Pyxis report question...being falsely accused!

Nurses Medications

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I am currently being accused of withdrawing medications and not wasting them in the pyxis. Everyone in our department asks a nurse to enter the pyxis first, then the "wasting" nurse completes the transaction. In effect, wasn't I "witnessing" instead of "wasting"? Are there separate pyxis activity reports for withdrawals, wastes and witnesses? I ALWAYS waste my medications and can't understand the discrepancies. They requested a drug test that should come back fine but I am on temporary leave while this gets sorted out. Any thoughts/ideas would be greatly appreciated.

Specializes in Emergency, ICU.
OK, stupid question from someone who never worked with IV push medications: Why can't IVP dilaudid come in pre-dosed syringes? Like a 0.4mg syringe, a 0.5mg one, etc? Why does it always have to be in vials and part drawn up and part wasted?

Yes it comes in 1mg and 2mg carpujets. The problem is doctors who are uncomfortable ordering proper pain control and order

Specializes in Emergency, ICU.
Sorry if this seemed confusing. We withdraw out our meds such as ativan, morphine etc. The only available amounts are always more that we will use. The pyxis asks if we will use all the med and we alway say yes and go on our way. Later, after the patient is medicated and/or no more is needed, we then go back to the pyxis at a a later time to "waste" the unused medication portion. The witnessing RN signs in first and the "wasting" nurse completes the wasted medication transaction in the pyxis. From what I have been reading, the way we have been doing this is not correct :/

Yup. There's your problem. You should be logging in to waste the meds You pulled to keep a clear record of your wastes. Plus, giving more than 1 dose from the vial, although convenient, is not acceptable practice.

In your defense, this is the way you were trained in this unit. If anyone needs to take responsibility, it is the manager that allowed this to become common practice.

I really hope it ends well.

I have investigated discrepancies in my former position. Let me tell you, not wasting immediately but rather after the fact is a big red flag.

Crap! We do this ALL the time on our floor. I think I'll be bringing this up w/ my manager and at the next staff mtg. Thanks for the info.!

Jasper676, how did this turn out for you? I am going through the exact same situation and I, too, have learned that while withdrawing more than the ordered dose and saving the remainder for a repeat dose rather than immediately wasting it was good for my patient and their pain needs, it looked suspicious to other nurses and was a red flag. In my case, our dept was so busy and understaffed that finding another nurse to waste at the time of dispensing it was nearly impossible. My situation was a little different than yours. I supposedly had a coworker that reported concern that I was carrying around medication in my pocket for most of my shift, that I asked her to "witness" that I wasted a medication that I no longer had in my possession, that one other time, I shook the vial while drawing out the amount I was wasting so she couldn't see it.....but the following events contradicted the statements. They claim that I did not document the medication waste. So how did this nurse know that I carried medication around in my pocket for most of my shift if I never wasted it nor gave it, and how would she even know that? The other two instances never happened. I was put on paid leave while they did their investigation. They never did ask for a drug test, so I immediately went to another hospital and had one done....I did this weekly x3 tests just to prove they were all negative. Even though they did not do a drug test, they made me go to a rehab center for an evaluation, which was also negative. Then things got really interesting once they found that out. The rehab evaluator had to speak with them as part of the evaluation, to determine what the concern was since I had no history and there was obvious reason for me to be there. This evaluator called me to tell me what they said, and was concerned that they made reference to my personal medical history of a recent injury that I received treatment for at their facility, and comment was made that a narcotic had been prescribed,(which I never even filled) and my medication discrepancies started right after that. How did they know that unless they looked in my chart?? I called medical records and asked for a copy of who had accessed my chart, when and why. I was fired the very next day. The union has filed a grievence, and I have a lawyer, since they told me that they are reporting me to the board of nursing. I have reason to believe that they altered the patient medication record to omit my entry, making it look like medication was taken out of the Pyxis and never administered. The MAR is the only place where you can edit/omit and it does not show up on the patient summary log. But it does show up when medical records does an audit--every electronic log in to a chart leaves a footprint. Why would they do this? Hospitals go through waves of financial ups and downs. This is how they save money--fire a nurse high on the pay scale and replace her with a new grad for half the price. 6 of my fellow nurses had the same fate this year and none of us diverted. I have another terrific job, but I can't wait to see them recognized for their wrong doing. I did learn from this awful experience, and unfortunately, my pt will just have to wait for their pain med for a little while if it will prevent becoming a target.

Keep in mind that the iteration of the Pyxis you are using will determine how you waste your narcotics. The Pyxis medstation 2000's gave you the option of administering the whole dose (if your ordered dose was less than the total amount in the vial/carpuject). However, the new Pyxis medstation 3000's have a different setup and don't give that option.

Specializes in Post Anesthesia.

There may be some "glitch" in the way you are wasting your meds- Have your unit director or a senior nurse walk you through the steps both as the nurse wasting and as the witness. It may be something as simple as not hitting the right button, in the right order to record the waste. It could even be some quirky password issue- maybe have your account/ID deleated and re-entered with a different password to get a fresh start. Something is wonky- get it straightened out before you get the reputation of being the slickest diverter to ever work there.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
OK, stupid question from someone who never worked with IV push medications: Why can't IVP dilaudid come in pre-dosed syringes? Like a 0.4mg syringe, a 0.5mg one, etc? Why does it always have to be in vials and part drawn up and part wasted?
The cost of specialty vials and the extra cost/space of keeping different doses on hand in stock especially if they are uncommon dosages.
Specializes in OR/PACU/med surg/LTC.

Unfortunately on my floor we use the vials again. So we draw it all up in a syringe and after we use what we need, we put the syringe back into the pt specific drawer and then waste at the end of the shift. I'm going to need to ask my manager if that is acceptable on the floor as I don't want to get in trouble. When I work in LTC we do the same thing but we are often working independently and don't have another registered staff member to witness' the waste right away.

Unfortunately on my floor we use the vials again. So we draw it all up in a syringe and after we use what we need, we put the syringe back into the pt specific drawer and then waste at the end of the shift. I'm going to need to ask my manager if that is acceptable on the floor as I don't want to get in trouble. When I work in LTC we do the same thing but we are often working independently and don't have another registered staff member to witness' the waste right away.

If more than one nurse can access those patient drawers, you're screwed. Who is to say what's in those syringes when you go back is still what you put in originally? Who is to say it will still be there when you go back later? And how will you know who replaced/took it?

Specializes in HH, Peds, Rehab, Clinical.

How are you allowed to withdraw MORE than the ordered dose? And I'm sorry, to say, it looks damned suspicious to me as well =(

Jasper676, how did this turn out for you? I am going through the exact same situation and I, too, have learned that while withdrawing more than the ordered dose and saving the remainder for a repeat dose rather than immediately wasting it was good for my patient and their pain needs, it looked suspicious to other nurses and was a red flag. In my case, our dept was so busy and understaffed that finding another nurse to waste at the time of dispensing it was nearly impossible. My situation was a little different than yours. I supposedly had a coworker that reported concern that I was carrying around medication in my pocket for most of my shift, that I asked her to "witness" that I wasted a medication that I no longer had in my possession, that one other time, I shook the vial while drawing out the amount I was wasting so she couldn't see it.....but the following events contradicted the statements. They claim that I did not document the medication waste. So how did this nurse know that I carried medication around in my pocket for most of my shift if I never wasted it nor gave it, and how would she even know that? The other two instances never happened. I was put on paid leave while they did their investigation. They never did ask for a drug test, so I immediately went to another hospital and had one done....I did this weekly x3 tests just to prove they were all negative. Even though they did not do a drug test, they made me go to a rehab center for an evaluation, which was also negative. Then things got really interesting once they found that out. The rehab evaluator had to speak with them as part of the evaluation, to determine what the concern was since I had no history and there was obvious reason for me to be there. This evaluator called me to tell me what they said, and was concerned that they made reference to my personal medical history of a recent injury that I received treatment for at their facility, and comment was made that a narcotic had been prescribed,(which I never even filled) and my medication discrepancies started right after that. How did they know that unless they looked in my chart?? I called medical records and asked for a copy of who had accessed my chart, when and why. I was fired the very next day. The union has filed a grievence, and I have a lawyer, since they told me that they are reporting me to the board of nursing. I have reason to believe that they altered the patient medication record to omit my entry, making it look like medication was taken out of the Pyxis and never administered. The MAR is the only place where you can edit/omit and it does not show up on the patient summary log. But it does show up when medical records does an audit--every electronic log in to a chart leaves a footprint. Why would they do this? Hospitals go through waves of financial ups and downs. This is how they save money--fire a nurse high on the pay scale and replace her with a new grad for half the price. 6 of my fellow nurses had the same fate this year and none of us diverted. I have another terrific job, but I can't wait to see them recognized for their wrong doing. I did learn from this awful experience, and unfortunately, my pt will just have to wait for their pain med for a little while if it will prevent becoming a target.
Specializes in OR/PACU/med surg/LTC.

Ya I don't agree with how my floor is doing it. I'm going to ask what the official policy is.

if the dose is less than the smallest stocked dose in the pyxis, you have to take that vial and waste the overage...

How are you allowed to withdraw MORE than the ordered dose? And I'm sorry, to say, it looks damned suspicious to me as well =(
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