Pulling meds early?

[snizzlenort]

I work in PACU, and frequently have been pulling meds before or very shortly after a patient lands. Generally, I pull oxycodone, acetaminophen, dilaudid, fentanyl, and zofran for almost every patient. If it's ordered or I think I'm likely to need it, I'll also pull reglan, scopalomine, and / or toradol. I find that having these meds at the bedside makes it much easier to immediately respond to patient reports of pain or nausea, and it doesn't violate any policies. I know a lot of Endoscopy and procedure nurses pull up meds they expect to use during as case, but I wonder if anyone in recovery uses a similar method to streamline care.

edit, to address some of the comments: I have an order for the drugs, and I find that I use at least a portion (25 - 50 mcg fentanyl and 0.2 - 0.4 mg dilaudid in most patients) of the narcotics in 95% of the cases. We don't need a witness to return zofran, so that isn't an issue. Oxycodone and APAP are the typical discharge prescriptions, and we frequently start those right before the patients leave. The policies don't prohibit this; I've read them multiple times.

[Princessachula5]

What if you loose those medication..the ones you can loose your license for??

[RNKPCE]

Not a PACU nurse but at our hospital if you pull a med the clock starts ticking, not sure if this is just for narcs. If you haven't administered in 30 minutes it is considered overdue in our EMR. Management can run reports on overdue meds and doesn't look good if you are always late, especially on narcs. We also can't return meds once checked out so even if they aren't opened we have to waste so that is $$$$

[ArtClassRN, ADN, RN]

Just make sure the books are cooked.

[Been there,done that, ASN, RN]

They do give analgesics and anti emetics, but patients sometimes have pain or PONV regardless. Hypertension is rarely an issue, and generally speaking, our anesthesia department does a great job. Some patients have a history of chronic pain, so they need more opioids, and sometimes no matter how good the anesthesiologist/CRNA is, people wake up in pain from surgeries. My goal is to be proactive and efficient in treating whatever complaints they have.

What does your management say about that goal? If they agree to this practice, you may be okay.

Having narcs laying around is not a good idea. The patient may be in pain for the time it takes you to obtain the med, really how long is that?

I am a HUGE pain management advocate. Sticking your neck out like this is NOT worth it.