Pre-pouring meds ... am I wrong?

Vito Andolini · Aug 23, 2008

i think you probably did the right thing. I think more nurses need to do this - refuse to accept dangerous conditions and jeopardize their licenses and their livelihoolds. You might want to call first and talk to the DON and make sure the key has been found and that you are still welcome there. I'm sorry you have to deal with this nonsense. How did they suggest you keep your narcs safe? And I think pre-pouring is against policy in most places, maybe even violates JCAHO rules, CMS rules maybe. And once you had locked your cart, what if you needed to get back into it for any reason? What then? And how ridiculous that Pharmacy wouldn't give you the key for the presumably short time for someone to get a replacement key. How long was it going to take? How incompetent of Admin not to have a back-up key.

Ms. Nightingale never had to deal with stuff like this, I'm sure.

allnurses Guide · Aug 23, 2008

Well, where I work we dont' even have med carts; we have to keep going back and forth to the med room to collect our meds for each patient. However, I generally have 6 patients, not 40 or whatever. =)

Um, that in my opinion would have really been your only option, to go back and forth to the med room. Not too feasible in LTC. =)

As far as pre-pouring meds... I have in the past, gotten all of my patients' meds together in medicine cups and then put them in their drawers in their medicine carts, but they were still in their little packages. And, note I said MED CART. Um.. *scratches head* AFTER you pre-poured all of those meds, what were you supposed to do with all of the cups that you poured them into if you didn't have a cart to push around?

Sounds like an unfortunate situation all the way around. I mean, the keys got lost... the patients needed their meds... what could anyone have done? Yeah, it really sounds like the only option would have been to have the nurse, you, keep going back and forth to and from the med room to collect meds for each patient. The med pass would have taken about five hours or so. I'm not sure how else it could have been done safely though.

allnurses Guide · Aug 23, 2008

Wait, who all would have access to the med room? Where I work, anyone can get to where the meds are, but the meds are all in an omnicell. If anyone and everyone who works the floor has access to the open narcs, then I guess it is truly an unsafe situation for you. Bottom line, you aren't wrong for doing what you did.

aznqtpie · Aug 23, 2008

Only nurses have the keys to the med room. On the unit I was on, there are 4 halls, 2 nurses. So even though the other nurse had the keys to the med room, she would have to had come to open the med room everytime I needed a PRN or anything rather in that case. And Im sure she would've been happy with that. (sacrasm)

The whole key ring was lost. Med room keys, treatment cart keys, central supply...all those keys were on that ring.

And to clear any confusion, when I refer to 'pre-pouring" I am saying I was expected to pop the meds OUT of the blister packs and pre-pour the liquids into the med cups and line them up, labeled with names on them for me to pass duing the shift.

SunnyAndrsn · Aug 23, 2008

I know of nurses who pre-pour meds and keep them LOCKED in their cart. I have gotten 2-3 ppls. meds ready (one at a time), labeled them with their initials and kept them locked in my cart.

Other nurses where I work will get most of their meds ready, lock them in their cart, and then just grab and pass. I don't feel comfortable with that at all.

I work in a SNF (skilled nuring facility) in Ca and is in charge of passing meds to 35+ patients at a time. I went into work today and am told that the keys to the cart I am assigned to are missing and that they have been looking for them all night long. The night shift had called Pharmacy to come and unlock the cart but they couldn't leave the key because it was the master key. So the cart (including the narcotic box) was remained opened but locked in the med room all this time. I suppose I was expected to pass my meds with a towel drooped over the narcotic box all day long? I was ready to refuse the cart due to the inability to open/lock both the cart and narcotic box when my supervisor asks me to accept the cart anyway and told me that I can just pre-pour everyone's meds in advance and leave the cart in the med room. I have NEVER felt comfortable with this practice with one patient, let alone 35+. I told her I would not accept the cart and that my license was too important to lose if I had made a med error due to accepting it. She got sassy with me and asked me what the big deal was. I told her I am responsible for this cart and everything in it after I accept it, and with it open at all times, especially the narcotic box, it will increase errors/theft and I was not willing to do that. She asked me if I wanted to talk to the DON about it before I make any decisons and I told that I would gladly talk to my DON. A few minutes later, the supervisor calls me on the hall and tells me that if I don't want to accept the cart, that I can clock out and go home. Which is what I did.
Am I wrong for doing what I did? Is pre-pouring meds for that many (any) patients even legal? Was there any other solution that would've allowed me to perform my shift safely with the cart unlocked at all times? I don't beleive I walked out on anyone because I had not counted narcotics or received report from the nurse on the previous shift. I am scheduled tomorrow and have a knot in my stomach now wondering if I still even had a job.

medsurgrnco, BSN, RN · Aug 23, 2008

I think you did the right thing. But they should have given you a spare key to the med cart. Since they didn't have a key, the only other somewhat reasonable option I could come up with is to set up meds for part of the patients and give them using a tray to carry your meds, and repeat several times till all meds were given. You still would have to get the other nurse to let you into the med room, and would have a med cart in the med room that the other nurse could access. (I thought most nurses in SNFs prepoured meds due to the high patient loads.)

rn-jane · Aug 23, 2008

You did the right thing, too much room for error. Unless you could honestly wheel the cart inside each patient room with you. They should have a replacement cart available when these things break down. I don't like to prepour meds.

Jules A, MSN · Aug 23, 2008

Since you were not comfortable with what they proposed I absolutely would stand behind your right to refuse. I hope this works out ok for you.

Do you keep your cart in a locked med room? If so I would have just poured six or so on a tray, labeled them and given them out and then start over with the understanding from management that it was going to take longer.

If the cart couldn't have been locked in a room I probably would have done the same thing with the understanding from management that I was not responsible for the med cart contents. My thoughts would be that just being a nurse on the floor does not indicate automatic responsibility for the med cart.

DusktilDawn · Aug 24, 2008

What you were asked to do goes against accepted Standards of Practice. I don't doubt this is also against their very own policies and procedures. I think it would be awesome if you could cite their own policy and procedure and than ask why they think it appropriate that YOU violate it along with violating Standards of Practice within your state (YOU, the one who would be expected to violate that policy and Standard of Practice, the one with the license on the line). We can't pick and choose when to disregard policy and procedure and Standards of Practice.

Although the med cart with in a locked room, others still had access. Anything goes missing, who's going to get the blame?

I think you did the right thing.

RN1121 · Aug 24, 2008

You totally, without a doubt did the right thing, IMHO.

You should be proud of yourself to be able to:

1. Identify a potential safety issue dealing with the care of your residents;

2. Cared enough about it to know your rights; and

3. NOT ACCEPT an assignment you feel is unsafe.

I have done the exact same thing before. I have refused an assignment due to safety issues. You have to be reasonable when choosing to walk away. Know your rights. You of course, don't have the right to walk away from your patients. That's abandonment. But it seems you identified an issue prior to accepting an assignment.

Here, in PA, we aren't supposed to pre-pour meds on SNF; but we can pre-pour them in assisted living. It's been a little while since I've worked in direct pt care, so I'd have to double check my accuracy on that one.

Best wishes.

:yeah:

Vito Andolini · Aug 24, 2008

I think the real problem was that the narcs would have been left unlocked.

She could have rolled her cart with her wherever she went - except to potty break. Oh, but not to worry - she likely gets no potty break. :devil:

Pre-pouring - to me, this means pouring meds for med passes other than the current one you are giving out right now. This is a bad habit, as you could wind up giving a later dose now, long before it was really due. Technically, I guess it could also mean opening meds too far in advance of when you are actually going to give them. Is that right?