Med carts with no drawers

  1. Long time reader, first time poster. So I need some advice. Our facility is switching out our computer+scanner+med carts, from huge, heavy, hard to push things with several drawers each (for separating patient meds into 6 drawers plus a larger supply drawer for primary and secondary IV tubing, alcohol wipes, labels, syringes, needles, filter needles, medicine cups, 2x2s, stopcocks, curos for peripheral IVs and central lines, etc).... to these really light computers with scanners. But no drawers. Word of mouth from our director (I need to check if policy has changed or has no mention) is to go back to med room for each patient compared to previously loading up according to the eMAR, and returning for only as needed extras or insulins, another IV bag, etc. With 6-7 patients receiving oral meds, IV antibiotics, IV bags, and pain/nausea meds PRN, we are not too sure how that's going to affect workload. And safety for all.

    And ignoring that part, how to keep the meds safe? We are a medsurg floor in a big hospital, so meds are in single dose packets. But without a drawer, they just sit on the flat top of the workstation. In perfect world, fine. But they're going to roll or slip off. And we can't be with them from med room to administering in patient room 100%. What do we do if a family member approaches as asks for water, or an emesis basin for another patient while we are in the hallway? Or what if I am in a patient room with them and family, and they ask to go to the restroom? How can I help the patient while leaving the meds exposed on the cart, opened or unopened? What if there's a narcotic? What if I am drawing vial or preparing to give an oral narcotic or patch like Fentanyl and a bed alarm goes on down the hall? Before, we could drop in a drawer, push to automatically lock, and scramble to find patient before they fell. I can't leave it on top, can't be like "here take this!" and wait, nor shove it in my pocket, or waste time taking the cart when we keep our patients safe by literally running to a bed alarm (which isn't going to help since it's loose on top, or open in a cup if I got that far).

    Besides writing to our director laying out some of these concerns, and finding one article to print out about workflow with carts that have lockable drawers or none concerning going back and forth, what can we do in the meantime? Oh yeah, the carts have an open basket near the floor we have some few supplies in ziplock bags, but a lot less than before, so we'll still have to make extra trips to med/supply room even then.
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    About Astral Walker

    Joined: Sep '18; Posts: 7; Likes: 5

    23 Comments

  3. by   JKL33
    Quote from Astral Walker
    And we can't be with them from med room to administering in patient room 100%.
    My guess is that this is about to change. It will have to and you should make sure that it does, since you will no longer have a means of securing the medication.

    I haven't seen a med cart on a regular hospital floor in years, so maybe others who are doing things the way your place does will chime in. In places I'm familiar with, going back and forth to the med room/dispensing machine patient by patient is exactly what is done.

    DO NOT leave meds unattended for bed alarms or someone's water refill or anything other than a code blue level emergency. Just don't do it.

    Word of wisdom: You are not going to change what has been decided by any rationale you can possibly give. The only thing you can do is follow the new procedure. Your words of alarm and concern will be taken as a sign that you are averse to change. And the truth is, some of your concern is likely for nothing. It'll be okay. As far as I can tell your new method will be what everyone else has been doing as long as I've been a nurse.
  4. by   beekee
    We don't use med carts in the hospital I work at. We get the meds from the Pyxis and scan using a computer in the room. As for supplies, I plan ahead. If I'm hanging an IV, I bring tubing, curios, and a flush. If I'm giving an IM injection, I grab a syringe, alcohol wipe, etc. We have locked drawers in the patients' rooms, where we keep things like inhalers and insulin pens. We usually keep a stash diabetes supplies in the drawer too, if needed. Yup, you'll need to go back and forth for PRNs. It's not too bad. You'll learn to be more proactive.

    If you are in the room and the patient asks to use the restroom, hopefully there's a locked drawer you can throw stuff in if needed. If not, definitely suggest it to your manager.

    As for bed alarms, I don't get them if I'm pulling or administering meds. Maybe that's a bad attitude, but I can only do so much. If the alarm is going off for a long time, I might put the meds in a locked drawer and check it out. But, if I'm with a patient, I try to be with that patient. I can't be everywhere.

    If a family asks for something in the hall, I tell them I'm busy right now but I will be back in 10 minutes to address their concerns. If it's an emergency, then yeah, the meds are going in my pocket.

    This change will take some getting use to, but it's totally doable. Good riddance to the heavy carts!
  5. by   mtmkjr
    I feel the frustration as well.

    We haven't used med carts in ages. But the last WOW we used had 2 small drawers beneath the area where the keyboard was. you could keep each patient's meds locked and off of the top of the cart while doing your med pass. The drawers were handy for a few supplies like flushes, insulin syringes, dressing change supplies, you name it. They didn't hold much, and you cleared it out before the next shift.

    Then back in the Spring, the hospital replaced all the WOWs. The new carts have NO drawers. There is a basket on the back side. Several tables that pull out and one little bowl that swings out from beneath where a little mouse table/pad is positioned.

    We do not have locked drawers in the patient rooms.

    I don't know what the powers that be were thinking with this change! There is no way to secure meds, needles, syringes... Even if I only have what I need for the current patient, there is a chance I have to leave the WOW for sudden urgent needs. I DO answer bed alarms because we are hyper-focused on falls while at the same time losing all options for reasonable restraints. (for example, beds cannot have 4 railings up without a physician's order - If an alarm goes off that person might be halfway out of bed).
    When I have to leave my cart, I sometimes stuff the meds into the little bowl that can be swung out of sight, but it doesn't close all the way.

    We haven't been given a reason for why these completely open carts were chosen. The only thing I can think of why they would choose drawerless carts is that maybe there were nurses pulling meds for more than one patients, or certain items being left in the carts that shouldn't have been there. But that could have been addressed in other ways.
  6. by   MunoRN
    I've never seen a med cart where you can load it up with multiple patient's meds in a hospital setting, typically you have to go to the Pyxis and pull meds for patients individually, so it would seem unlikely that you'll find any sort of evidence to bring to your manager that what you're being asked to do is outside the normal. In addition, surveyors will often frown on any system where nurses are routinely pulling meds for multiple patients simultaneously for multiple patients, even if they are then separating them on a cart.
  7. by   mtmkjr
    delete double post
  8. by   mtmkjr
    Quote from MunoRN
    I've never seen a med cart where you can load it up with multiple patient's meds in a hospital setting, typically you have to go to the Pyxis and pull meds for patients individually, so it would seem unlikely that you'll find any sort of evidence to bring to your manager that what you're being asked to do is outside the normal. In addition, surveyors will often frown on any system where nurses are routinely pulling meds for multiple patients simultaneously for multiple patients, even if they are then separating them on a cart.
    You probably meant this for OP, but my post is unclear on this. To clarify ... with both the old WOWs and the new WOWs, the policy is the same. You may only pull meds for one patient at a time.
    I would pull meds for my patient but keep them in the drawer below the keyboard. as I scanned them I would put them on top at the moment I was to be giving them.
    Now my workspace is much more limited because everything has to sit on the top.
  9. by   Astral Walker
    Quote from JKL33
    DO NOT leave meds unattended for bed alarms or someone's water refill or anything other than a code blue level emergency. Just don't do it.

    Word of wisdom: You are not going to change what has been decided by any rationale you can possibly give. The only thing you can do is follow the new procedure. Your words of alarm and concern will be taken as a sign that you are averse to change. And the truth is, some of your concern is likely for nothing. It'll be okay. As far as I can tell your new method will be what everyone else has been doing as long as I've been a nurse.
    So it becomes OK to pocket meds in case of a Code Blue? I should remind you this is med surg, so we do have occasional Rapid Responses and Code Blues. Tonight I had to leave meds on the WoW in a room UNSECURED because I heard someone's pulse ox go off. Thankfully it was simvastatin and a BP med, and the patient was bed bound, so wouldn't have been able to grab them or anything. lt seems to me from reading other notes that the majority of other carts have at least ONE lockable drawer for emergencies. Maybe that's what I should mention to my director, if we can get just the one added instead of the basket that is pretty useless otherwise (i saw another nurse's med cart drop the IV tubing since it slipped through the bars).
  10. by   morte
    Quote from JKL33
    My guess is that this is about to change. It will have to and you should make sure that it does, since you will no longer have a means of securing the medication.

    I haven't seen a med cart on a regular hospital floor in years, so maybe others who are doing things the way your place does will chime in. In places I'm familiar with, going back and forth to the med room/dispensing machine patient by patient is exactly what is done.

    DO NOT leave meds unattended for bed alarms or someone's water refill or anything other than a code blue level emergency. Just don't do it.

    Word of wisdom: You are not going to change what has been decided by any rationale you can possibly give. The only thing you can do is follow the new procedure. Your words of alarm and concern will be taken as a sign that you are averse to change. And the truth is, some of your concern is likely for nothing. It'll be okay. As far as I can tell your new method will be what everyone else has been doing as long as I've been a nurse.
    did you miss the part about not being in individual packaging/
  11. by   Astral Walker
    Quote from beekee
    We don't use med carts in the hospital I work at. We get the meds from the Pyxis and scan using a computer in the room. As for supplies, I plan ahead. If I'm hanging an IV, I bring tubing, curios, and a flush. If I'm giving an IM injection, I grab a syringe, alcohol wipe, etc. We have locked drawers in the patients' rooms, where we keep things like inhalers and insulin pens. We usually keep a stash diabetes supplies in the drawer too, if needed. Yup, you'll need to go back and forth for PRNs. It's not too bad. You'll learn to be more proactive.

    If you are in the room and the patient asks to use the restroom, hopefully there's a locked drawer you can throw stuff in if needed. If not, definitely suggest it to your manager.

    As for bed alarms, I don't get them if I'm pulling or administering meds. Maybe that's a bad attitude, but I can only do so much. If the alarm is going off for a long time, I might put the meds in a locked drawer and check it out. But, if I'm with a patient, I try to be with that patient. I can't be everywhere.

    If a family asks for something in the hall, I tell them I'm busy right now but I will be back in 10 minutes to address their concerns. If it's an emergency, then yeah, the meds are going in my pocket.

    This change will take some getting use to, but it's totally doable. Good riddance to the heavy carts!
    Locked drawers in the room sounds like an option, hadn't considered it since we have no supplies in rooms other than actual wound dressings perhaps if we are doing changes and have like extra boxes of 4x4s or something that will be used up the next time we do a dressing change. Hope that sentence made sense!

    Our hospital's culture makes bed alarms like a top priority. Write ups and such. Plus, I don't want my patients to fall, or even another nurse's patient! We don't want them to open their surgical wounds, plus we get a lot of knee/hip surgeries and have had those patients fall and have to return to surgery, which is absolutely horrible. Write and peer review are something we want to avoid as well.
  12. by   morte
    follow the money...
  13. by   Astral Walker
    Quote from mtmkjr
    Then back in the Spring, the hospital replaced all the WOWs. The new carts have NO drawers. There is a basket on the back side. Several tables that pull out and one little bowl that swings out from beneath where a little mouse table/pad is positioned.

    We do not have locked drawers in the patient rooms.

    I don't know what the powers that be were thinking with this change! There is no way to secure meds, needles, syringes... Even if I only have what I need for the current patient, there is a chance I have to leave the WOW for sudden urgent needs. I DO answer bed alarms because we are hyper-focused on falls while at the same time losing all options for reasonable restraints. (for example, beds cannot have 4 railings up without a physician's order - If an alarm goes off that person might be halfway out of bed).
    I'm glad I'm not alone at not understanding the lack of thinking in the exact choice of these carts, or at least the modular feature used. We are not allowed 4 rails, even with a doctor's orders, and something like a posey wrap has to be velcroed so the patient is able to take it off (which makes it pointless for those very confused patients, alas). As I said before to someone else, I think the one lockable drawer will be all we really need. Going back and forth will be a new hassle, but at least it's not endangering our patients or our license like unsecured meds, thanks for commenting :]
  14. by   Astral Walker
    Quote from MunoRN
    I've never seen a med cart where you can load it up with multiple patient's meds in a hospital setting, typically you have to go to the Pyxis and pull meds for patients individually, so it would seem unlikely that you'll find any sort of evidence to bring to your manager that what you're being asked to do is outside the normal. In addition, surveyors will often frown on any system where nurses are routinely pulling meds for multiple patients simultaneously for multiple patients, even if they are then separating them on a cart.
    Now that I went through the policy, I see this is spelled out clearly. Still need a lockable drawer, in cart or room though I think. Hopefully we can get that. But it's a shame our patient scores are going to drop again with us being late with pain meds, but what else can we do? Most of us give pain and nausea meds to 4 out of 7 patients multiples times per shift. But if this prevents those kinds of med errors, then that's good. Do you think they'll fix our ratio too (I doubt it, but I can hope!)?

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