PIXIS and Narcotics

[needsmore$]

hi guys

just a quick question--kind of debating with pharmacy dept at my hospital

re-the pixis and returning meds

i always thought safe nursing practice was--if you remove a narcotic to administer and for whatever reason, it is not given-- it should be wasted and signed as such by 2 nurses witnessing this--even if the med was never removed from it's vial or it's carpuject tube

my pharmacy states we can return these to the external return bin. these bins are emptied weekly by a pharm tech.

now-- my dilemma. i am the last nurse to sign out this med (call it dilaudid). i never open it or crack it's seal. i return it to the return bin. pixis records that i have done this. 3 days later a pharm tech empties the bin. how do i know they don't pocket that med and then claim i never actually returned it? my word against someone else's?

am i the only one that thinks this could be a problem? my pharmacy director thinks i'm making a mountain out of a molehill.

i don't think i am. so, i am asking for your input-- how do you guys handle this in your units?

have a good weekend! thanks

[Ginger's Mom, MSN, RN]

Places I have seen have 2 nurses witness returning it to the bin. I would have issues with the process you listed.

[HonestRN]

At my hospital, a nurse has to co-sign narcotic returns. That is she has to enter her employee number and scan her finger.

[needsmore$]

Thank you-

[lvnlrn]

I'm a former pharmacy tech who used to work in a hospital that utilizes Pyxis machines, and am now in nursing school doing clinicals at that same hospital (it's been interesting getting the nurses' perspectives on everything...having to call down for missing meds, etc!).

When the pharmacy techs do the afternoon narcotics run, part of their job is to empty the return bins. However, they could not empty the return bin (or place narcs into the Pyxis inventory for that matter) without a nurse from the floor witnessing them open the return bin (or watching them place narcs into the Pyxis if refilling it). The screen will tell the nurse and tech what should be in that return bin, and both the nurse and pharm tech can verify the contents. The nurse who witnessed the emptying of the return bin also had to sign in when the return bin was being emptied, so his/her name was also in the Pyxis's "brain" as having witnessed the removal of the contents.

The techs then have to bring back the nurses' signatures from each unit that a nurse witnessed them, that everything was accurate, and nothing was missing, which was then kept on file in the pharmacy.

I think you're completely right in protecting your license. If a key is all that is needed to empty that return bin and especially if it's a box not actually located inside the Pyxis, it would be easy for whomever had that key to help themselves and then claim the drugs as never being inside when they went to empty it.

Good luck with the pharmacy...I hope they understand where you're coming from and can figure out a way to protect both you and their pharmacy techs' licenses!

[needsmore$]

Thank you for your input--I have never had a pharm tech ever ask a nurse to witness the retun bin-- emptying. Nor have I ever been prompted to have another nurse witness returning a narc to that bin

And Valium/Ativan-- our PIXIS does not prompt for a second nurse to witness those wastes either...

[I_LOVE_TRAUMA, RN]

We don't waste if not tampered with/opened. But our pixis has a return option, and when two nurses return it, it goes right back into the count and then a receipt conformation spits out.

[needsmore$]

I have never had a pharm tech ask me to witness them adding narcs to the PIXIS either-- some days there are 2 of them, other days, like today, only 1. Adding them incorrectly would certainly cause discrepancies to show up when accessed later-

I don't mind adding them back to the original bin they were removed from--but that external bin...sorry- I'd rather waste it with a witness then risk having my dept head wonder about 'missing' returns--which is what is occurring now--

people saying they're returning meds and being told that the med isn't there

Why is it always the nurse who is at fault?

[needsmore$]

But our pixis has a return option, and when two nurses return it, it goes right back into the count and then a receipt conformation spits out

This option works for me--

I'm hoping to take all these great ideas and your input back to my dept--to let them know of how others are handling this

[NotReady4PrimeTime, RN]

Our practice is as described by lvnlrn. We have to have two nurses witness any waste or return of a controlled substance. And I have been asked by the Pyxis tech to verify that s/he has removed and replaced anything from the locked return bin inside the top drawer of the main processor with me as the witness.

[cpillow]

Mountain out of a molehill.

[mwboswell]

I'm a former pharmacy tech who used to work in a hospital that utilizes Pyxis machines, and am now in nursing school doing clinicals at that same hospital (it's been interesting getting the nurses' perspectives on everything...having to call down for missing meds, etc!).

When the pharmacy techs do the afternoon narcotics run, part of their job is to empty the return bins. However, they could not empty the return bin (or place narcs into the Pyxis inventory for that matter) without a nurse from the floor witnessing them open the return bin (or watching them place narcs into the Pyxis if refilling it). The screen will tell the nurse and tech what should be in that return bin, and both the nurse and pharm tech can verify the contents. The nurse who witnessed the emptying of the return bin also had to sign in when the return bin was being emptied, so his/her name was also in the Pyxis's "brain" as having witnessed the removal of the contents.

The techs then have to bring back the nurses' signatures from each unit that a nurse witnessed them, that everything was accurate, and nothing was missing, which was then kept on file in the pharmacy.

I think you're completely right in protecting your license. If a key is all that is needed to empty that return bin and especially if it's a box not actually located inside the Pyxis, it would be easy for whomever had that key to help themselves and then claim the drugs as never being inside when they went to empty it.

Good luck with the pharmacy...I hope they understand where you're coming from and can figure out a way to protect both you and their pharmacy techs' licenses!

That's exactly how it was where i've worked with automatic dispensing stations in the past.

Sometimes (in the larger hospitals) the Pharm techs didn't get the nurse, but then there were TWO pharm techs witnessing each other emptying the bin or restocking.

There was always a double check.