Which way is the right way?

[Nurseynurse11, ASN, RN]

I’m not sure if this is the correct forum I just need some clarity...to keep things short my question is, if a nurse pulls a med from back up like a Pyxis or Omnicell does that same nurse have to administer the medication? Are the rules different if depends whether it’s a narcotic or not? I know that as a nurse you never administer a med you personally did not draw up, pour, or pop but meds from the back up come in their packaging and are labeled.

[JBMmom, MSN, NP]

I think that technically and legally, yes, you should administer any narcotic that you pull from a pyxis. However, sometimes another nurse needs a hand (emergency, precaution room, etc) and I have pulled from a pyxis and handed it to another nurse. It's unlikely that anyone tracks things other than narcotics.

[Nurseynurse11, ASN, RN]

Thanks for responding. I’m just confused because when you get a med from backup you need to pull it out under a patient’s name and the med comes in its package so as long as it’s documented as administered to that same patient in my mind there shouldn’t be an issue?

I was orienting someone the other night and they couldn’t figure out their password for the backup so I pulled a narc and watched them administer it and document it but now I got a call saying it was never documented as given so I need to write a statement and put in a late entry. I’m very confused why the documentation that I 100% witnessed the orientee do is not longer in the system but now I’m also being told that I should’ve been the one to document the administration to begin with being as I pulled the med.

[ruby_jane, BSN, RN]

22 minutes ago, Nurseynurse11 said:

I was orienting someone the other night and they couldn’t figure out their password for the backup so I pulled a narc and watched them administer it and document it but now I got a call saying it was never documented as given so I need to write a statement and put in a late entry. I’m very confused why the documentation that I 100% witnessed the orientee do is not longer in the system but now I’m also being told that I should’ve been the one to document the administration to begin with being as I pulled the med.

Ah. Ok, so you pulled it and never gave it.

So...you see why that's an issue. Next time it happens you can:

Stop the line and get the password; or

pull the med and give it yourself.

[CalicoKitty, BSN, MSN, RN]

The reason people tend to pull and give the meds on their own is accountability. You are responsible for the meds pulled. If someone pulls again or forgets to give, that's on you.

[Nurseynurse11, ASN, RN]

This is true..I completely understand that to my job it appears as though I pulled a med and never gave it which is what really upsets me because I physically watched the nurse give and sign for it so idk what happened maybe it didn’t save somehow who knows. I don’t think they would’ve ever said anything to me about me pulling it and another nurse giving it if the documentation was there. I guess I should really just count my blessings that my job is allowing me to do a late entry and write a statement.

Thanks again for all the insight...this is another learning experience I had to get the hard way.

[JKL33]

So was it actually not documented/filed correctly or is your employer just not making the connection between the fact that you took out X med for Y patient, and another nurse administered X med to Y patient without removing X med from the cabinet (because you had removed it) within the same coincidental time frame that you had removed the med? Have you been able to verify that the documentation isn't there?

Well, in any case, now you know. If you remove a med, it is either administered to the patient by you, wasted by you, or returned using an official return procedure, by you. That's it. Don't do anything else with medications, including handing them to someone else or failing to use the proper procedures for one of the above 3 options.

[Nurseynurse11, ASN, RN]

I haven’t been able to verify the documentation or lack of yet. They want me to go in and document it under my name so when I do so I’ll be able to see if there is an administration by that other nurse noted.

Hopefully that’s the case but I’m not holding my breath. I can’t imagine them not going in and checking. I’m just so baffled that the administration isn’t documented because I really did watch the nurse do it and even helped them write the progress note along with it. I’ve honestly never pulled any type of drug for another nurse before and didn’t think much about it this time around since it was for my orientee but in hindsight I really should’ve been more mindful

[Guest219794]

Nursing standard of care would be 5 rights- right nurse isn't included.

But, apparently your hospital has a different expectation.

[MyaRN]

If you pulled the meds from the pyxis and it should scanned on the pt arm band together with the eMAR on the pt chart.. and it should be documented as given

[JewlB]

On 5/8/2019 at 11:10 AM, Nurseynurse11 said:

Thanks for responding. I’m just confused because when you get a med from backup you need to pull it out under a patient’s name and the med comes in its package so as long as it’s documented as administered to that same patient in my mind there shouldn’t be an issue?

I was orienting someone the other night and they couldn’t figure out their password for the backup so I pulled a narc and watched them administer it and document it but now I got a call saying it was never documented as given so I need to write a statement and put in a late entry. I’m very confused why the documentation that I 100% witnessed the orientee do is not longer in the system but now I’m also being told that I should’ve been the one to document the administration to begin with being as I pulled the med.

Do u use pyxis or omnicell? - what state- some state rules impact what they have to look at

[MunoRN, RN]

Organizations often prefer that the nurse who removes the medication from an ADC is the same person to chart it in the EMR, this isn't a regulatory or legal requirement, it just makes it easer to audit for discrepancies, even though it's not actually that hard view the audit based on patient rather than nurse, so it's more based on laziness and an inability to understand the auditing functions than any sort of rules.

They look for medications that were removed from an ADC but not charted as given to that patient, and the default way of doing that is to compare the medications a particular nurse removed vs what they gave. You can also compare the medications that were removed for a particular patient vs those given to the patient, in which case it doesn't matter which nurse removed them, but that takes an extra button click.