pyxis dilemma

[cptluciejensen]

I work at a hospital that uses pyxis for narcs and bar code med administration for giving meds. I had a pt that was hurting, I had him for 6 hrs and knew I didnt give him ivp morphine so I went to the pyxis to get it so I could scan it. I noticed another nurse took out the med but did not scan it in. pt was not her pt. I had to call the MD and say the dose was not effective and needed a different order so I did take care of the pt's pain. I have noticed this nurse taking meds out for multiple pts that were not hers, at times I have asked my alert and oriented pt's if they got anything for pain and they have stated no. in a shift most of us get into the pyxis 5-6 times to get things out, either routine or prn meds. I noticed this nurse takes 20-25 out per shift, at first I thought maybe she was just really aggressive with pain management. occasionally if we have a pt in pain on the ward and the nurse is in a procedure one of us will give the pt a prn but we would of course talk to the pt's nurse prior to giving anything. this nurse does not and the only way some of us found out they "got" a prn is by seeing the med taken out of the pyxis.

I had a pt friday that used to be a medic, she had a stress test and it was negative, that was around noon, and she was back at the ward at 2pm, when I went to dc the pt I noticed she had taken out her IV already, (pt stated she was an emt and wanted it out) no problems there. I saw on the pyxis that this nurse took out 2 2mg vials of morphine at 4:01pm and 4:27pm, her ride came about 4pm and she left about that time, the pt declined any pain at dc, the nurse didnt scan the med in the barcode system. how did she give the ivp med if there was no IV? I noticed a pattern before any of the pt's get discharged she is in the pyxis getting meds out for the dc'd pt even if it isnt hers. some pts do have long drives home and with some conditions if certainly is appropriate.

however if the pt's chest pain has been resolved why is she getting meds out for a pt she isnt even discharging.

Other nurses are noticing this as well. the nurse that is doing this is a msn nurse, she is married to a dead beat dad that works sporadically so she has to pay the child support on his 5 kids. She is vested with this employer, I generally like her. She actually got promoted to another job, she will be in charge of the hospitals palliative care program. From what I understand she will not have access to drugs in that job and they will supposedly take her out of the pyxis system it is supposed to be an administrative job. (she wanted to do overtime on the ward but they wouldnt let her because the job will be funded under a different account and she wouldnt have access to the barcode system or the pyxis. )

I guess her last day on the ward is this weekend (which I am off) and her new job starts next week.

I have noticed the discrepancies in the meds for several months (i,e, pts that are not hers getting pain meds from her and they deny getting them or say they are ineffective) in the past week the discrepancies have been massive. she has been taking out narcs based on the max prn frequency but when I go into the computer none or very few of these are documented as given.

She is a big girl (300 lbs) she did break her leg last year, she is about 50 yrs old, a good and educated nurse, the work on out ward is physically demanding and there is a lot of walking and lifting. She might just be having a lot of pain, maybe this is why she went to the desk job, or maybe she is stocking up because she wont have access any more. She wont be on my ward any more so it really isnt my problem anymore

I cant believe the powers that be havent seen where she took out so many drugs and were never documented as given. I talked with a co-worker (and a nurse) that I went to college with and we have been friends 25 years and she thinks she is just hurting because the job is too demanding physically. since she wont have access to drugs anymore she thinks we should just blow it off

what should I do with the information that I have? It can all be verified in the computer.

[UM Review RN, ASN, RN]

Are you saying that you and other nurses noticed this trend and didn't report it? Aren't you obligated to report things like that?

I would've reported it to my manager, if nothing else to cover my behind, especially if she was supposedly taking meds out for my patients.

[cptluciejensen]

I noticed it a few months ago but she did scan the med and pt's can be forgetful.

I didnt notice a bunch of meds taken and not scanned. It is just the past week that it has gotten really bad, that I have noticed all of her narc activity. actually I just now figured out how to get a report by name of what has been taken out. and then checked if the corresponding meds were given. my suspicions are not proof and I dont want to get someone in trouble if they are innocent. but friday when I figured out how to check what was taken out by nurse and she had taken out 25 meds and only a few were scanned. It pretty much tells me my suspicion is right.

she however is no longer going to be working my floor. I wonder if the hosp already knows of this because they are going through the extra effort to take her out of the pyxis when she takes her new job. I have only been pretty sure since friday night late

[netglow, ASN, RN]

Oh, geez. You'd think someone would notice. But, they still might. I just hope that this doesn't end up being something that ends up being a problem for the rest of you. I would think that once she leaves things would stop. But people like that are desperate, and they find ways to continue. Who knows if she finds a way to access under someone else's code. Things have been simple for her on your floor, somehow she might find a way to continue to affect your floor's meds. If she continues... she will state that she doesn't work on your floor, and how could she have access...

Good idea that you have some notes jotted down... dates also.

[Connie Elder]

You have no choice but to report this. By not doing so you are enabling this nurse to continue being a thief, drug abused. This will most certainly cost her her nursing license. How will this look to the hospital administration and your nurse manager that you have know about it for so long and did NOTHING? There is no excuse or reason that this nurse who is stealing the durgs should be doing this. Comments have been made that her husband is a do nothing type of person and she has 5 kids and has he MSN. So what! Do you want someone like that taking care of your loved one? She need's help and quickly. Don't let another day go by that you have not reported this. I only hope that she has not used or somehow obtained someone's sign on information to the pxysis, that will only get that person in trouble. Pts can be forgetful but that many, I don't think so. I am appalled that somoene would say just to blow it off. I have been a nurse for 32 years and I am quite appalled that someone would even mention this. It doesn't matter, who ever is stealing drugs, needs to be reported and for you knowing she is stealing htem and doing nothing about it, to me you are just as abd, you are an enabler. Also, I am a travel RN and have worked at facillities where nurses have been caught doing the same thing but NOT as long as this nurse is. They have been immediately fired and reported to the board of nursing. By a nurse holding on to this type of information for so long, you might even risk getting in trouble yourself and being reported to the board. Is it really worth it? Report her and do it now!

[cptluciejensen]

I just figured it out for sure friday night

[Connie Elder]

Figured out what? SO are you going to report her or not?

[UM Review RN, ASN, RN]

Still, you need to report it. In my state, it's the law.

[cptluciejensen]

I just figured out for sure that she was taking meds for herself instead of just being aggressive with pain management

[Connie Elder]

Wehn a nurse contemplates doing something like this, she needs to first of all think of her pts and what harm can happen to them? A nurse calls to tell the Dr. that the current pain regime is not working, the Dr. increases the pain medication, the nurse gives it, (since the nurse stealing the drug)is off shift at this point, the pt, goes unconscious and has to be transfered to the ICU and if the pt isn't transfered the pt receives some Narcan? This could of all been prevented if the nurse had been reported in the first place. We have to remember that we as nurses are pt. advoocates. Do not talk to this nurse who has the drug/theft problem. She will only become defensive and could turn the tables on you, especially if she somehow obtained your sign on information to the pxysis and has been stealind rugs under your name. How will a person feel if the nurse if this nurse who is stealing drugs dies off an overdose? That can't be explained to her 5 kids but maybe to her lousy husband.

[kanzi monkey]

Ughh, that is a horrible situation. I am not jealous. But you have to do something about this for, like, a hundred reasons.

1. If what you say is accurate, it seems pretty clear this nurse is diverting narcs. Whether for her own personal use, for distributing, or for helping another who might need it, diverting is diverting. No matter how benevolent her intentions, nor how much she may actually need them, narcs cannot be dispensed in this way.

2. You need to protect yourself. You are a witness to this, and if anyone were ever to ask you at what point you became aware of what was going on, you have an honest answer--last Friday. Lying about this if you're questioned would be disastrous. Telling the truth--that is, that you knew and didn't report--would be seriously regrettable if not disastrous. You don't know where the narcs are going, and if someone ODs on unprescribed narcs (the existence of which you were aware of)...I don't need to finish that thought. This also applies to the nurse in question--if she accidentally or purposefully harms herself with these meds, and you could have stopped her...you get my drift. Oh, and like 2ndwind said--you have no idea what lengths she may have gone to to obtain someone's pixis code. If she were to use yours, and your code got caught--crappity suckola.

3. The pixis is recording that these meds are taken out under a particular patient's name. I don't understand the relationship to electronic med dispensers and insurance reimbursement, but I'm fairly certain there is one. My facility uses Omnicell, and I've been told that if I take a medicine out under a patient's name, but don't administer it nor return it, that patient will be billed for it. Probably not itemized, but the overall cost of their admission is related to the medications they've received during their stay. Even if multiple doses of narcotics don't add significantly to the cost of a patient's admission, I honestly don't know what kind of access the insurance company has to the type of medication used and for what indication. I believe the payor has all the access it wants--and if an insurance company notices that a particular patient uses a lot of narcs, I don't know if this can be used against them (ie, chronic pain, cancer, etc.). Even though the pt would likely prevail if an issue arose (an audit or reconciliation would show the disconnect between EMAR and Pixis), a lot of bureaucratic paperology would stand between the pt and an accurate medical record. This is similar to what happens with identity theft--it is horrible for the victim.

4. I'm wondering if this nurse actually plans on having easy access to narcs in the future. Usually access to narcs opens up substantially with palliative or hospice care, as the objective is to maintain pt comfort during end stage illness or end of life care. God forbid this RN deprive one of her patients of the medicine they need so that she could use it for her own purposes.

I'm sorry.

-Kan

[cptluciejensen]

I kind of just opened an anonymous email account and sent the tip to the manager as a sms text message. every cell phone has an email address, like for those with verizon it is [email protected] if anyone audits the past 5 days it will be obvious who is doing this.