Pre-pouring meds ... am I wrong?

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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.

OP, please get in touch with your coworkers who were there and overheard/corroborate your side of the story, take down all information as detailed as possible. You could very easily get a lawsuit in your favor, wrongful dismissal and a paid holiday until you find a better place to work. I am not sue happy, but when employers pull this kind of @#$, they deserve a kick in the shorts.

100% sure the facility has a policy against what they asked you to do, not to mention JCAHO. Your nursing board would probably be interested to learn of this, too. Anyways, for now, just CYA and see what they do. Also, be aware of retaliatory actions from them. The same all applies.

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Okay....what about the other side to this. Sometimes crap happens and you are placed in this situation. The facility should have a back up plan for missed keys. We have a few options (can you tell this has happend before) Not sure if pharmacy has keys to out cart, but I would be calling them first. I would then call the DON. (I know she has keys) I also think the maint director has them locked away some where. I've also had to call a locksmith before when I locked them inside of the cart. All of these options should at the most take 2-3 hrs.

Why couldn't you have just taken the key to the med room from the other nurse? That way only you would have had access to the room. Pour one resident at a time and then hunt them down.

No..it wasn't the best solution, but I've been in sticky situations like these and made do.

But....If you really didn't feel safe, you did the right thing

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Specializes in Nephrology, Cardiology, ER, ICU.

Agree - you did the right thing. To pre-prepare meds is not the standard of practice. Always wrong.

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Specializes in Acute Care.
Okay....what about the other side to this. Sometimes crap happens and you are placed in this situation. The facility should have a back up plan for missed keys. We have a few options (can you tell this has happend before) Not sure if pharmacy has keys to out cart, but I would be calling them first. I would then call the DON. (I know she has keys) I also think the maint director has them locked away some where. I've also had to call a locksmith before when I locked them inside of the cart. All of these options should at the most take 2-3 hrs.

Why couldn't you have just taken the key to the med room from the other nurse? That way only you would have had access to the room. Pour one resident at a time and then hunt them down.

No..it wasn't the best solution, but I've been in sticky situations like these and made do.

But....If you really didn't feel safe, you did the right thing

at all the jobs i've had, any missing keys... the off-going shift cannot leave until the keys are found.
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okay....what about the other side to this. sometimes crap happens and you are placed in this situation. the facility should have a back up plan for missed keys. we have a few options (can you tell this has happend before) not sure if pharmacy has keys to out cart, but i would be calling them first. i would then call the don. (i know she has keys) i also think the maint director has them locked away some where. i've also had to call a locksmith before when i locked them inside of the cart. all of these options should at the most take 2-3 hrs.

why couldn't you have just taken the key to the med room from the other nurse? that way only you would have had access to the room. pour one resident at a time and then hunt them down.

no..it wasn't the best solution, but i've been in sticky situations like these and made do.

but....if you really didn't feel safe, you did the right thing

do you work in ltc? 35+ residents and probably at least 2 med passes and running back and forth to the med room. nearly impossible and definitely not safe!! you did the right thing, kudos. :yeah:

i also like the idea of citing there own p&p if they try to fire you. that would be so cool to see! how would a don or administrator react to that? what could they say? what could they even do? however, this may be a sign of a bigger issue within the facility that they would allow you to do this. think about it.

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I also like the idea of citing there own P&P if they try to fire you.

I'd like to see them FIND their P&P. ;)

A lot of LTC's accept pre-pouring. In fact, after i left my first job I had to unlearn a lot of bad, unsafe habits I had developed - including pre-pouring and signing before they were given.

I would have pre-poured with names on med cups placed on top of the cups into which I poured the meds, after vitals were gathered for all of my dig and metoprolol folks, and then run around with a tray.

It's not best practice, but I don't know that leaving 35 chronically ill folks without medication is good practice, either. Stuff happens, and it isn't as if they lost the keys on purpose. Yeah, that they don't have a spare pair stinks, but they don't, and the residents still need their meds.

You technically did the right thing. I have a feeling that you're going to hang for it.

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Specializes in Acute Mental Health.

Surely, there must be more than 1 key in the place. Some higher up must have a master key. Sounds weird, but if they knew this for so many hrs, why couldn't someone go have a key made, or have the locksmith come in? I just passed my pn boards, so I may not know anything yet, but that doesn't sound safe at all. I can't imagine trying to get 2 med passes done in one shift. Kudos to you!

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I hope this works out. Please let us know what happens.

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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.

You are not wrong, the manager was. You can always get another job, but not another license. Let us know what happens.

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Okay....what about the other side to this. Sometimes crap happens and you are placed in this situation. The facility should have a back up plan for missed keys. We have a few options (can you tell this has happend before) Not sure if pharmacy has keys to out cart, but I would be calling them first. I would then call the DON. (I know she has keys) I also think the maint director has them locked away some where. I've also had to call a locksmith before when I locked them inside of the cart. All of these options should at the most take 2-3 hrs.

Why couldn't you have just taken the key to the med room from the other nurse? That way only you would have had access to the room. Pour one resident at a time and then hunt them down.

No..it wasn't the best solution, but I've been in sticky situations like these and made do.

But....If you really didn't feel safe, you did the right thing

I don't think you read her post clearly. :confused: Also, there is no way she'd ever get done by doing 1 res at a time. Plus, the trouble, as I recall, was that the narc section could not be locked. How could she keep her narcs safe?

Sorry if I misunderstood.

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did the shift before you count the narcotics

could you roll the cart into the rooms and give out these meds

they could have given you the keys to the med room even if they didn't have duplicate keys to cart

in this state pre-pouring is not allowed no matter what type of facility it is, which is not to say i haven't seen it done but it is wrong and should not be authorized by superiors

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Stand up tall - you did the right thing! :bow:

steph

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