Pulling Meds for Multiple Patients

Snow1278, RN · Dec 14, 2007

I work on a tele unit and we have both pyxis and medication drawers. I do not pull multiple patient meds at once becaus I have to pull each drawer out and get their meds, pull up insulin, and get some of the narcotics they receive from pyxis. I am too afraid of making a med error by pulling out the wrong meds. The only advice I can give is to make sure you check your meds in the room next to the patient, armband and all.

Shantas · Dec 14, 2007

You just need one med error.....it can not only ruin your lisense but also can harm a human being:o

One Patient At a Time!!!!

nservice · Dec 14, 2007

I pull up one patient's meds at a time. It's the way I was taught and it seems safer. Other than safety, My concern is how other nurses feel about waiting for the Pyxix when you're monopolizing it to pull all of your patient's meds at one time? Just a thought.

tlh65 · Dec 14, 2007

We have a Pyxis machine. I pull meds for all my patients at once. We have ziplock bags. I pull meds for one patient, put them in the bag and label the bag. I then go to patient #2, do the same. We have MAC carts (Medication Administration) for computerized and scanning of the meds via a bar code. We scan the patients meds and there ID bracelet and the computer will tell us if there is a discrepancy. I ALWAYS follow the 5 rights while giving meds as computers tend to have errors - BUT YES, i pull my patient meds all at once within 30 minutes before. I do not pull narcotics at this time. I pull those separately.

tlh65 · Dec 14, 2007

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.

Neither do I. I do it the same way as above. One patient at a time. My meds stay in my med cart locked up during administration.

Boston-RN, RN · Dec 14, 2007

Is there a Joint Commission ruling on this?

Yes there is. I don't know exactly the way the rule is written but a good rule is to follow what your policy and procedures are. I'm sure all the policies are JACHO compliant and therefore covering your butt either way. With technology with barcodes and scanning and pyxis's etc your facility has to have a safe/efficient process in place that is compliant with JACHO standards.

Most facilities encourage more efficient processes so if you feel your way is better and still safe be the hero and make a recommendation.

Blee O'Myacin, BSN, RN · Dec 14, 2007

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.

Just because some clinical instructors are teaching inexperienced students short cuts, doesn't mean that it's a) the proper way of doing things, or b) in accordance with facility policy. With how hard the Joint Commission comes down on us for daring to shove a saltine in our mouths in any location other than the staff lounge, I highly doubt they would encourage pulling meds on multiple patients at the same time.

Doing something "how you were taught in school" doesn't make it a valid argument standing on it's own, IMHO.

And one more thing about clinical instructors, they have 10 students on the floor at any given time, then whomever is doing meds that day pulls more than one with the instructor, and the instructor "trusts" that you will all get it right? That's way more patients than you will ever have on your own, and yet these instructors are juggling med passes to more patients than a single assignment? I find that scary.

Blee

clee1 · Dec 14, 2007

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.

While working on med/surg, I used a similar system all the time - without error, I might add. All meds are scanned at bedside along with the pt bracelet to ensure no errors are made.

This practice may violate someone's cockamamie policy or regulation, but then again, let the azzhats that create such foolishness in the name of "safety" walk the halls in repeated trips to the med room - I just DON'T have the extra time! :angryfire

treysdaddy08 · Dec 14, 2007

I think it is also being missed that most of the people doing this are saying that they are doing it PER HOSPITAL POLICY! They've been taught to do it this way in school (if they were using a pyxis) and the hospitals policy is to do it this way (if they have a pyxis). Please realize that this is a new machine, and it may be 'safer' to do it this way than it has been before. The meds are disbursed in their package, so there is no possibility for cross-contamination if they aren't removed from that package. The meds have a receipt which is checked when they're disbursed against the mar, and then checked again against the mar before giving the med to the last pt. All rights are still checked in order, and this way just saves a shade of time. (again, per hospital and school policy)

treysdaddy08 · Dec 14, 2007

And one more thing about clinical instructors, they have 10 students on the floor at any given time, then whomever is doing meds that day pulls more than one with the instructor, and the instructor "trusts" that you will all get it right? That's way more patients than you will ever have on your own, and yet these instructors are juggling med passes to more patients than a single assignment? I find that scary.
Blee

I'm really confused about this quote. In my school we have 2 patients. Our instructor watches us pull the meds, makes sure we do our 7 rights, and will follow us (never leave our side) until we pass the meds. Trust has nothing to do with this. We have never used a pyxis, so we haven't been taught the multiple-pull, but those that have been taught I would assume are taught the same way.

ktwlpn, LPN · Dec 14, 2007

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.... .... 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..[/quote)----------- The pyxis is another safety net to help prevent med errors.Over-riding that system defeats it's purpose-that's a no -brainer. We need all of the levels of protection available to us-I have seen too many nurses loose their jobs recently.If you did make a mistake while passing meds in this way you would have NO defense and if the patient had a negative outcome you could also be prosecuted if you did not follow your facilities P and P...Why take the chance with your license? However if this IS your facilities P and P then you must be safe.However I watch nurses sit at the nurse's station and pre-pour their entire med pass and then get up and administer-if they are double checking them all again then they have done twice the work. Pre-pouring meds (labeling,bagging ,etc) seems like alot of extra work to me-it takes more time then just pouring and administering the meds,doesn't it?

MAISY, RN-ER, BSN, RN · Dec 14, 2007

Learned to pull meds one at a time, for all of the reasons previously cited.

However, when I was granted an externship, was advised I'd never be able to pass meds in timely fashion if that practice was continued. I then learned to pull meds for all patients, place in plastic cups with room numbers on it, but keep all meds wrapped until room time.

When I went back to school for final semesters, nursing instructor almost had a cow when she saw me pulling and checking meds quickly. The practice was one at a time....would not work in school, but advised real world practice.

Currently due to working in ER, I usually pull by the patient. It is rare I have more than 1 or 2 hold patients. Other meds are as needed.

Personally, I don't see a problem with a med tray with bags or cups. I see that as no different than a roving med cart-mistakes are made when the details aren't noted. Checking careplans, MARs, or any other safeguard your institution has against name band is the only safe method of med distribution. Most mistakes are due to the lack of following protocol when handing meds out.

Even now I leave all meds wrapped until room time. I have learned in the past that patients will want to see packaging, or may refuse...then med is wasted. I believe if meds are presorted they should never be unwrapped. Pharmacists have trouble identifying some drugs...we should not be guessing as we administer.

Maisy;)