Pulling Meds for Multiple Patients

[trustsupplyguy]

In order to save time, I will often pull meds from the Pyxis for more than one patient. For example, I'll get patient #1's meds, put them in a little zip-lock bag, put the Pyxis receipt with the patient's name into the bag and them zip it shut. Then I'll do the same for patient #2. So ultimately I have 2 or 3 ziplock bags containing meds and the related Pyxis receipt.

Several nurses have told me this is "bad" and not to do it. But I don't get what the problem is. When I get to the patient's room, I pull his ziplock and check everything against the MAR before giving the meds. The receipt is in the bag so anyone can see whose meds these are and what meds were taken from the Pyxis.

Will the meds from bag #1 jump into bag #2 by magic and change what's written on the Pyxis receipt? Seriously, am I missing something (I am pretty new)? Is there a Joint Commission ruling on this? I have never had a problem doing this, and it does save time.

[CaLLaCoDe, BSN, RN]

This sounds like your time management skills are in check! I don't understand the complaint of your coworkers either. You may wish to clear this with the manager of the department rather than suffer possible write ups from your coworkers. Now if it concerns a controlled med such as a narcotic I would not be caught dead having that in a zip lock even if my intent was not to take it home with me it would be hard to prove otherwise.

[kpyers32!]

I'm a new grad with no experience but in school we did learn to never pull meds for more than one pt. at a time, because of the possibility of mixing them up. Your system seems mix up proof to me. I did see nurses during clinicals pulling meds for multiple pts. at a time.

[TazziRN, RN]

if it was "good" you would have been taught that method in school. i would venture to guess you were not.

i am an old nurse with many years under my belt and not only would i never do that, i would caution any nurse i observed doing that. mistakes can be made when pulling one pt's meds at a time and checking them against the mar and doing all the checks. pulling meds for multiple pts is a mistake waiting to happen. if and when that mistake is made and it is discovered that your usual practice is to pull meds for multiple pts at the same time, your goose will be cooked.

[trustsupplyguy]

I could see a potential problem if the Pyxis let me pull meds for multiple patients simultaneously. But it won't.

I actually learned this technique from a teacher in nursing school.

[TazziRN, RN]

still not an acceptable practice.

it doesn't matter if you can pull meds for all pts all at once or not. even if you pull meds for one pt and only one pt, there is still always a chance for mistakes to happen. as you will hear as you go further in your career, this happens more than you think. there are careless nurses who make mistakes that can be easily avoided, and there are just as many nurses who follow all the steps and still make a mistake. it's easier to defend yourself if you had one pt's meds in your possession and not more than one.

[trustsupplyguy]

With all due respect, if I gave meds the way they made us do it in nursing school, I'd be the laughing stock of all my co-workers. None of them do it the way my nursing school taught, simply because they don't have time.

Come to think of it, I have never seen a practicing nurse pull meds the way we were taught in nursing school. Never, ever.

I guess when you have one patient like in nursing school, you can do things the theoretically correct way.

[TazziRN, RN]

then i guess nursing practice in your area is different than in mine. pulling meds for more than one pt is not only discouraged around here, more than one facility will write up a nurse caught doing so. if you were to move here and were caught doing what you describe, you would find yourself being advised by your coworkers to change that practice.

bowing out now. we obviously will never agree on this one.

[lil' girl, LPN]

Well then just call me the laughing stock, because I pull my meds the way I was taught. I don't have "time" not to. And my patients trust me to pull their meds and not mix them up which is a potential if you pull more than one pts. meds at a time. Just wondering if you have made a med error yet? AND (not accusing) just asking, if you did you would of course admit it? Well once you make one, you might just change your mind about the ways you do your meds. Trust me you WILL make a med error.

[Scrubby]

I have no idea here what a pyxis is so i'm pretty confused...can someone please explain???

Do you mean by pulling meds that you take some tablets from another patients packet and use it on someone else? I don't have any probs with this as long as it's the right drug and dosage etc. Otherwise a patient may miss out and if it's available from another patient this makes sense....

[al7139, ASN, RN]

Hi there,

I just had to put my two cents in! I work on a very busy telemetry unit with a load of 5-7 patients.

In our unit, pulling all your scheduled meds for all your patients is the norm. I do it, and I have not yet had a problem with it. I will pull all my meds as you describe (each pt has their own bag, and the Pyxis receipt goes into the bag). I then go the the nurses station, and begin giving meds. I take the MAR, the bag and check each med against the MAR prior to going into the room. This allows me to read the notes, cut a tablet, and double check that these meds are for this patient. I then take only that patients meds and their worksheet into the room, again do my 6 rights, and give the meds.

Another thing I do at the start of shift is to go through the meds I need to give that shift, and highlight any that are partial doses (i.e. 1/2 tablet, 10ml of a 15 ml liquid, and any IV meds that require dosage calc like 60mg of Lasix from a 100mg vial (I get a second check from another RN for the math)). This has helped me to make it safe, but also save time.

I know that in school, for the first year we had 1-2 patients and we did pyxis pulls individually. In our final year, we used this method, but were very careful and systematic with it.

Don't feel like you are doing anything wrong. I think that this method not only saves you time, but as long as you are vigilant and pay attention, it is safe as well.

Amy

[Spidey's mom, ADN, BSN, RN]

I'm with Tazzi on this one.

What is the policy of the hospital where you work? I'd go there first.

But in the end, I still wouldn't do what we call "pre-pouring". It is against the rules where I worked. I was taught not to do it in school. I don't care if people laugh at me.

steph