Pulling Meds For Another Nurse To Pass

[Dudlydorite]

I refused to pull meds for another nurse to pass. Although the meds would of still been in the sealed package and pill bottles placed in the patients box, I refused. I cannot guarantee the other nurse passing them will verify correctly and/or administer the right med to the right patient. I see this has been done previously on all shifts and I was told, “that’s what we do so the floor nurse can do her assessments right away when shift starts”. It doesn’t matter if the meds are still sealed, I’m responsible for verifying meds for another nurse I’m supposed to trust to verify again?  No! Uh nuh! Excuse me, but I’m not going down under the bus if that nurse makes one human error. Am I wrong for refusing? I’ve never heard of such practice and have never done this in the 18 years of practice. 

[Leader25, ASN, BSN, RN]

Absolutely never. I worked once where they had the old way set up, one nurse did all meds all night long, one did vitals, besides being short staffed the shift did not get along with each other. Real nasty stuff, related to where they got their training  from. So no dot not do this.

[JenH3, ASN, BSN, MSN, EMT-B, EMT-I, APRN]

I honestly don't see the problem here. I agree you shouldn't pull controlleds and leave them.  However, the nurse administering the meds you pulled will be signed in under their own name so if there is an issue, it falls squarely on their shoulders. I will definitely pull controlled meds and hand them to another nurse if the situation warrants. I will also give meds to a patient that is not mine to help another nurse out... I can read and do my own quick assessment prior to; I would call it using my own judgement. 

Your refusal might come across to your co-workers that you are not a team player and they will probably stop helping you out when you need something. Just things to keep in mind. 

[JKL33]

4 hours ago, JenH3 said:

Your refusal might come across to your co-workers that you are not a team player and they will probably stop helping you out when you need something.

 

Well, depending on the exact circumstances the OP is talking about I might agree that pulling packaged meds for someone else is far from the most risky thing I've heard of. But environment and culture are important with regard to management support. And...

My qualm with the OP scenario is how things like this usually go. You know there will be people who do nothing but straight up administer whatever they found in the box...which was filled by someone else. And even usually-prudent people are at risk for falling into the poor practice of not carefully double-checking when they know the first check has supposedly already been done. It's just probably not the best process for safe medication administration and given the untold resources we've sunk into trying to improve medication administration safety it's nonsensical to purposely complicate the process just because it helps us get by with fewer staff on duty.

Annnnyway....Your rationale is one of the worst reasons I've ever heard for doing something. There are professional ways to voice concerns about a process and it is legitimate to do so. May the gods help patients whose nurses do things so that their work friends will play nice. Coworkers won't stop helping you unless they're emotional cripples/manipulative. Being a team player doesn't mean never having any lines drawn. There are innumerable ways to help others. Possibly the most important thing is one's spirit/intent/attitude.

[JenH3, ASN, BSN, MSN, EMT-B, EMT-I, APRN]

10 minutes ago, JKL33 said:

 

Well, depending on the exact circumstances the OP is talking about I might agree that pulling packaged meds for someone else is far from the most risky thing I've heard of. But environment and culture are important with regard to management support. And...

My qualm with the OP scenario is how things like this usually go. You know there will be people who do nothing but straight up administer whatever they found in the box...which was filled by someone else. And even usually-prudent people are at risk for falling into the poor practice of not carefully double-checking when they know the first check has supposedly already been done. It's just probably not the best process for safe medication administration and given the untold resources we've sunk into trying to improve medication administration safety it's nonsensical to purposely complicate the process just because it helps us get by with fewer staff on duty.

Annnnyway....Your rationale is one of the worst reasons I've ever heard for doing something. There are professional ways to voice concerns about a process and it is legitimate to do so. May the gods help patients whose nurses do things so that their work friends will play nice. Coworkers won't stop helping you unless they're emotional cripples/manipulative. Being a team player doesn't mean never having any lines drawn. There are innumerable ways to help others. Possibly the most important thing is one's spirit/intent/attitude.

JKL33,

You are really something else...  You completely took what I said out of context.  What I was saying is that since the indoctrination of the electronic medical record (which is a requirement for CMS reimbursement), it is much harder to make a mistake because many places are required to scan the medication barcodes under their own login credentials.  You are also implying that other nurses are inept and incompetent. I am saying that we are all nurses with the same licensing and responsible for what we do, not what someone else does.  It is illegal for anyone to pre-pop medications when they come in a multiuse card/vial/bottle but it is NOT illegal to pull individualized medications and place them in a facility-approved place (bag, box, med cart) that lists a room number as long as the medications remain in the original packaging.  So, the next time you decide to jump all over someone, please know what you are talking about better than the person you are accusing. 

 

[klone, MSN, RN]

I'm so confused by people's responses here. The OP asked about pulling medications out of Pyxis (or whatever) and LEAVING THEM IN THEIR ORIGINAL SEALED PACKAGING, for another nurse to then administer. Not pulling up meds in a syringe, or popping pills out of a blister pack and putting them in a pill cup. 

Why is this even a question?

[JKL33]

18 hours ago, JenH3 said:

it is much harder to make a mistake because many places are required to scan the medication barcodes under their own login credentials. 

 

11 hours ago, klone said:

I'm so confused by people's responses here. The OP asked about pulling medications out of Pyxis (or whatever)

There is no indication in the OP that either barcode scanning or pulling the meds from an ADC is involved here. Maybe that doesn't matter. Or maybe one or both are involved.

My thinking flows in this order:

1. Medication administration is a major area for errors and other aberrancies (diversion, etc). Our systems have evolved in ways that try to improve upon these errors and other problems. It is fair to say that a great deal of energy and money have been expended in this effort.

2. This is literally doubling/repeating an error-prone process and making two RNs separately responsible for a single task, one of whom who has no control over the final outcome. This is being done because otherwise "the" nurse on the floor will not have time to perform all of his/her assigned work.

3. I believe that if the person who completes the first part of this process (but, by design, not the second/final portion) makes an error and it moves through to the patient, s/he will be involved in whatever aftermath ensues. It won't be seen as a time-saving favor at that point. ETA: The involvement of a second person puts both people at risk for various unnecessary trouble and drama. He-said/she-said situations, proving who did what/when, etc.

4. Assuming that all medications remain in their packaging and that no controlled substances are involved, I would do this--so long as a policy was in place which specified final responsibility for the med pass. If management's support and attitude is that this pulling of meds is a basic task being done as a matter of their business preferences, fine. But...

5. I absolutely do think hard when I am asked to risk something solely so that someone else can do their business preference. And I feel that's what this is. People may disagree with the amount of perceived risk--but risk also has to do with workplace culture and dynamics. And I am including my professional record/reputation and intolerance for drama/BS when I speak of risk, not strictly licensing.  I have had zero performance, discipline, licensing, legal or other formal problems thus far in my career and I believe it is because I am (admittedly) very cautious about others' wise ideas exactly like this issue we are discussing.

[JKL33]

18 hours ago, JenH3 said:

JKL33,

You are really something else... 

Not trying to be.

18 hours ago, JenH3 said:

You completely took what I said out of context. 

It was not my intent to take your reply out of context.

18 hours ago, JenH3 said:

You are also implying that other nurses are inept and incompetent.

Some are. But my perspective doesn't have anything to do with whether they are or aren't. This topic is about the introduction of an unnecessary second person into an already-error-prone process that someone else is going to complete.

18 hours ago, JenH3 said:

It is illegal for anyone to pre-pop medications when they come in a multiuse card/vial/bottle but it is NOT illegal to pull individualized medications and place them in a facility-approved place (bag, box, med cart) that lists a room number as long as the medications remain in the original packaging. 

I'm aware.

I'm not talking about what is legal or not legal. You can review and see that I didn't make any statements about legality at all.

18 hours ago, JenH3 said:

So, the next time you decide to jump all over someone, please know what you are talking about better than the person you are accusing. 

What are you talking about?

 

[JenH3, ASN, BSN, MSN, EMT-B, EMT-I, APRN]

10 hours ago, klone said:

I'm so confused by people's responses here. The OP asked about pulling medications out of Pyxis (or whatever) and LEAVING THEM IN THEIR ORIGINAL SEALED PACKAGING, for another nurse to then administer. Not pulling up meds in a syringe, or popping pills out of a blister pack and putting them in a pill cup. 

Why is this even a question?

Exactly my point.

[Susie2310]

21 hours ago, JKL33 said:

 

There is no indication in the OP that either barcode scanning or pulling the meds from an ADC is involved here. Maybe that doesn't matter. Or maybe one or both are involved.

My thinking flows in this order:

1. Medication administration is a major area for errors and other aberrancies (diversion, etc). Our systems have evolved in ways that try to improve upon these errors and other problems. It is fair to say that a great deal of energy and money have been expended in this effort.

2. This is literally doubling/repeating an error-prone process and making two RNs separately responsible for a single task, one of whom who has no control over the final outcome. This is being done because otherwise "the" nurse on the floor will not have time to perform all of his/her assigned work.

3. I believe that if the person who completes the first part of this process (but, by design, not the second/final portion) makes an error and it moves through to the patient, s/he will be involved in whatever aftermath ensues. It won't be seen as a time-saving favor at that point. ETA: The involvement of a second person puts both people at risk for various unnecessary trouble and drama. He-said/she-said situations, proving who did what/when, etc.

4. Assuming that all medications remain in their packaging and that no controlled substances are involved, I would do this--so long as a policy was in place which specified final responsibility for the med pass. If management's support and attitude is that this pulling of meds is a basic task being done as a matter of their business preferences, fine. But...

5. I absolutely do think hard when I am asked to risk something solely so that someone else can do their business preference. And I feel that's what this is. People may disagree with the amount of perceived risk--but risk also has to do with workplace culture and dynamics. And I am including my professional record/reputation and intolerance for drama/BS when I speak of risk, not strictly licensing.  I have had zero performance, discipline, licensing, legal or other formal problems thus far in my career and I believe it is because I am (admittedly) very cautious about others' wise ideas exactly like this issue we are discussing.

I agree completely with your first three points.  Even if a policy was in place that specified final responsibility for the med pass, and all the medications remained in their original packaging, and no controlled substances were involved, I would first want to know my state BON's position on this practice.  It's hard for me to believe this would be a practice they would approve of.  It also seems to me that this practice would be circumventing pharmacy controls.

[MPKH, BSN, RN]

I’ve pulled meds for my coworkers, and I’ve definitely given meds that were pulled for me. The meds are left in their sealed, original packaging and placed in the patient’s specific bin in the med cart outside the room. The nurse looking after the patient then administers the medication after doing their own safety checks.

 

[NurseScribe]

I agree with Speedynurse and some others-it depends on the unit. Where I work now (psych ward) the day shift nurse will pull out the scheduled medications for the evening shift and put them in the locked patients drawer. I have no problem with this since I scan every pill and bottle. The evening shift then pulls the night shift nurse's meds and puts them in the drawer. Teamwork saves time. 

[Maizie Wilharm, BSN]

I work in the OR and there was a system of ancef being delivered from the pharmacy via tube system for pre-op to leave with the patient for me to grab and take to the room and the CRNA would then administer prior to incision. Due to less lab staff and taking up time in the tube system they now stock prefilled syringes in pre-op and only recently some of the nurses in pre-op have refused to pull the medication to leave at the bedside because in their words “I’m not the one giving it”. But I, the OR nurse aren’t administering it either when anesthesia is used for a case. And I’m having trouble citing literature to help develop a policy for my hospital on how to handle this conflict.