Medications NOT being scanned?!?!?

[scmelendez1]

Does anyone (or has anyone) ever worked in a facility or just a particular area of a hospital that does not scan medications before administering?

I mean: pulling meds from the Pyxis and then going directly to administer to the patient to administer without scanning wristband nor the actual medication in the patient room.

Any thoughts about working at a place that does this as an accepted practice on a daily basis?

Thanks!

[quiltynurse56, LPN, LVN]

In the not so distant past, this was normal. I don't know if it is a common practice or not. You do have to follow the 5 rights of medication administration as well as triple checking when you pull the medicine. Ask for name and birthday to verify the person is the person that gets that med.

Triple check:

When you pull the med out

When you close the pyxis

When administrating to patient

5 Rights:

Right medication

Right patient

Right dose

Right time

Right route.

[akulahawkRN, ADN, RN, EMT-P]

I worked for a facility that, until very recently, did not scan medications prior to administration. In fact, they weren't scanned at all. There was no provision for it. They have since added the ability to scan medications and most meds are scanned. Some medications won't scan or aren't "as ordered" so you have to do things manually. Otherwise it wasn't bad at all. Where I'm at now, they prefer that all meds are scanned prior to administration. Only in a very limited set of circumstances will I NOT scan a med before administration, and that's primarily those occasions when I have no mobile computer nor do I have a working computer and scanner in the room at the time. I generally prefer to scan all the meds because this system does catch instances where you're going to administer a medication to the wrong patient. Where I'm at now we use an OmniCell (same general ideas a Pyxis) and I'll pull meds from there for ONE patient at a time. While it's more efficient to pull meds for multiple patients, it's far easier to give the wrong med to the wrong patient. Scanning all meds will help you catch this but I prefer to ensure that there's no way for this to happen. Pull meds for ONE patient at a time.

[RainMom]

Surgery--- pre-op, OR, PACU, post-op (outpt discharge). Ratio is typically 1:1.

[Rose_Queen, BSN, MSN, RN]

Most units in my facility scan meds. Mine does not. I work in the OR- I only have 1 patient, and the armband that is supposed to be scanned is under the surgical drapes. Plus, I never have orders placed for meds I use- they are part of our surgeon preference cards, and my manual entry of the drugs is what creates the orders that the physician signs off on after breaking scrub. Of the very few errors that have occurred, it is usually a medication on the sterile field that wasn't labeled (policy violation and extremely poor practice) or a surgeon who didn't tell anyone he/she wanted something different than what was on the preference card.

Besides, this used to be the norm everywhere and likely still is the norm in many places. Technology is only a tool- it cannot replace the clinical judgement of a nurse. It's still not foolproof.

[scmelendez1]

Thanks for replying. I'm only a second year nurse and all I know and have been taught has been scanning pt wristband and meds at bedside. It's probably BEST PRACTICE to do so but it appears that it's still not a universal requirement/practice. I agree that we must go through all the RIGHTS each and every time despite the tools we have available to avoid med errors.

It was just surprising to me that an ER at a very busy trauma hospital still has not implemented that requirement. Of course there are situations in the ER that scanning meds isn't feasible due to time contraints but that is not always the case.

Thanks again for responding to this concern!

[Penelope_Pitstop, BSN, RN]

I've been a nurse for 11 years and I remember how huge a transition it was for us to switch to scanning and whatnot in 2008. The ED (level 1 trauma facility - 1000 bed teaching) didn't switch to electronic until...2011?

Outside of acute care, there are nurses who work in areas wherein scanning meds just isn't feasible. Any community setting and most psych settings, for example.

Do your checks, know your rights, et al.

The scanner is NOT the nurse.

[RNrhythm, BSN, RN]

My former LTAC, which I left a few months ago, did not use scanners. No Pyxis, either. It was a national corporation and our computer system was in-house and very primitive.

It was not unusual to see a nurse hurriedly charting all her meds at the end of her shift. If you were covering for someone's break, you would have to check with the primary nurse before you gave anything.

It was not unusual to get a patient that had been Q4 for pain meds for the past month, yet nothing was charted for the previous shift. I would go check the paper narcotics log. If that nurse was coming back, I would jot down the times and let them know what they needed to retroactively chart when I saw them in report. If they were off the next day, then it was the pharmacy's problem and a month later they would leave her a note and a copy of the narcotics log.

It was not unusual to give a med and then find out the order had changed or had expired an hour before.

I don't miss those days!

[bgxyrnf, MSN, RN]

One ED with which I'm affiliated still doesn't scan meds. They say it's coming but still not there as of this writing.

Another ED with which I'm affiliated are hard-a$$es about scanning. Beyond that, they require a second nurse to "countersign" in the eMAR for high-risk meds which can be ridiculous. Picture an unstable septic patient on whom you've started a norepi drip and titrating aggressively... and the computer demands that you go find a second nurse to sign-off on each rate change. Beyond impractical

[Daisy4RN]

I remember 'back in the day' when we didn't have to get meds out of the Pyxis OR scan the med, OR scan the patient, ah the good old days, just a nurse using her/his mind with no extra work/pain in the ...