Pyxis machine and nurses diverting meds.....

CrunchRN, ADN, RN · Jan 12, 2012

I don't know the answers on the Pyxis, but if I were you I would go right away to a lab that does urine testing for drugs of abuse and get tested so you have your own proof you had not ingested any of the drugs.

docpsychrn · Jan 12, 2012

Good idea! I will do that this afternoon...we are sort of in a snow storm right now! But excellent idea!

backtowork · Jan 12, 2012

If the pills are missing under your ID in the pyxis, they can fire you, report you to the board, and to the police. A clean urine will help, but it does not get you off the hook from them accusing you of misappropriation.. Our hospital policy states if you remove a narc, and the patient refuses it, you waist it with another nurse and she puts her id into the pyxis as the witness. What does your hospital policy say? Did you document in the patient's chart that they refused the meds? I agree with Crunch about the UA, but I would ask an attorney as well. If there are narcs missing, someone is going to have to be identified as to who did it.

luvche · Jan 12, 2012

The Pyxis we had would not let you close a narc drawer after opening without first putting in a count. We could not simply "cancel" it. It is not helpful now, but in the future, I would advise always count ANY controlled med drawer upon opening it for ANY reason. Even if it is cancelled.

docpsychrn · Jan 13, 2012

The medication was not a controlled substance. Tramadol. It is in with all the other meds like Tylenol, Motrin, pepto and naproxen. There has never been any counting of these meds since I have been employed there. The supervisor would even go in and pull a motrin for herself or others and then push, cancel withdrawal once she got the medicine. So, meds were taken out of there all the time for different reasons. Again, I have never pulled anything out meds other than for patients or emergency reasons only if they had an order.

wooh, BSN, RN · Jan 13, 2012

In the future, count. If the count on the screen isn't right, you've documented in there what your count is, and then the pharmacist will move on to the person in the drawer before you.

docpsychrn · Jan 13, 2012

That is what scares me...the staff nurses never count the pyxis. It hadn't been counted since Sept of last year. So that means that hundreds of meds have been pulled since that time with no count ever made but now they are asking me where the meds went just because I had 2 pts that didn't want that particular med. Again, I never waste or return a narcotic or controlled substance without a witness. When it comes to Tylenol etc, I just leave it in there and move on to the next med. We pass meds on so many adult pts that want so many prn's and then emergency meds etc that the pxyis is our savior with determing who has had what meds for when we chart our prn's. We scan everything we give and it automatically goes right into our charts. So, it it's not scanned, it's not given (or that's the way it's suppose to be). I've seen a lot of mistakes made with this system but I have never given a med and not scanned it. So, I am really upset that I am being questioned as to why meds are missing when I have never had a med error or anything since I have worked with this employer. I have made 3 med errors my whole career. I just don't know what to do....what to say...what they are going to do regardless of what I say to them...

jmo1231 · Jan 13, 2012

Dear docpsychrn, I wouldnt worry too much about it. If you are innocent and didnt take the Tramadol for yourself then eventually that will be proven. If you provided a urine sample as backup just in case they question you then thats further proof you didnt take the meds. Let this be a lesson to not only you but your unit and hospital to get a safer system in place for the pixis to prevent this from happening again. I dont know what else "they" could do to you ?Personally and quite frankly I dont know why you are that upset maybe I am missing something? I mean the worst that could happen is an investigation on the unit and like I said if you are innocent that shouldnt matter so good luck and keep us informed.

Multicollinearity, BSN, RN · Jan 13, 2012

That is what scares me...the staff nurses never count the pyxis. It hadn't been counted since Sept of last year. So that means that hundreds of meds have been pulled since that time with no count ever made but now they are asking me where the meds went just because I had 2 pts that didn't want that particular med. Again, I never waste or return a narcotic or controlled substance without a witness. When it comes to Tylenol etc, I just leave it in there and move on to the next med. We pass meds on so many adult pts that want so many prn's and then emergency meds etc that the pxyis is our savior with determing who has had what meds for when we chart our prn's. We scan everything we give and it automatically goes right into our charts. So, it it's not scanned, it's not given (or that's the way it's suppose to be). I've seen a lot of mistakes made with this system but I have never given a med and not scanned it. So, I am really upset that I am being questioned as to why meds are missing when I have never had a med error or anything since I have worked with this employer. I have made 3 med errors my whole career. I just don't know what to do....what to say...what they are going to do regardless of what I say to them...

docpsychrn,

I'm guessing by the 'doc' in your name that you are a correctional psych RN? If this is the case, I don't understand how the medications have not been counted in the PYXIS. Is your facility NCCHC accredited? Counting medications is a requirement for for accreditation. Also, your pharmacy department should have been doing audits at certain intervals. Who checks for expired medications?

I also understand the big deal this is because everything is different in a correctional healthcare facility if something is missing. The worry is an item has been stolen and/or given/sold to an inmate.

FYI for non-correctional nurses: when something desirable like pain medication or a single needle goes missing in a correctional facility, staff can be looking at felony charges if it is found to have gone into the underground prison economy of contraband. Something like one missing angiocath or missing pain medication can cause an entire prison to go into lockdown. Almost every prison facility has internal investigators whose job is to investigate staff and try to find who is "dirty" or bringing in/selling contraband.

Tramadol is basically treated like a controlled in most correctional facilities because it is desired by many. However, if the facility is going to treat tramadol like a controlled when it is missing, they need to treat it like a controlled every day and count it at every shift change. This sounds disorganized.

I don't see an obvious problem with your nursing license because the medication has not been counted in accordance with controlled medications. I do see a problem with your employer due to legal risks in the correctional environment.

It may sound odd to an investigator that you had two times where you canceled taking out the medication right after the drawer opened. I would think you will have to explain this. I'd expect a special investigations file to be opened. If you are innocent, there will be no evidence, and you have little to worry about. It is stressful to say the least, though.

docpsychrn · Jan 13, 2012

The meds were cancelled out 2x because each time they didn't want the medication so I just closed the door back. I didn't even look at the medication. Im just standing in the med room and because they wanted something harder (I start with the lower amount of meds) they refused the tramadol. It's just so upsetting to me! I can't even remember the last time I saw that pocket or how many were in it! We don't use a lot of pain medicine so I rarely even pulled that med up on the pyxis. Anyways, thanks for all your help and I will let you know what happens.

Multicollinearity, BSN, RN · Jan 13, 2012

I wonder if a coworker saw this twice and used it as an opportunity to take some, throwing the count off, knowing you were the last one in there?