Question about medication return to pyxis

[jcm2696]

So here's the story:

on my clinical cal day it's hard to find our instructor, it's a large unit and there's 8 of us with 2 patients each so I can't always ask her for advice. I was at the Pyxis pulling my amplodipine for my patient and the dose was 15mg. The Pyxis asked how many 5 mg packets I was removing and I said 3. The drawer and pocket opened and I removed the packets. When I was double checking two of the packets were very stuck together so I had to yank them apart so I technically pulled 4 packets. I asked a nurse nearby what to do and she said just return it to the Pyxis so I did that. Then I double check my med with my instructor and she gave me the go ahead to administer them. Prior to scanning them I noticed that one of the three packets was actually a 10mg tablet and the other two were 5 mg. So I scanned and administered the 10mg and one 5mg and asked a nurse what to do since I couldn't find my instructor and she said to just return the extra tablet to the Pyxis. My concern is that there will be a discrepancy on the Pyxis since I said I was only pulling three packets but administered two and returned two. Any advice?

[Wuzzie]

Good on you for checking the packets. This would be a situation where I would hold onto ALL the packets (even the empty ones) and find the nurse taking care of the patient or my instructor to show them what happened and to demonstrate that you did give the correct dose. You are correct that the Pyxis record will be wrong. It will look like you only gave 10mg. What you had was a "near miss" medication error because the wrong dose was loaded into the Pyxis. An incident report needs to be written. To be clear, you did nothing wrong. It was a system error that needs to be addressed. You will not be in trouble.

[jcm2696]

So did I technically return the medications properly?

[jcm2696]

Good on you for checking the packets. This would be a situation where I would hold onto ALL the packets (even the empty ones) and find the nurse taking care of the patient or my instructor to show them what happened and to demonstrate that you did give the correct dose. You are correct that the Pyxis record will be wrong. It will look like you only gave 10mg. What you had was a "near miss" medication error because the wrong dose was loaded into the Pyxis. An incident report needs to be written. To be clear, you did nothing wrong. It was a system error that needs to be addressed. You will not be in trouble.

so I did return the extra medications properly though?

[Wuzzie]

If you did a "return" in the Pyxis yes what you did was technically correct. The problem is that now it thinks you only gave 10mg and this will show up in the unlikely case that they do an audit. Also, the pharmacy absolutely needs to know about the condition of the packets AND that there was an incorrect strength loaded into the drawer. You returned it correctly but there was some follow up that needed done. Fortunately you scanned the meds so there's a record of what you actually gave in the chart.

[AnLe, ASN, RN]

I was at the Pyxis pulling my amplodipine for my patient and the dose was 15mg.

So I scanned and administered the 10mg

I am confused about this. What did the order state to give? Was it to give 3 5mg amlodipine tabs? Because if so, then you made an error. There has to be an order for giving 1 10mg and 1 5mg amlodipine tab for you to administer it that way.

After noticing you had 1 10mg of amlodipine, you should've stopped and gotten the correct dosage of med. Then writing out a "near miss" report for the 10mg of amlodipine that was in the wrong place in pyxis. (Haven't used Pyxis in awhile, there are Omnicells in the hospital I'm at.)

The whole point of an instructor is to run information by them when you're unsure. Our instructors in nursing school always made sure we had their cell phone number to inform them of when we needed them. Yes, you cannot write any patient information, but you can state how you noticed an error in the medication you had, want to know what to do next, or tell them what you are going to do.

[jcm2696]

On the MAR it said 5-10mg tablets=15mg

[AnLe, ASN, RN]

On the MAR it said 5-10mg tablets=15mg

Oh ok, I'm sorry. In the hospital I'm at, they're extremely specific.

I was very interested in knowing that you were able to administer meds without your instructor or a nurse present. We weren't able to do that in school.

[Wuzzie]

I am confused about this. What did the order state to give? Was it to give 3 5mg amlodipine tabs? Because if so, then you made an error. There has to be an order for giving 1 10mg and 1 5mg amlodipine tab for you to administer it that way.o.

Is that how they write med orders in your neck of the woods? In all my years I have never seen the specific strength written out unless it was for a Tylenol or whatever and the order was for 1-2 tabs. Our orders for this particular med would be Amlodipine 15mg PO and we would adjust according to what the Pyxis dispensed whether it was three 5mg tabs or one 10mg and one 5 mg. That just seems awfully picky.

[AnLe, ASN, RN]

With the omnicell I frequently used and the meds I obtained during my final semester, I don't recall it having different dosages in the area it indicated. Sure, some meds had different packaging than others, but they were the same dose.

I want to say that yes, the hospital is picky in how things are dispensed.

[neogirl]

My school didn't allow you to give meds without an instructor right there to cosign.

[NICUmiiki, DNP, NP]

I would have started the return, placed the medication back, but then clicked cancel so the Pyxis thought that I removed the correct dose.

We could give medications by ourselves after checking them with our instructor in our later semesters.

!!!!! There should have only been one dose in any particular Pyxis pocket, and the situation should have been written up to prevent that from happening again.