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.

[treysdaddy08]

If I understand correctly, a pyxis is a new system that dispenses the meds for the patient by scanning their barcode on their mar (or something else) against the machine. So if I were in the hospital, my info would be input into the pyxis, and the pyxis would spit out the meds I was to receive at that time, along with a receipt. They are saying that they are taking these meds, and the receipt and putting them in a plastic bag, and doing this multiple times at once.

I have one question and one statement. My question is this: several of youa re saying that a med error could happen and this is a poor way of doing your med pass. Is it a poor way because a med error is more likely to happen? And if so, could you please enlighten me as to how? Or is it poor simply because (swallow your pride here) you're not familiar with it, ergo it's new so it must be wrong.

Now my statement. Tazz, I believe said "I'm guessing they're not teaching you this at your school", or something of the like. Well, according to at least 2 posters, they ARE teaching it at their schools. Does that make it more valid? according to the arguments posted, it does.

[Shantas]

In our hospital, each room has a locked med cabinet with two drawers in it. We dont have a pyxis yet so the pharmacy deliver the meds directly in the patient's room. So we just take the MAR, go the patients room and give the meds to the individual patient.

We will get pyxis next year, I suppose then we will just have to walk back and forth to the patients room!!

I dont think I will feel comfortable with taking all the meds for all the patients out at the same time.

I did that once and I placed the meds in individual cups and I marked them, but when I was giving the meds I gave the wrong meds to the wrong patients. Fortunately it was only multivitamin and colace....since than I am very very carefull....we are human and human can make mistakes!!

[elthia]

I work on a unit that has hallways that are anywhere from 140-400 feet long, and I take anywhere from 5-7 patients.

I pull each pt's med from the pyxis and compare it to the MAR, put it in a bag with the pt's name. I then lock that bag in a drawer on my computer on wheels. I pull all my pt's meds for my med pass, and place their meds in drawers on my computer on wheels, turning it in effect to a med cart.

I load up the computerized barcode med admin program and go about my med pass administering my med according to the 5 or 6 rights, depending on how many rights you want to say there are now. The computer is my MAR, and I don't remove any meds from their package until I am administering them to the pt, and I compare every med to the MAR regardless of whether it scans correctly or not.

I just don't see how pulling all my meds at once can be dangerous practice.

[EmmaG, RN]

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.

This attitude really disturbs me and I'm confused as to why you even started this thread. I agree with what Tazzi and Steph said above, and that you need to follow your hospital's policies.

I couldn't care less if safe practice makes me a 'laughing stock' among my co-workers. I'm working on my own license, not theirs. Regarding cutting corners to save time, drug errors are far more time-consuming than simply doing it correctly in the first place.

[skittlebear]

I work on a unit that has hallways that are anywhere from 140-400 feet long, and I take anywhere from 5-7 patients.

I pull each pt's med from the pyxis and compare it to the MAR, put it in a bag with the pt's name. I then lock that bag in a drawer on my computer on wheels. I pull all my pt's meds for my med pass, and place their meds in drawers on my computer on wheels, turning it in effect to a med cart.

I load up the computerized barcode med admin program and go about my med pass administering my med according to the 5 or 6 rights, depending on how many rights you want to say there are now. The computer is my MAR, and I don't remove any meds from their package until I am administering them to the pt, and I compare every med to the MAR regardless of whether it scans correctly or not.

I just don't see how pulling all my meds at once can be dangerous practice.

I agree with this post. If the medication is still in the package and kept safely in the med cart, how could that be pre-pouring? As long as your comparing the medication to the orders and MAR before you give to your patient, I don't see how that could constitute a med error any easier than running back and forth from the pyxis to the pts room. As for any Narcotics, that's a different story.

[Sabby_NC]

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.

totally agree and i don't care how much you check and double check accidents do and will happen with this practice. :uhoh21:

personally i would not be opening myself up to a future boo boo!

[fultzymom]

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....

A pyxis is a computerized med cart that holds each persons medications in a seperate drawer. You must have a password to get into, then scroll down to the patient et meds that you want. By pulling, they are talking about pulling them from the patients drawer to give to that person.

I have experience in this area. If yu have two peoples meds at the same time it is possible, no matter how careful you are, to give them to the wrong person. We were taught not to do this in school and for a very good reason. When I started my job I was taught to do this to save time (I work LTC-med passes VERY long!!). I had the meds in seperate containers and still managed to give the wrong ones to the wrong patient. This was my first med error ever and I was mortified!! If you are doing this practice, I would advise not to do it. Any thing is possible, even if you are thinking you are taking every precaution possible. Learn from my mistake. Have only one patients medications in your hand at a time.

Making sure you are safe is better than not being the laughing stock of your fellow nurses any day. Trust me on this one.

[mauxtav8r]

One issue not yet mentioned . . . infection control.

I hear the "pro multiple meds at a time" folks taking the baggies and containers of various people's meds with them as they complete the med pass. No way to maintain technique. On my floor a nurse was written up for entering a pt's room with the meds for another pt in a bag in her pocket. Nobody involved was on contact isolation, but the point was made. There's no way to be sure there was not contamination.

[RN1989]

JCAHO regulations require that the MAR be taken to the pt's room and not simply checked before going to the room.

I believe that it is in a nurse's best interest to take the meds, unopened, to the pt's room with the MAR. Check the MAR name/DOB with the pt's bracelet (and verbally) then RECHECK the meds against the MAR in the presence of the pt while opening them and putting them into the cup in view of the pt. It takes a hair bit longer but not much once you get the hang of it. This method is a last double check to prevent errors. This is also an excellent time to help educate your pt on what they are taking and why. Doesn't have to be a big explanation, one or two words works too. It also helps to reassure the pt that you are taking every precaution to give them the correct drug. They are much less likely to hassle you or sue you if they felt that you are taking "extra" precautions to make sure they get the right med. They don't have to know that it is a JCAHO reg. If you do this every time, you will have a much easier time in a deposition because this is your normal practice and shows you follow regs and are conscientous.

Don't think you don't have time to take these precautions. Obviously people are screwing this stuff up somewhere or people wouldn't be dying and nurses wouldn't be in court fighting for their licenses.

[elthia]

One issue not yet mentioned . . . infection control.

I hear the "pro multiple meds at a time" folks taking the baggies and containers of various people's meds with them as they complete the med pass. No way to maintain technique. On my floor a nurse was written up for entering a pt's room with the meds for another pt in a bag in her pocket. Nobody involved was on contact isolation, but the point was made. There's no way to be sure there was not contamination.

I do not take the meds from one pt into another pt's room in a baggie. The meds are locked into the med drawers of the computer on wheels/med cart I take with me from room to room per hospital policy.

What I do is turn my computer into my own personal med cart for a single med pass, and pull all the meds I need for all my patients from the pyxis with the exception of narcs and place those meds in separate drawers in my personal "med cart". The barcode computer med admin program is my MAR, and I double check the med with the MAR whether it scans ok or not, likewise the pt's armband.

How is this dangerous practice because this is not how I was taught in school or contaminating the meds? In school I wasn't even taught how to use barcode med administration, so I obviously cannot give meds the way I was taught in school.

[shellsgogreen]

i also stick with what i learned at school, which is to pull for the patient you are about to give - the cart is there, the mar and i'm checking the vitals to determine whether i need to be giving the bp meds or not, among other things.

i imagine even if i were to pull for more than one, i would still be checking them over again before i give it - too much can happen in the space of administering meds to one patient to the next .

also, our carts are locked, so it may be feasable to lock the meds up, however, other personnel can access them, so it is also possible for them to pick out something without anyone knowing.

my hospital also advises against pulling for more than one, and rightly so, is my humble opinion .

[elthia]

also, our carts are locked, so it may be feasable to lock the meds up, however, other personnel can access them, so it is also possible for them to pick out something without anyone knowing.

my hospital also advises against pulling for more than one, and rightly so, is my humble opinion .

i understand...but as long as there are no narcotics/controlled substances that you have signed for, what is the danger of other personnel having access to the meds by knowing the access code?

meds that are not floor stock, i.e. in our pyxis, are kept in a large med cart in our med room, and meds are routinely footballed up through the tube system...both are in the med room that has the same access code as the smaller computer med carts. so theoretically it is possible for someone to steal non narc meds without anyone knowing from anywhere.

i still would check the meds against the mar before administering the meds, and so would notice a medication was missing.

it's allowed to pull for more than one pt at my facility, that's why the computers are set up as mini med carts