Nurses don't do their 3 med checks?

[OsceanSN2018]

I've been to two higher acutity clinical sites so far on a med-surge/oncology floor and a cardiac observation unit (step-down CCU), and some of the nurses seem to not do their three medication administration checks. I didn't give it much thought until my second clinical rotation and now I'm wondering if this is considered "normal" for some nurses? For instance, I shadowed a charge nurse in the CCU and she would just open up the patient records on the EMR then take medication out of the pyxis without even reading the labels on them. I asked her why don't she read the labels and she said that she been doing this for a long time and know how each medication package looks like... So then went to each of our patient rooms and gave the medication to them without asking for their name/DOB. She just scanned their bracelet and administered the medication without telling the patient about the meds. Plus, she made me administer heparin in an insulin needle saying it's "fine".

She is not the only nurse who I've have seen not doing their 3 med checks, and I wonder if this could become a problem?

[Crush]

I never ever have time for a med error and always have time to triple and sometime quadruple check. I have been a nurse a long time and still can't stress how dangerous it is to bypass any safety checks in providing safe, quality patient care. I know where I work, we all triple check our meds. I would say that is not and should not be the norm.

[Susie2310]

And medical errors have been shown to be the third leading cause of death in the US.

[Crush]

And medical errors have been shown to be the third leading cause of death in the US.

exactly. Safety checks are there for a reason.

[BrandonLPN, LPN]

Taking medication out of the Pyxis without even looking at the label is bizarre. How much time did that really save? One second? I've done Med Passes from Hell, fifty patients on evening shift, and I've never poured a pill without glancing at the name/dose. That's crazy.

But to play the devil's advocate re: not asking the patient's name and DOB..... I don't think that makes her a bad nurse.

But then, I come from LTC, where there:

A. Is no Pyxis

B. Is no scanning

C. Are no wrist bands

D. Most of the residents would be justifiably annoyed if nurses asked them that a dozen times a day every day for years on end

[OsceanSN2018]

Taking medication out of the Pyxis without even looking at the label is bizarre. How much time did that really save? One second? I've done Med Passes from Hell, fifty patients on evening shift, and I've never poured a pill without glancing at the name/dose. That's crazy.

But to play the devil's advocate re: not asking the patient's name and DOB..... I don't think that makes her a bad nurse.

But then, I come from LTC, where there:

A. Is no Pyxis

B. Is no scanning

C. Are no wrist bands

D. Most of the residents would be justifiably annoyed if nurses asked them that a dozen times a day every day for years on end

Yeah, I thought it was completely bizzare too, especially being just a student. I kid you not, she just started grabing meds out the pyxis drawer very quick and then put them on the counter to put them in the cup or draw them up. Not once did she look at them labels. And she even told me what packaging to look out for when taking meds out the pyxis, which I took as her "teaching" me to be good as her.

[Sour Lemon]

You are there to learn, not to teach. Focus on improving your own practice, not picking apart what actual nurses are doing. There's nothing worse than a know it all student.

[OsceanSN2018]

You are there to learn, not to teach. Focus on improving your own practice, not picking apart what actual nurses are doing. There's nothing worse than a know it all student.

I was not teaching anything to the charge nurse as I was just shadowing her. Plus, I did all what she wanted me to do. And you are very rude. I guess the saying is true that nurses do eat their young...

[nursej22, MSN, RN]

Yeah, not a safe practice for you to adopt. I've seen the wrong meds /doses come out of PYXIS and the wrong name tag on people.

But you won't do yourself any favors to point that out. That being said, when you get familiar with meds, you can do your checks pretty quick: as you pull, as you scan, as you pour.

[OsceanSN2018]

Yeah, not a safe practice for you to adopt. I've seen the wrong meds /doses come out of PYXIS and the wrong name tag on people.

But you won't do yourself any favors to point that out. That being said, when you get familiar with meds, you can do your checks pretty quick: as you pull, as you scan, as you pour.

I understand. But I didn't point it out to anyone on the floor or my clinical instructor... Plus, I did not know that this can be common practice.

[Crush]

I think coming here and asking is a good thing. It is how we learn and grow. Some answers we will like and others we may not. But there might be something to be learned from all answers. You get response from all kinds of settings, experiences, etc and that is so cool.

[OldDude]

I have to admit the EMR is an additional level for med admin safety. But not looking at the label is pretty bizarre. I did run across a situation recently at Urgent Care where prefilled syringes of liquid Benadryl and Prednisone were mixed together in the same bin.