Meds in unlabeled bags... Is it safe?

Nurses Medications

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Would y'all have any problem storing meds for your patients in your WOW with no identifying features except for a room number? Our new charge nurse has started gathering our AM meds- which is really helpful & saves time, but he won't put anything other than the pt's room number on the stocked baggies (I included a pic). Sometimes he gets meds and room numbers mixed up, which hasn't been an issue for me because I use the computer/barcode scanner to administer all my meds, but makes me worried for others (however if they don't bother to scan their meds, a pt's name on the bag probably wouldn't make a difference)

He said he doesn't want labels on the bags because we keep all 9am meds for all 6-7 patients in our WOWs and he thinks it could cause a HIPAA violation...?? It would be really difficult for anyone not standing directly at the WOW to see anyone else's names on the labels.

Am I just anal & want everything labeled appropriately or is it a legitimate safety concern?

Specializes in Oncology, Palliative Care.
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RN/EMT-P

He's an RN, we both are.

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1. One of your bags read Xanax, can he pull a narc for a patient that is not his?

2. How do you know some of the nurses do not scan their meds before administering them to their patients ?

3. Does your WOW have draws?

4. How many patients do you have and what type of floor is it?

5. Do you have the same charge nurse everyday?

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When I worked the floor - one hospital we pulled our AM meds (all meds really) from the floor's pyxis. You had to be creative with your timing when for them or you wasted time standing in line. Another hospital sent all the blister packets a patient was scheduled to get that day in an envelope which was stored in a locked box outside the patient's room. RNs and LPNs had a key. All you had to do was grab IV meds from the med room or pull narcotics, other controlled substances or medications added/changed but kept in the floor's pyxis but most of your meds were ready for you. You just had to sort through the envelope and scan the meds that matched the orders for administration. You still had to do your checks (applicable vitals, patient identifiers, etc), and I double checked the system, but it was a wonderful system.

To answer the question, I would have no problem with pulling and storing meds in baggies/envelopes etc that were kept in a locked location. I would not be okay pulling things that need refrigerated or narcotics/other controlled substances for more than one patient at a time. I don't see the issue if you are checking and/or double checking appropriately.

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Specializes in MICU, SICU, CICU.

Does he withdraw any of these meds from the pyxis?

How are patients credited for unused meds if they are not labeled with a pharmacy label?

Have there been any "missing medications?"

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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.

Because of our beloved HIPAA.

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What does he do about controlled's?

Also, suppose a pt has changed rooms? And a different pt is now in 403A.

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

It's more of this: many times I have found the incorrect beds in the incorrect bins in our Pyxis. I do not trust every charge nurse that I work with to check every single med after they pull it out to make sure they grabbed it from the bin (sadly), which means if it is incorrect then I have to go back to the Pyxis anyway. Also, many of the meds I give are IVP so if we are referring to someone else drawing them up and labeling them for me to give, that ain't happening.

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Didn't have time to read all the comments but...Do these med pulls include any controlled substances? Benzos, Narcotics? If so I would have a huge issue with this. Even if not, our policy says only have one persons meds pulled at any one time and no meds in the wow, but we only have one drawer for syringes, flushes, etc.

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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?

RE: Narcotics-

TJC is not who you should be worried about. Your BON and the DEA is who you should be worried about. As soon as you take a narcotic and put it into a baggie, it becomes diversion. That narcotic needs to stay within your sight/control at all times. Believe it or not, you can be charged with trafficking.

As far as the other meds, you are breaking so many of your hospital's established policies and procedures that you are considered negligent. If they have a Pyxis, then they are most certain to have established a protocol (P&P) in which only one patient's meds are to be pulled at any given time. Those meds are to be immediately given to said patient after the rights have been verified and the meds have been scanned.

Actually, there are so many things wrong with this scenario, that I would seriously advise you to stop this practice immediately and (if asked why) explain the reasoning to your supervisor .

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Specializes in Oncology, Palliative Care.
RE: Narcotics-

TJC is not who you should be worried about. Your BON and the DEA is who you should be worried about. As soon as you take a narcotic and put it into a baggie, it becomes diversion. That narcotic needs to stay within your sight/control at all times. Believe it or not, you can be charged with trafficking.

As far as the other meds, you are breaking so many of your hospital's established policies and procedures that you are considered negligent. If they have a Pyxis, then they are most certain to have established a protocol (P&P) in which only one patient's meds are to be pulled at any given time. Those meds are to be immediately given to said patient after the rights have been verified and the meds have been scanned.

Actually, there are so many things wrong with this scenario, that I would seriously advise you to stop this practice immediately and (if asked why) explain the reasoning to your supervisor .

NO narcotics are being pulled early... Nothing is being pulled from the Pyxis early. He is only separating the 9am meds from the rest of the meds sent for a particular patient from pharmacy, he's just not labeling the bags in which he puts the 9am meds.

I've spoken with him 3 separate times asking him to either not get my meds together or to leave the pharmacy stickers on the bags the meds are sent in. It really can be a huge time saver when someone gets the meds together, but all of the other charge nurses leave keep the pharmacy labels on the bags.

I kind of wonder if he's doing it to be more passive aggressive than anything at this point, which is a management issue I'll have to take up the chain of command.

I'm so appreciative of y'alls advice!! Thank you!

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How about this...

Ignore his bags. Put in return bin.

Pull your own meds just like you're going about your business.

This is in accordance with "what you allow, you encourage."

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Specializes in Oncology, Palliative Care.
How about this...

Ignore his bags. Put in return bin.

Pull your own meds just like you're going about your business.

This is in accordance with "what you allow, you encourage."

To clarify, he's not pulling anything from the Pyxis, only from the patient's envelope of meds that is sent from pharmacy- & they only send exactly what is needed.

He pulls them before the start of shift while we are getting report. He did not pull my meds today, so maybe I finally made myself clear yesterday after the 3rd time talking about it with him. We'll see!

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