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Discussion

need feedback on med problem

I had this pt. who became extremely psychotic. The Dr. phone ordered a med for the pt. There was another nurse (LVN) and myself (charge RN) working. The LVN told me the med. could not be overrided in the PYXIS. As the pharmacy person was leaving the unit, I asked them if they could overrided the med for the pt. The person nodded their head no and had the door open to leave. I said outloud "I'll call ***** (the supervisor) to come and override the med. (one of the job requirements of the sup.) When the pharm person heard me say this, they closed the door and came back into the unit and started talking to the LVN as I started to talk to the sup. The pharm person then starts scolding me loudly about calling the sup. I put my hand over the phone and loudly pointed out that they said no and also the urgency of the med for this pt. This pharm person tells me they were not talking to me, they were talking to ****(LCN. So, I talk the sup. and told them what happened and during my conversation, I see the pharm tech entering the med. room (to ovveride for the med.). While the pharm was in medroom, I am tellling the sup. about the urgency of the med, pharm saying no, raising their voice when they heard me calling the sup. I then let the sup. go b/c the pharm person came out with the med. Later in the shift, I spoke tot the LVN about it. The LVN just basically told me it was a very tense situation and basically blow it off. I spoke to the sup. later and told them the conversation b/t the LVN and myself and I agreed with the LVN about blowing it off and chalking it up as just a tense situation. Should I report this to my manager?

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    Did the pharm person mean he couldn't or wouldn't override the Pyxis? Was it impossible or against policy for him to override it or did he just not feel like it? This makes a difference.

    Where did the tenseness of the situation come from? From him worrying about the supervisor getting involved and him getting into trouble from it? From the loud voices talking about it in front of everyone?

    You told the supervisor. The LVN knows. What would you want to accomplish from telling the manager?

    I think it's more productive if you just try to talk to the pharm tech about it and straighten things out with him rather than getting more people involved. You got the Pixis overridden and would have gotten the supervisor to do it if the tech hadn't. It sounds like a personality clash, and it's always good to try to work through those things yourself before involving the boss.

    I would write about it and keep it for my own records, though, in case you aren't able to work through it with the tech, or if things escalate.

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    I agree with Whispera.

    It doesn't sound like you've had a direct, productive conversation with the pharm tech about the situation. Use those therapeutic communication techniques :)

    "Help me understand..."

    Start with something none threatening ...

    I'm not used to needing this med from the pyxis is there a way for me to override it? if I need it in the future should i call the tech on duty or the pharmacist? That way he or she has to declare how to handle it.

    Their supervisor knows of the situation if it becomes a repeated issue I would let your manager know so they can handle it manager to manager.

    On a side note, it doesn't seem very useful to have meds in the pyxis the nurse can't access. Especially if they're emergency meds. Maybe that should be addressed with the manager. :)

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    • Experts

    Let it go, MollNick. You've established your position of power and the Tech aquiesed to your request. Bringing more attention to the situation will bode no good.

    I established this ground rule with my Supervisor upon my hiring: I will attempt to resolve any sort of conflict with a Co-Worker at the time of its occurrence. If my Co-Worker and I cannot resolve the situation, you will be informed.

    Dave

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    This sounds like some major communication problems. Teamwork?? What was the rush to call the sup.? Why did the pharm. say no? I would worry more about working together and find out the reason for the initial refusal. I do not believe calling the manager would help matters. First, try to resolve the matter, as you can work together in the future. Isn't that a goal to work together as a team to benefit patients? I would try to have a meeting with those involved and try to resolve it among yourselves.

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    • Experts
    I agree with Whispera.

    It doesn't sound like you've had a direct, productive conversation with the pharm tech about the situation. Use those therapeutic communication techniques :)

    "Help me understand..."

    Start with something none threatening ...

    I'm not used to needing this med from the pyxis is there a way for me to override it? if I need it in the future should i call the tech on duty or the pharmacist? That way he or she has to declare how to handle it.

    Their supervisor knows of the situation if it becomes a repeated issue I would let your manager know so they can handle it manager to manager.

    On a side note, it doesn't seem very useful to have meds in the pyxis the nurse can't access. Especially if they're emergency meds. Maybe that should be addressed with the manager. :)

    Honestly, when you have an extremely psychotic patient about about to hurt themselves or someone else, you don't always have the luxury of going the therapeutic "Now help me understand..." route. Psychotic patients can do a lot of harm in a little time...and perhaps the pharm tech, who probably isn't on the units on a regular basis, doesn't understand that. If I'm screaming for Haldol IM NOW, trust me in that there's a damn good reason there, and a power struggle with pharmacy is not it.

    That being said, I do agree that this matter should be addressed--therapeutically--with the pharm tech at a better time and place. Conflicts should be worked out. Whether you apologize is up to you...I would at least say that I was sorry if the tech thought I was being rude but explain the reason why (i.e., the escalating patient). Point being, there has to be some provision for nurses to get to meds in an urgent situation especially if Pyxis can't be accessed or overridden. Each of the units I worked on in my last facility had an emergency stash of non-Pyxis meds issued by pharmacy for just such a reason. Perhaps that's something your facility may consider.

    I wouldn't bring it up any higher in the chain of command--the supervisor knows and if they want to take it further they can do that on their own; you don't need to be doing it. But I agree with previous posters: document it so you have your own record should there be similar future incidents.

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