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.

Specializes in Geriatrics, ICU, OR, PACU.

As a DON, I am sitting here wondering why the DON didn't have spare keys to the cart?! You did absolutely the right thing--when I was a charge nurse on the floor passing meds to 30 patients, I would have never accepted a cart in that situation. Pre-pouring medication is bad practice, and it would net the building a citation if a surveyor were present. Call the DON, and have a conversation with her about what SHE would do given that situation. Here's one of the tags that pre-pouring can get you:

F-281: Facility services must meet professional standards of quality (e.g., noncompliance

exists if errors in medication administration technique are identified)

I hope you have a decent DON who you can talk to professionally. YOU did the right thing.

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Specializes in OR, ER, L&D, LTC, Home Health, Peds, SNF.

Well, the weekend has come and gone. I have spoken to the DON and I told her what I was expected to do that Saturday and I strongly expressed to her how uncomfortable I felt doing it. (I am not supernurse and I never claim to be.) She stated understanding and actually spoke with the on shift supervisor and told her that she NEVER should've asked me to do that. Not sure what happened after that but I am glad that the DON understood where I was coming from. I don't know why the DON didn't come in with the spare set of keys that I now know that she had. Makes it crappy because its the pts that suffer without a proper med pass. I can only hope they all got their meds somehow that day. I just wasn't willing to put my license on the line for it.

Reading the post on the "flipside", I wouldn't be wasting my time calling everyone who might have the keys since I feel the keys should've been found or a spare set present before I got there since the incident happened on the 3-11 shift the day before. And I suppose I could've taken the keys from the other nurse and run back and forth 35+ times from the med room / pt room to do my run. But I don't think I would've been able to get all the meds out on time to each person. We have wanderers and such that makes it hard to hunt down in less than a few mins. So no I would not have been willing to do that.

But thank you ladies for your words of encouragement. I still have a job. But I'm not sure how long I plan to stay there since certain practices I don't agree with are permissable by some higher ups. I have gone back to work since this and its amazing how word travels. I'm not one for gossip so I ignore it. :)

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Wow...I diddn't read your first post that well.

I would be raising heck if that happed the previous day and if the DON wasn't notified. What a cluster....see, stuff like this is why we have a bad rep in LTC.

Good for sticking up and I hope your DON follows thru.

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Specializes in Community Health, Med-Surg, Home Health.

When I work per diem, I have a pyxis where I have to pull medications from. We can print out a medication sheet every 4 hours, which acts as our MAR. I have pre-poured for 3 patients at a time and locked them in my cart, because I can re-check again before I actually administer, but to do this for LTC is a nightmare. If you did not feel safe, then, it was better to walk out. I wonder how many other nurses have been told to clock out before your situation (and probably never returned).

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Specializes in Med/Surg.

You were absolutely correct and smart to protect your license. Pre pouring is a dangerous practice. Too much room for error. If your DON doesn't understand, too bad, it's not her license. You can find a better job and I would report them to your states division for nursing homes. Not in retaliation but because they really should know :nurse:

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