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.

[Alnitak7]

In some continuing education I took years ago, they said the nurse can't even save a set up dose for a patient inside the med cart. Even if the patient's name is written on the container and they think the patient might change their mind and take it later it can't be stored in a locked cart. I did not want to debate with them. I still wondered, why if someone religiously keeps the cart locked when their back is turned, what the state board would be afraid of?

[mmc51264, BSN, MSN, RN]

i medicate one pt at a time, we have single pre-packaged doses that have to be scanned in the room. I usually put them in a med cup and then a baggie. Carry them by hand. Insulin is usually in a pt specific bin and I keep it in its labeled baggie and carry an unopened syringe to pull up in the room. Anything that has to be cosigned (insulin the biggie) has to be drawn up and verified my another nurse and they sign off on the computer. I avoid anything in my pocket so I don't end up taking it home.

[ausrnurse]

I don't mind so much if it's the original packaging on the way to draw it up (eg., a vial of antibiotic powder before reconstitution). I think carrying IV medications that have been reconstituted is an infection control risk and you are risking leakage or contamination as mentioned above. I would be seriously questioning a persons common sense if they told me they walked around with narcotics in their pocket. That is completely about covering your own backside and I would not want to be the nurse who was known for carrying a drawn up syringe of IV fentanyl in my pocket if it started going missing.

[mindlor]

It is technically against DEA regulations to carry narcs in our pockets per our director.......

[psu_213, BSN, RN]

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

For me, the meds will still be in their original unit dose packages and I can pull up the eMAR on the computer in the room on the COW (yes, I called it a COW!). No narcotics of course.

Then again, you have to have computers in the pt rooms or COWs for this to work.

[Mr. Murse]

I regularly carry meds in my pockets, it's rare that I can walk across my unit without having to do something else on the way. So I just do that instead of picking them up and setting them down all the time (which is worse than pocketing them, IMO). I have a sort of a system though. All the pockets on my scrubs are designated for different things. I have two pockets on both my pant legs and the two on my left leg are designated for meds. I never carry more than two patient's meds at once (and only one's if they have a lot) and of course I always double check everything once I get in the room. I also try to minimize the amount of time I carry them and always go straight to the room if possible.

Also if at all possible I try not to put narcs in my pocket unless something urgent happens that I need my hands for while I'm on my way to administer them.

As for people worrying about mixing meds......if you're careful about not putting more than one person's meds in the same pocket you pretty much eliminate this problem. Then on top of that most hospitals now days have MARs with scanning systems that require meds to be scanned, which further reduces the margin for error. Not to mention you should recheck your meds anyway before you give them regardless of whether they've been in your pocket or not.......

[calivianya, BSN, RN]

I carry meds in my pocket a lot because I'm often bringing other things into the room, like the cup of water, cup of ice, and soda the patient asked for. It just seems silly to say I should have to carry things and risk dropping meds everywhere just because... pockets are bad? I don't get what the deal is about carrying meds in a pocket. We scan all our meds in the room anyway, so it's not like I could open the meds somewhere else, discard the packaging, and just bring the meds. I wouldn't be able to scan them if I did that.

Do all these nurses have supervisors frisking the nurses during the shift to see if they're carrying meds in their pockets or something? I really fail to see how this is a problem at all. What exactly is the difference in carrying a med in your pocket vs. your hand other than the fact that you might get lint on the packaging?

[NicuGal, MSN, RN]

I have done this taking our kids for MRI or IR. Their Pyxis doesn't have our dilution of narcs. We typically take a vial of Versed and 3 syringes of Fentanyl. We put them in a biohazard bag and carry them in our pocket. When we get back we waste what we haven't used. No way would I leave narcs in the bed I am

not near, better on my person

where I can keep tabs on them.

[K+MgSO4, BSN]

a much safer option than a pocket! Sharps Caddy « PD Medical

[EmergencyRN22]

I do very, very rarely and never anything that needs a witness waste. However, I do carry flushes in my coat pocket.

If my hands are full, I may place Tylenol in my pocket IN the original package. I NEVER carry meds for more than one patient anywhere on my body.

I ALWAYS do a full body pat down at my locker before leaving.

[Overland1, RN]

Waste the unused medication ASAP. The cost of the medication is likely less than the container/vial it came in, and most are "commodity items" with costs so low, it would surprise most folks. The difference in cost between a "10" of Morphine and a "2" of Morphine is negligible.

As one poster mentioned, what if you keep the narc in your pocket and the vial/syringe leaks? Good luck with that one (saw that happen with an EMT a few years ago, and there was hell to pay for her).

If you have to "pre-draw" a medication in the med room, it must be labeled with patient name and room number, name and amount of the med, dates (draw/mix and expiration), and special info (i.e., must be kept cool). Slight exceptions would include a "code", in which case somebody breaks open the crash cart and the med tray.

[psu_213, BSN, RN]

I do very, very rarely and never anything that needs a witness waste. However, I do carry flushes in my coat pocket.

The only time this happens for me is when I pull it from the Pyxis, take it into the room and the patient says "I really need to go to the bathroom first" (or they are in X-ray, etc.).

If stuff goes in my pocket (narc or otherwise), it must be in its original package.