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.

[Magsulfate, BSN, RN]

Oh dear,,, now I've read the comments I have to say one more thing,, or a few more things.

First of all, I felt so drawn to commenting IMMEDIATELY once I read your post that I couldn't read the comments. Can you understand where I'm coming from?

You did a really good thing by going to the manager about it. Now it is their job to investigate and you probably will never know what happened, or what they found. They can't tell you the findings of their investigation.

But, you did an honorable thing,, this nurse will get the help she needs and most importantly the patients will not be harmed by her anymore.

I have TONS of experience with recovering nurses, as I am one myself and I now work with them in my state as an advocate. It is something that you would never want to be witness to, but it happens way more than anyone can imagine.

The very worst thing you can do is feel sorry for this nurse, or be afraid of her losing her job/career. It was beyond that point, and you should be worried about her losing her LIFE. There have been nurses that have overdosed and died because they were diverting, yes it happens all too often.

And what about the patient that was seemingly getting narcotics all through one shift,, and then the next shift the nurse actuallY GIVES the narcotics and the patient has an overdose reaction because they were never actually given the med before?

This goes way beyond a diverting nurse, the ramifications of her addiction can hurt more than just her, and you don't want to be the one that knows and feel guilty about it, or much worse be investigated by the board because you knew and did nothing about it.

I don't know you, but I am so proud of the way you handled this. YOu did what you had to do, even though it was hard for you. I'm glad you came on here for advice. You never know, someone else may read this and save a life, somewhere. You just never know.

Now, this nurse will hopefully get the help she needs. She may go into the recovering nurses program in your state,, it is up to her to figure out if her license and life is worth recovering for. And you can go in with your life and nursing care,, you're a good nurse ! :)