Meds in unlabeled bags... Is it safe?

MunoRN, RN · Sep 12, 2015

I think your new grad has gone a little HIPAA crazy, which understandably happens, but you might explain to him that HIPAA doesn't require or even encourage all patient identifiers to be removed from medications or what they are contained in.

That being said, I don't really see a serious problem since the medications themselves are remaining properly labelled in their blister packs and you are checking the medication orders, the medications, and and the patient identity prior to giving them, having them in individualized bags is just to make it easier to find the meds that you will then subject to the full administration process.

blondy2061h, MSN, RN · Sep 12, 2015

If the meds themselves are in a labelled, sealed blister pack, I don't get why you car if you're taking them out of a bag right in the locked WOW drawer or having to walk to the med room to get it. That's assuming your WOW's have locking drawers (we've trialed several brands where I work and they all do..) and that there are no controlled substances being pulled from the Pyxis. You can still do you 6 checks against the MAR and the packaging.

madwife2002, BSN, RN · Sep 12, 2015

moved to patient/med forum

danceyrun · Sep 12, 2015

I personally don't give mess that someone else has pulled unless it's in an emergency situation. To answer your question, I would have a problem with it.

blondy2061h, MSN, RN · Sep 12, 2015

I personally don't give mess that someone else has pulled unless it's in an emergency situation. To answer your question, I would have a problem with it.

You trust the pharmacy techs you probably barely know more than the charge nurses you work with?

AJJKRN · Sep 12, 2015

A Pt label should never be placed on the med baggie, hence that someone bypasses scanning a Pt armband and scans the baggie instead (high risk for wrong Pt to get the "right" meds). This should be way more of a concern than having a bunch of individually labeled medicines to sort through. If people do there meds checks consistently - the five, six, or is seven rights now - then the risk for med errors would be the same as just pulling the meds yourself.

BiohazardBetty · Sep 12, 2015

I think your new grad has gone a little HIPAA crazy, which understandably happens, but you might explain to him that HIPAA doesn't require or even encourage all patient identifiers to be removed from medications or what they are contained in.
That being said, I don't really see a serious problem since the medications themselves are remaining properly labelled in their blister packs and you are checking the medication orders, the medications, and and the patient identity prior to giving them, having them in individualized bags is just to make it easier to find the meds that you will then subject to the full administration process.

He's not a new grad :/ He's been a nurse, & even the full-in nursing supervisor, for probably 10 years or more.

I don't so much have a concern about administration as I do about storage. I don't mind that he pulls our meds, I actually really appreciate it because it can save a lot of time. What I'm worried about is walking around with medications (in their blister packs & in bags) with no designated "home" besides a room number- which I was taught is never ever considered an appropriate identifier. Especially once I put the meds from the Pyxis in them, like Xanax or Norco, if the baggies aren't labeled with a patient's name or med rec I feel like I'm just walking around with a drawer full of drugs.

Does the Joint Commission have an opinion about something like this? Could I be cited for not having medications appropriately labeled with a designated home?

BiohazardBetty · Sep 12, 2015

A Pt label should never be placed on the med baggie, hence that someone bypasses scanning a Pt armband and scans the baggie instead (high risk for wrong Pt to get the "right" meds). This should be way more of a concern than having a bunch of individually labeled medicines to sort through. If people do there meds checks consistently - the five, six, or is seven rights now - then the risk for med errors would be the same as just pulling the meds yourself.

Only the actual chart stickers would scan as the armband would. The stickers that come from pharmacy are only labeled with barcodes for the particular med that's sent in that bag, but the sticker also shows the pt's name, room number & ID number... So that's not a concern. I have put chart stickers on bags for meds that I am sending to another unit or if the patient is in the dialysis pod or something, but only to do my best to make sure the meds are labeled appropriately.

JustKeepSmiling, ADN, BSN, RN · Sep 13, 2015

This in theory sounds helpful. This in practice sounds like it has too much potential to cause a med error.

I'm too neurotic for this, I want to pull my own meds.

No narcotic should ever be hanging around in a bag or cup. Narcotics should only be pulled when needed then immediately administered or returned.

I question how this charge nurse has time to do this, and why.

I suggest you keep your guard up. And politely decline the help, give a reason if you prefer. When I look at the MAR to pull meds I'm thinking about the patient's dx and hx, making correlations. Say you want to keep that going.

emmy27 · Sep 13, 2015

I don't see how this is any more dangerous than working somewhere where meds are pulled from the pyxis rather than send up from pharmacy pre-sorted in bags or envelopes.

He's making extra work for himself, and it's goofy and has nothing to do with HIPAA (surely these meds aren't being left unattended anywhere, so it doesn't matter if they have patient identifiers on them) but you're supposed to scan the meds and cross-check the patient identifiers with the actual patient anyway, and not rely on a label on a pharmacy envelope.

If you're saying that you're pulling controlled substances from the pyxis all at once and sorting them in to the bags in advance of administering them, I would NOT do that, personally, regardless of how the bags are labelled- our TJC survey preppers have been extremely insistent that we shouldn't have narcs for more than one patient on us at a time, and shouldn't put them in to our pockets. Having a large number of waste-worthy meds out at once seems like it's setting yourself up for a potential problem or even just getting called out by management for bad practice.

BiohazardBetty · Sep 13, 2015

Does the pharmacy ever send pre-filled syringes, or reconstituted IV meds? I would be VERY concerned, and personally refuse to administer any of those with evidence of label tampering, if those had labels removed in favor of a charge RN's homemade label. Stuff like that, the only way I know what is in it is by reading the label affixed and/or verified by the PharmD. I would not be at all okay with 100 ml of NS with a handwritten label saying Zosyn 3 gm.
Individual pills in blister packs, again you still know what's in them, so that doesn't bother me so much.
But a question I do have, is if they are locked in a drawer, why the heck is the charge RN taking precious time to relabel everything? Isn't there something better he could be doing, since he has this time on his hands? Oh, like answering call lights, helping pass the meds, helping w/ treatments, helping w/ hourly rounds?
THAT, I don't get.

Sure there are lots of things he could be doing, but this is what he chooses to do & he's not one you can tell "no" :)

He's not actually removing labels from anything, he's just not using the pre-labeled bags the meds are sent from pharmacy in. He's taking the meds out of those bags, sorting the 9am meds, & putting the 9am meds into the big bags pictures in the OP, & labeling them with the room number.

Medic24 · Sep 13, 2015

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RN/EMT-P