injury or even worse:

[mariebailey, MSN, RN]

Sorry guys, but this sounds contra to many policies regarding medication administration. Especially for narcs. Medication in your pockets can leak, get lost. For medications that need a witness, your witness needs to verify both drawing up and wasting. I would not want to witness a medication taken from someone's pocket.. how could I know that it was actually that medication?

By placing meds in your pocket you are setting yourself up for an error and potentially being accused of diverting

Just my 2 cents..

I understand what you're saying. In my situation, it was a PO med that was both packaged & in a plastic bag that was labeled with the drug info & patient name. It was 1 capsule, & no wasting was required. Our med drawers are unlocked, so it's against policy to put narcs in there. In retrospect, I should not have gone down to the pharmacy to pick it up until the drug was due. I was trying to get the trip out of the way in anticipation of a new admit. I didn't think ahead a/b where to store the drug.

[Here.I.Stand, BSN, RN]

I stopped doing that the day I accidentally left with Dilaudid in my pocket. Fortunately I realized pretty quickly what I'd done, and my colleagues trusted me when I went back in and asked for a witness to waste...and nobody from the DEA came beating down my door.

If I have a large amount of drugs to bring to a patient, I'll put them in a lab bag to carry them into the room. We have some bright fanny packs w/ the hospital logo on them, for when we have to take the pt for a scan and need to bring PRNs along.

[cheezwizz90]

The lab bag/fanny pack idea is great!

I've also gone home with IV narcotics in my pocket...probably three times, which lead to a trip back to the hospital to waste it. I'm thankful that I've established myself as a trustworthy nurse with integrity. I would do the same for most of the people that I work with, but there are a few who I wouldn't trust.

After the third time, I made myself a note so that I would always remember to empty my pockets before leaving the breakroom. Being a human is tough!

[RNNPICU, BSN, RN]

Going home with narcs or any meds is reportable. You are lucky. Keeping meds in your pocket really can lead to errors, meds can leak, cross contaminate. If you have other pts meds in your pocket and they are not labeled it is possible to give the wrong med to the wrong pt. Shifts get so crazy, hectic busy and nurses are pulled into so many directions.

[NurseEmmy]

Sometimes you just run out of hands. This being said, it is best to not make it a habit. Taking narcs home in your pocket is a big risk. I think not allowing saline flushes is a bit ridiculous though.

[vintagemother, BSN, CNA, LVN, RN]

I worked in psychiatric nursing. I would typically load the syringe in the med room and then recap it, place it in my pocket and then walk to the pt.

I felt like this was not a best practice, however, I also did not feel that walking down a hall with a visible syringe was going to make my pt want to be compliant, and I also felt a visible syringe would make the other Pts get anxious.

I mostly had to do this when we were trying to administer anti psychotic meds in a situation in which we weren't sure if the pt would comply, nor were we sure if a "hands on" administration would be necessary.

Do any nurses on here know best practices for these types of scenarios?