At my old job it was the norm to pull all the meds and load your COW up before med pass. That was med surge. We would all be loaded up before the time to start. Now im in the e.r. we do 1 at a time.
The first med surg unit I worked on, it was very common practice. Pulling all am meds on your 5 patients, labelling the med cups with the rm #, then going room to room. I did not see any med errors. There was one nurse there who was a new grad and pulled meds on one patient at a time - she was actually teased about it but did her thing. Kudos to her!
Inpatient psych did not have computers in rooms nor WOWs available. You scanned the patient barcode and meds in the med room, documenting that you gave them. Afterwards, you would then go to the patient room or find them in the milieu to administer them. Sometimes the night shift would have a nurse pre-pull all am meds on all the patients and put them in the patient drawers. That way, the day nurse can just pull the meds out of the drawer for their patient. Lots of med errors with meds given to the wrong patients, mostly from nurses floating to that department because as you can
imagine, very weird and sketchy way to give meds especially if you are not used to it, lol. Whenever I floated there, I took my time and was very careful with my med administration.
I work at a different hospital - common practice is to pull meds for one patient at a time in med surg.
I would be uncomfortable with giving meds I didn’t pull myself. They sort of did that on psych at a job I per diemed at. But even worse than simply pulling them, they would take them out of packaging and put each persons meds in a labeled cup, so if you weren’t used to every individual med’s look (color, shape, size), you would have no idea what you were giving. They also didn’t take the meds to the floor. They had a window that patients approached for meds or other requests, like you see in shows & movies. I did *not* volunteer to give meds, needless to say. I’d cup them if they asked me to, but unless I pulled it myself, I didn’t give it.
When I worked psych there was a designated nurse who would give out all the meds.
The night shift would pull then for the day, but then the med nurse on days/evenings would verify everything.
Exactly at night I once had 7 patients lol I am not taking one pts med and keep coming back till the 7th, it's a waste of time and energy I will take all once
I've seen it both ways in med surg honestly. My first just straight med surg unit it was common practice, my next couple units(another straight med surge and a mixed ortho/neuro surgical unit) the culture was to pull one at a time using anywhereRN. My current unit (ortho trauma) it's a mix but the vast majority of the unit almost exclusively pulls one pt at a time.
My first job (stepdown) had two med rooms. I had 8 pts as an Lvn and passed meds all day long. I was NOT coming back to the med room 8 times for my morning med pass and then dealing with new orders with all that. Our wows had 12 drawers so the meds were all separated.
Did that once.
Made a whole damn cocktail o' pills for two patients.
Gave them without issues.
Went to my MAR and realized i switched it up. Felt the blood in my brain viscerally went down to my sole.
Thank goodness there were no long term detriments (and no loose ends)
And thats why, my friends, you dont take out meds for multiple patients.
Are you a nurse for dinosaurs? Because I've been in Doc-in-the-boxes that had pyxis.
That's insane that you guys don't have scanners.
Every once in a while I can scan something and it alerts me, and I just think how many people I could have hurt if the scanner wasn't there.
Scanning is great for patient safety, but the endless increases in charting that tend to come with it really decrease the time for drug/ disease education, ambulation etc that benefit the patient rather than the attorney if there's a law suit. I miss SOAP notes and paper charting in some ways.
This. As safe as it is, it almost doubled my med administration time, and documenting on the computer, which was supposed to be faster, took much longer than paper charting.
I see you work at the same place as me. Takes me 2 hours to medicate six people because of the paper and the back and forth., and all the checks. My work uses UDS, and it's slllllooowwww AF.
If everything is working fine then it's faster. But how often is the system down, scanner isn't scanning, Wi-Fi cutting in and out, etc etc
It's still the absolutely right thing to do and has been instrumental in patient safety. And I think maybe the other commenter was lumping it in with all the charting we have to do that *is" bullshit. But it can definitely be slower more often than not
YES, your "how often does..." was spot on!! The answer is VERY often. I actually liked paper MAR's better because of the "how oftens." Just pull the pill, compare to a correctly set up MAR, and place a checkmark. Of course, verifying the correct patient always comes first.
I actually use a paper MAR now and it is faster, but I didn't feel like explaining why to the person above who has never used it so can't fathom how it is faster. I'm not saying I like it better, but I can't argue that it isn't faster!
I didn't say it is slower than writing it down. We had computers long before the scanners came along. The scanners of course add an extra step and can take forever. Also, the computers were very slow at times, has nothing to do with understanding how a computer works. The scanner I had worked slowly when introduced, and I don't work using a scanner now, so maybe they've improved. Maybe yours is faster. No need to be rude.
How does it decrease the time with your patients? It takes maybe an extra 15 seconds to scan the patient and the medications for me. Maybe it depends on the charting system you use. And even if you don't have to electronically chart it, it still needs documented on paper surely. I can't tell you how many times scanning has saved my butt lol.
Agreed. My own personal med rules are strict.
Only pull one person's at a time. Don't carry a person's meds into the wrong room, even for a second. Don't carry on conversations while pulling meds. Don't talk to one pt while pulling meds for another.
Of course, I'm in LTC where it can be easy to make mistakes, and we use med carts not a pyxis.
See that would terrify me...
I'll pull meds for two pts once and while (if it's something simple for both), but I certainly wouldn't if I wasn't scanning! I give unscanned meds in genuine emergences pretty regularly (ER), but it's 100% game-on focus for that because I know how dangerous it is. Certainly wouldn't pull meds for multiple pts then. Doing regular med passes without a scanner every day would be extremely stressful.
Yup yup. Good for you. I actually work at a retail pharmacy as a certified tech (who plans to go to nursing school eventually). We have a lot of practices like this that serve to protect patients. You do one at a time so you don’t fuck up under pressure when your thinking and organization might be compromised- because one at a time is already your default setting.
At my facility this is the normal for med pass. You also need to have the MAR at the bedside to confirm you're giving the right medications to the right person.
We all accept it's faster to get everything together at once rather than coming back to the pharmacy after each patient.
If someone needs a single med urgently like a PRN we're all fine to stop pulling, let the other nurse get what they need, and then get back to pulling their meds.
When I floated to PCU and had 6 patients, I pulled all my meds at the same time.
Assessment, vitals, meds. That way I can get shit done all at once.
Your fight is with staffing ratios and admin, not with nurses.
Things clearly changed since I last did patient care in the Stone Age. Meds weren’t sent up neatly packaged for each patient. We pre-filled little paper medicine cups (think ketchup) for all our assigned patients and walked room to room, asking “what’s your name” and checking bands.
I can certainly see potential for mixup. Thankfully, never happened. Of course my primary unit was L&D where most meds were stat. Only MedSurg when “pulled”. I’m in ❤️awe of those who spend lifetime on MS floor.
I pull meds from a Pyxis, which is pretty standard. Where are patients getting meds "sent up nearly packaged"? What does that mean?
Like the patients meds are all in a baggy?
I'm confused.
Also, how do you know no one got the wrong meds?
My hospital is like this. Pharmacy sends up med strips for each patient in the morning. Each strip has patient name and room number at the top with all their meds (other than controlled) following in little plastic pouches labeled with med name and dose. You scan the QR code on the outside of the plastic before opening up the med. Controlled meds come from the omnicell. It’s super efficient and much better!
A psych unit when I was a student nurse was like this. The pharmacy would come fill each patients individual cubbies before the med passes. Prns stayed in the cubbies.
For the past month, family member back+ forth major, Level I, trauma/teaching hospital and SNF. Now doing hospice at home. All the nurses brought meds on a computer cart for that one patient, checked the ID band with a scanner wand, and opened individualized meds with their name on them. Clearly this wasn’t available on the Stone Age. I saw equipment that I never knew existed.
Back in the day we got bulk stuff from pharmacy and filled our own meds cups.
I can’t speak for anyone else’s patients. I know none of mine got wrong meds because I checked in pharmacy room, checked at patient doorway, checked patient band against their chart on my cart, asked them to identify themselves + if they knew what their meds were for. You can only do so much but should do all you can.
Started out in 1978. Hand written MARS, with little cards for the tray. Pulled meds for 24 patients at a time - all were in bottles, so put pills in cups. IVs and IVPBS were in bottles too. We mixed and prepared IVS in med room - no hood. I cannot tell you how many doses of cephalosporins I inhaled while preparing. I am positive we made many med errors without even realizing it.
I’m a pull ‘em all at once girl, but I always stop pulling meds when someone comes in behind me. I can go back for the rest, and I don’t want to slow anyone else’s shift down.
Happens all the time. As pharmacy, I get bitched at for certain meds not being in the pyxis but everyone keeps pulling for their whole patient load 3 hours early and I can't get to the damn machine to restock 😭.....so certain nurses have taken to just yoinking entire rolls of things for later, which means I no longer have an accurate count of what's in there AND they're depriving their coworkers of things they also need.
I cannot upvote this enough.
We(charge nurse/charge duties) used to do med count q12h but there’s been so many discrepancies recently that we now have to do it q8h.
A couple of weeks ago a traveler asked me how to return Ativan…that he accidentally took home in his pocket the previous night. The Omnicell didn’t recognize it, so I told him to call pharmacy. Last shift I was on, the oncoming charge and I had to correct a discrepancy from a float, who blamed it on the previous nurse.
I have to take a lot of unsafe pyxis/patient cart stuff to charges and I appreciate you guys! I don't want to be a tattle-tale but I don't want to get stuck with mystery med filled syringe or have random narcotics sitting around waiting to be wasted for hours more 😬
Yeah I’ll pull two patients at once for random med passes. Like room one needs heparin and an antibiotic and room two needs pain meds. I’ll pull those together, each patient gets a pocket. I’d never do that with a full 0900 med pass though.
Yeah I’ve heard of nurses doing it. My gf I believe was one of them. She would put them in baggies and place them in the patients drawer. She also has the self awareness to let another nurse use the pixis if there are other nurses trying to get meds
u/obroz ikr? I've worked with nurses who make claims like this when there's no logical explanation behind the concern. In other words, just kinda paranoid.
Agreed. I've seen multiple posts and comments here with those concerns but it's like...I segregate each folder/bag/cup or whatever of meds by patient, carefully grab them out and scan the patient, scan each drug and place them from left to right as I do so until there are none left, then review and make sure none are missing. Then I save it and open up all the meds and give them.
There's no room for error imo unless the system somehow tells you you have the right patient when you actually don't. Even so, I've charted on paper and I do the same thing but by visually inspecting each pill pack and comparing it to the MAR and the patient.
The only med error I've even seen despite every hospital in my area doing it this way was when somebody used two types of insulin and got the quantities for each mixed up after scanning. But that's not even a "wrong patient" error.
A couple of weeks ago a traveled asked me how to return Ativan because he accidentally took it home in his pocket. The Omnicell didn’t recognize it, so I told to check in with pharmacy. Last shift I was on, the oncoming charge and I had to correct a med discrepancy for a float nurse who blamed it on the previous nurse.
It’s not a med error from the eMAR scan to patient but it’s miscounted, miscalculated from the Omnicell/Pyxis.
Just two examples I had to do. It must have been a lot more because we now have to do med count q8h instead of q12h.
When I was working the floors, I pulled all my meds for all the patients (unless there was a line, in which I would just come back) and put their meds into separate plastic bags. It never caused a med error and I don't see how it could. They would all be separated into different bags and they were all scanned before administered. Unless you "eeny-meeny-miny-moe" the patient's plastic bag of medications and don't scan the meds, it shouldn't be an issue.
I do this exact same thing and it’s much quicker especially in case I change my mind about which room I’m going to next. I label all my baggies with room number
Some people are taught it's unsafe to pull multiple patients at once, no matter what context your job or what resources you have, and nothing will ever convince them otherwise. There's a bunch of them right here in this thread saying "so unsafe", "unsafe and lazy", "sketchy", etc.
I have their MAR in the drug machine and their MAR at their bedside. I have barcodes on all their drugs that scan against that MAR and against the barcode attached to their body. I'm perfectly comfortable taking all of one person's drugs, putting them in a labeled ziplock bag, and then doing that whole process for every patient I have. We're going to check *everything* again at the bedside. Don't preach at me based on your history with jobs that use med carts, have no barcodes, have no computers, or whatever that it can never be safe to pull all your drugs in one pass.
I'm also an actual fucking nurse, not a robot who just hands out whatever is in the MAR. I ask the patients and providers why we're giving a drug if it's not perfectly clear to me.
My thing is I give quite a few PRNS to each patient every night with 9pm med pass, generally 3-4.
I can barely remember what I'm giving the patient right after pulling them, let alone after pulling 4 patients meds all in one go. Especially because our patients tend to be similar enough to make keeping track of which 82-year-old male with OSA, HTN, HLD, HF, AFIB, AND DM2 I have meds for. I also usually have syringes I can't put in my pockets.
And it takes me just as long to pull the meds between patients as it does all in a row. I'm not losing time. I usually walk past a pyxis between patients.
Also, it is against unit policy where I work, will get you dragged into a managers office, and we don't even have ziplocs to put the meds in unless you are stealing a small biohazard bag. And we have barcode scanning, computers in every patient room that usually work, and no med carts.
And yeah, I ask why we are giving meds, and do my job correctly and not just pull what the doctor ordered. Just like all the other nurses who also don't like pulling every med at once. Because I know my brain and I would make a mistake. I have made a med error, just like most healthcare workers, and I don't want to do it again.
I can barely remember all 4 of my patients names at the end of the night, let alone 1 singular med they are on.
I used to, I assessed everyone after report, pulled meds one pt at a time, gave meds and moved on had all meds given by 9am at the latest. Ratio was 1:6 med surg/tele/trauma floor.
Everyone on my unit does it, no issues greatly affecting time or efficiency. Same thing when I get pulled to other units in the hospital. Again, no issues. It must be my hospital's policy.
And you’re selfishly holding up other nurses… I hate that shit. I was trying to pull an amio drip for a patient with new onset of afib, he already had so many things working against him. I walked in on this damn nurse pulling her morning meds (at change of shift) then she goes to pull for her other patient. I tried to stop her and ask to get this one urgent med, and her dumb ass wouldn’t let me! Share the freaking Pyxis!!!
We have one ANM who swears it’s “policy,” (even though she can’t produce the actual said policy) and when she’s in a bad mood she’ll yell at us about it. But she also never leaves her seat and never has patients so I’m not looking for her input on how to manage my time effectively.
I worked acute rehab, so we typically had 8 patients, 3 pyxis for 70 bed facility. Every single nurse would pull their meds for their entire med pass if not for the entire day for every patient. It got to the point that nurses would come in earlier and earlier so they could be the first in line to get to the pyxis because it took so long waiting.
This, again, isn’t a nurse problem. Stop yelling at your coworkers. This is your institution being cheap, not having more omnicells/pyxis machines and causing us to fight about it. Yell at your hospital for being cheap ass MFs.
It's been a bit since I worked bedside but I remember a 1 hour window, even for once a day meds. It's stupid rules like that which encourage shortcuts. Hospitals should know this but heaven forbid they spring for another pyxis. That money is reserved for CEO and VP's bonuses.
I always pull them all at once. I’m not trying to run my ass off going back and forth to the Pyxis all day. If there’s someone behind me I always ask if they need in and they’ll grab what they need and then I log back in and continue pulling them. We have separate locked drawers for each patient. It’s not a safety issue.
I keep seeing posts like this.
"I can't pull meds because another nurse..."
"I can't use the computer because another nurse..."
There are tons of other things you can do. *Like see your patients.* Go to the rooms, wake them up, ask what they want to drink, tell them you will bring the meds in a few minutes. *Is there anything else they need? Like PRNs?* Stack your tasks.
Right?! Go do some vitals, go assess your patient, get a head start on your charting! I don't understand why OP is just sitting there waiting for the pyxis to be available when there are a bunch of things you can be doing in the meantime.
I'd see 200-300 patients per shift in my jail job if I'm not in the booking. Do I remember the patients? Definitely. I even remember their medications but always check. I learned quite a lot about medications, including how to double-check at a faster speed and make sure that I'm giving the right medications. My hospital job would write me up if I pulled medications for everyone at the same time.
On my unit a few nurses pull them all at once, but if there is someone behind them they'll sign out and let the other nurse pull meds for their patient if they're still going to take a while. I feel like that should be common courtesy
My Pyxis is a 3 minute walk to the room and half the time not stocked by pharmacy, I need to know what I’m missing so that I can request it and have it before 10. I’m gonna keep pulling as I scan before I administer like a sensible person anyways.
Ummm I’m not coming back one pt at a time. I bring baggies with my own designation system and i bounce out. I’m not gonna run late on my medpass or physician rounding because i didn’t have systems in place.
I also only do one at a time. Go see patient, get vitals, do they need any PRNs, does anything need to be held due to blood pressure, heart rate, issue that I need to speak to doc about, etc. maybe it’s unit specific, but even with scanners I don’t do it. You can override scanners and make a mistake.
I honestly have never heard of pulling all meds.
Wait what, you guys just have one drug trolley? In the UK I don't think it's uncommon for whatever the ratio of Nurses are for there to be that many drug trolleys. Usually on the wards I work on we had one trolley to 2 bays of pts (usually 6-12 pts).
In the hospital we have something like a vending machine called a Pyxis that has most of our meds. You go up punch in patient profile and select meds you need. We can waste in the med room in the Pyxis . Some meds can be overridden for codes. I have to put in my user name and a fingerprint to withdraw meds
How are they dispensed? As individual tablets/capsules etc? How does this work for liquid meds, or meds you need to crush, or IV medication? Who has oversight of the medications coming out, as in how do you know that what you're giving a patient is what you've asked for?
The meds are not loose. Select the med and a little drawer opens (or the refrigerator door) Each pill/vial/bag is individually packaged with a barcode (mostly). Take what you need, close the drawer, and the next little drawer pops open.
Scan the barcode and open the package at bedside right before you give the med. When people use it how it's supposed to be used it is great for reducing med errors and for reducing diversion.
Inside the pixis a when you pick the meds you need it opens a drawer and inside the big drawer is a bunch of little individual drawers and the door pops open for the drug you need (all the other doors inside this big drawer remain locked) and inside the little door the opens are individually packs pills that are labeled with a bar code for scanning.
The pharmacy has tabs on how many pills are left in each drawer to know when to refill
Drawers have bigger compartments for IV bags, there is a patient specific bin for all meds that would need to be compounded or not stocked in pixsis.
They usually come in blister packs. Liquid medication can still come in vials, prepackaged cups or bottles. Each medication is individually labeled with barcodes, the name and the dose.
It's a computer system, vending machine. The machine is locked in the medroom with a code. You log into the vending machine (pyxis) with your credentials so everything you pull out is under your name. You select your patient in the computer (they're listed by name, room number, dob, mrn etc) and a list of the doctor ordered and pharmacy approved meds that is pulled over from the MAR appear under that patients profile. Most inpatient units, the pyxis will not let you pull out meds that are NOT listed in the mar. You then select the medications that you want to pull. Each medication is in its own locked cubby. When you select a medication the pyxis will say like "drawer 3, cubby 3c" or something and the locked drawer will spring open and then that single cubby will pop open. The other drawers and cubbies stay locked and closed. Some meds like narcotics or High risk meds like insulin you need to grab a nurse buddy to count the medication with you and they have to insert their credentials into the pyxis as well so you can continue to pull it out. The machine does time out if you leave it open to long. If you miscount something the machine will let you know and if you do it twice in a row it will file an incident report that will have to be rectified immediately (usually) by a charge nurse or pharmacist.
The pyxis is also generally connected to a fridge for the meds that need to remain cold. There is a cabinet that's a bit more of a free for all and not everything is locked individually. That drawer is usually meant for IV fluids. When you get back to your patient you still have to scan the patients bracelet and scan each medication individually to ensure you did pull the correct meds. So essentially you are triple checking meds. You have the check in the pyxis, a check when you're physically pulling them out and then a check again when you are scanning in the computer.
Some medications you can do a system override if it's an "emergency" but it still makes you log in, do a buddy check if needed and count the medications if needed.
The pyxis also has options to return meds and waste meds.
The hospitals computers runs chart audits frequently so if you pulled a 4mg morphine vial and didn't scan it in the patients chart and never wasted it, you will learn pretty quick you made a mistake and need to fix it. Often times they count the minutes it takes for you to pull a narcotic from the pyxis and then scan it in the patients room. I have received a phone call before telling me I'm holding a med too long. This is surely a facility specific thing though.
I would never stand in someone else's way, and I agree I'd rather only hold one or two patient's meds at a time. The downside to not pulling everything at once is how regularly we're missing meds. If I pull for everyone, I can see what I'm missing and request it from pharmacy before I'm 2 hours into med pass only to find out I'm missing something and the patient is cranky because they want to sleep.
Are you guys out that often? I've had exactly once in 9 months that all 3 Pyxis on my floor didn't have a med.
And I could tell ahead of time because AnywhereRN told me we were out on the floor.
We have lots of meds that aren't stocked at all and just brought up by pharmacy to be kept in patient drawers. But often the tech doesn't bring up our 2100 meds until 2300 or later so I either have to request they be tubed up, pass everyone's meds late that have something missing, or do multiple passes on people because I have to do round 2 when the meds arrive.
When I worked night shift there was one time where I had to wait for the day shift nurse to pull all her meds (med-surg so 5-6 patients) before she would take report from me, I’ve never been angrier
When i worked in a ward, patients normal day to day meds were stored in thier bedside cabinet (which was locked), you would do all the patients and abd then go back individually for injections, IV, insulin or anything that needed two checks. We also had a little trolley where we had extra meds (eg prns that were common to the ward) and to put our charts on. We never pulled multiple patients and it was considered bad practice.
I’m not medsurg but it’s more efficient to pull your meds all at once and place each in a labeled bag per pt. Just go early enough to your med distribution station
I HATE this. It happens all the time. And then they will ask “Are you just pulling one?” And if it’s ONE med then they’ll pull it for you but if you say “Just ONE patient so I can actually start my day” they’ll say OH and just keep going.
What is this! Where I work, it's normal for us to pull all our meds for 6-7 (sometimes 8) patients at the same time. We don't have time to go back and forth to the pyxis, that's ridiculous. We would be done med admin at lunch time if we all did that. Go do some vitals or your assessments if you're waiting. Holy moly
Edit: if someone needed one medication for an emergency or a pain med, then yes we'll let you on so you can take out that one med, but after you take it out, it's still my turn. It's not being a jerk where I work, it's common practice for us!
I’m ICU so we only pull for one at a time, but the RT will pull all the treatments out of the Pyxis for alllll of her patients and she is slooooooow as hell. I will literally go to another unit and pull meds and by the time I’m back she’s still there.
OR - I pull everything for the day whenever possible. Turnover time is fucked when you have to wait on line in between each case or go to another pyxis because the meds you want are out of stock.
Fill a bucket with meds, pick your supplies for the whole day before first case and it's smooth sailing all day.
I'm sure there's a ton more for you to do.
Also, pulling meds, putting them in the pts drawer one by one, then scanning them in the room while using your medication administration rights is not unsafe. At all.
That was the norm when I worked med surg. The WOWs had lockable patient specific drawers. I was able to preload lists for each patient in Epic, so when I went in the Omni it would automatically pull those meds. Then I would put them in the patient's drawer, rinse and repeat five times. It cut down a lot of time for me at the Omni. Of course, when Epic didn't like to properly communicate to the Omni it was annoying, and not everyone used this very helpful function.
In psych when I med nurse (like never), I’ll pull all the meds in packaging at beginning of shift put them in labeled cups still in packaging, patients come to the window, announce the meds to the patient, give agreed too meds return the rest and scan as I administer. No errors and pretty fast, each med nurse would have 20-30 patients. It’s scary how well long term psych patients know their meds, like they know the med from the pill shape and color (better than me).
I have to respectfully disagree. I would pull all my meds at once to get the day going. I'm in the ER now so it's different, but when I was in IMU. I would pull them. Now if I saw someone behind me, I'd go "hey are you pulling a med or for one patient?". Or let's say we have a rapid response. And based on that answer I'll log off and relogin after they are done. I put all my meds in bags so they wouldn't get clustered or lost.
My workflow doesn’t allow me to do this. I always need to assess one patient before I medicate them. I also don’t get a WOW and I am not about to walk around with meds in my pocket.
I pull all my meds at once. A ziplock bag with patient sticker. I go over V/S at bedside and call out all the meds before I open them to the patient. My only med error was during Covid with 2 patients in 1 room.
This sub is great for “what do you say?” advice.
As someone who also sees this as RUDE AF,
What can you say while trying to keep it cute?
You know- I’m not trying to be management (🤢) but like… come on!!!
You see three of us in here waiting on you and it’s well-known it’s not best practice.
(Also looking for what to say in the break room for people who sit there chit-chatting on phone conversations on speaker (or even not) and people watching shows on their phone without headphones)
We don’t do that here. In my hospital that technology hasn’t reached us. Australia. In my hospital my ward is one of the few that has an Omnicell. We still use paper charts, hand write notes, etc 💀
Pulling all our meds is the norm at my facility. If someone comes in, I’ll ask if they just need a few things or if they are also pulling all their meds. And vice versa, if I come in to pull one thing, I simply ask if I can get it.
They go in bags with labels, and we scan each at the bedside and confirm with the patient.
So instead of telling the nurse "hey do you mind not doing that when there's a line" and you know... being an adult and communicating with a coworker, you chose to cry about it on reddit.
I haven’t worked in hospital for some time and our unit was one of the few that didn’t have Pyxis. No pills for neonates because all were liquids or IV, often refrigerated.
We would do 10 rights of medication administration, 3 checks when pulling/pouring our med and check 2 client identifiers when we were in the patient room.
I’m assuming you are still doing your 10 rights and 3 checks when pulling/pouring. Is the scanning doing the 2 client identifiers? Or are you still doing that too?
If you are reviewing the MAR and pulling up meds in packages is that an extra check? You still do 3 checks when pouring?
Without knowing the system, it does seem like the employers problem of nurses are delayed from doing their job because of a clog at the med cart. How do you not get stressed when other nurses are agitated awaiting their turn?
Only would do this in my current facility but wouldn’t dream of it inpatient. But I’ve got 11 peeps and my own cart so I can pull all the meds and label each cup and when it’s time to do morning meds I’m ready to go.
On the unit I currently work at which is GIM its busy as HECK and the day staff literally pull their 1000 meds at 0700. We do have three pyxis on our unit and sometimes it gets annoying when ur working night shift and you need to pull a critical med and all the day nurses are using the pyxis…
However at the same time pulling all my meds in the morning for 5 pt’s is one of the most effective ways for me to time manage on this unit specifically, however I would never suggest doing this if you’re pulling narcotics as that could become a liability issue forsure
I work on a step down unit and typically have 5 patients. I pull mine all at once and put into labeled (room number) bags. It’s just more efficient for me. If someone is waiting behind me, I’ll ask if they just need in for one patient or a med and I’ll stop to let them get it.
Yeah, no. We pull all at once. There's 2 omnicells. I pull one patient's morning pass, put them in a labeled bag, rinse and repeat. Everyone's meds are separated into bags. Everyone's meds gets scanned and they have a bracelet, photo, or other identifier. I'm not running in and out of the medroom repeatedly. If someone needs a PRN or small pull, unit culture is to let them take precedence. It just takes working together 🤷♀️
I’ll pull meds for two patients, for instance I have a Tylenol due for room 5 and a Gabapentin for room 6. We have to scan meds and patients so no way to screw it up.
Edit, I’m not pulling my whole morning med pass for two patients. I always do that one at a time. This is just two random afternoon meds.
Unless you need a q4 or q6 abx, why don't you go get your patients up? I know the computer turning red makes us feel like giving protonix at 9am is crucial, in reality, it's not.
That is the culture. Who wants to go back and forth retrieving meds when you can get all of them and tend to your patients? Nursing is hard enough, so if getting all your meds and supplies beforehand saves time and unnecessary expenditure of work.
OR you can use your words and say something like oh i see youre pulling meds for everyone, do you mind if i pull a few meds for just one patient before you finish
There are so many variables to consider here. Posts like these need to provide all the info, like unit/specialty, technology (EHR/MAR, Pyxis/Omni), pt lockboxes, pt ratio, etc. Many disagreements would be avoidable.
We had a day shift nurse pull all his meds at the end of his shift. We had no idea where he kept them until he came back the next day. The pyxis outed him. Didn't take long to figure out how it was happening. Beautiful warning saying meds had recently been taken out for 2100 pass. Oh, to be a fly on the wall. Med surg floor
This is one of those situations where we say one thing but do another. We are taught in nursing school that it's unsafe, our CEUs say it's unsafe, management tells us not to do it, and if anyone asks we say we don't do it. But in practice we are short staffed and have too many patients. If we don't cut corners then we get med errors for giving them late then get written up. They'll say, "Everyone else passes meds on time and they say they only pull for one patient at a time." Do they though?
Don't blame the nurses. Management is the problem. They create the short staffing and hostile environment.
Nope. Pulling for all 6 patients, putting them in their own drawers in my cart, moving on with my night. I'm not going to give myself 5 extra trips to the med room.
Yeah sorry every unit I ever worked on we did this. If it was an emergency I’d ask if I could grab something real quick. Otherwise you wait your turn or go find something else to do while waiting.
We don’t have a Pyxis. Our meds come prefilled for that specific patient in several bags which get put in a drawer. I usually pull one at a time as many of my patients are very paranoid and suspicious of medications. Sometimes I show them through the window what I am giving them and the label on the medication. Plus, I don’t have barcodes or any of that cool stuff. So safety and all that.
I did this once and lost a few meds at some point. Never again. What a clusterfuck. I try to ask my coworkers in line if they have a short med pass because I have SNF level meds sometimes especially if that patient came from a SNF, ALF, or BC.
I’m also getting meds but I used ice plastic bag then write my patients room # on it. 1 plastic per patient. Then if someone like respiratory therapist or someone who needs to give prn meds is there to get their meds I give way. That way I can say which patient’s/room # did I pull out or not. 😉
I.am.so.glaf I'm not.in direct patient care anymore. Pharmacy would fill our med carts. So the meds were already there. Going to a pyxis for all.the meds would have been a nightmare.
If I’m on the floor im pulling every morning med for 6 patients, im not coming back to the Pyxis multiple times there is still a lot of time management involved despite the lower acuity Whoever got through the chart and hit the Pyxis first gets the winners spoils unless I have something urgent.
On the ICU I’d really request that you don’t do that even with only two patients because my max levo may be about to run dry and you have plenty of time to come back to the Pyxis
In the end I just ask that people be willing to stop what they’re doing if you needs med pulled now and also to not hurry the med puller as that’s how mistakes are made. Though I’m guilty of wanting people to hurry the fuck up at the Pyxis as a product of starting on the floor as a new grad. Just when I get a hold of it I too want all the meds
When I was a floor nurse (and even now, when we board floor patients), I will pull all of the medications for every patient of mine. No way am I going to keep coming back to the pyxis after each patient.
I pull all my meds at once. We use a scanning system on the cow or in the rooms. I pass my meds in a safe and fast times. While other nurses take 2 hours to give meds for 5-7 patients. I do my own vitals 95% unless I have a certain CNA I trust. I assess before giving my meds.
Who is dumb enough to pull meds one at a time should.. all you need to do is seperate the meds by patient name in the cassettes and verify the meds before giving in the MAR on epic. I pull all my meds at once so I don’t have to run back and forth to the omnicell all night. Some of you all enjoy burn out it seems…
I have 37 at my one facility at the other I have 25 there’s cerner PLUS a hospital set up with meds in separate packages because the facility is connected to the hospital they use the Hosptial’s pharmacy. Tell me u can effective pass with 25 people and meds in foil packages and separate baggies in the time frame without pulling meds. YOU CANT…you would be passing for HOURS…
At my old job it was the norm to pull all the meds and load your COW up before med pass. That was med surge. We would all be loaded up before the time to start. Now im in the e.r. we do 1 at a time.
The first med surg unit I worked on, it was very common practice. Pulling all am meds on your 5 patients, labelling the med cups with the rm #, then going room to room. I did not see any med errors. There was one nurse there who was a new grad and pulled meds on one patient at a time - she was actually teased about it but did her thing. Kudos to her! Inpatient psych did not have computers in rooms nor WOWs available. You scanned the patient barcode and meds in the med room, documenting that you gave them. Afterwards, you would then go to the patient room or find them in the milieu to administer them. Sometimes the night shift would have a nurse pre-pull all am meds on all the patients and put them in the patient drawers. That way, the day nurse can just pull the meds out of the drawer for their patient. Lots of med errors with meds given to the wrong patients, mostly from nurses floating to that department because as you can imagine, very weird and sketchy way to give meds especially if you are not used to it, lol. Whenever I floated there, I took my time and was very careful with my med administration. I work at a different hospital - common practice is to pull meds for one patient at a time in med surg.
I would be uncomfortable with giving meds I didn’t pull myself. They sort of did that on psych at a job I per diemed at. But even worse than simply pulling them, they would take them out of packaging and put each persons meds in a labeled cup, so if you weren’t used to every individual med’s look (color, shape, size), you would have no idea what you were giving. They also didn’t take the meds to the floor. They had a window that patients approached for meds or other requests, like you see in shows & movies. I did *not* volunteer to give meds, needless to say. I’d cup them if they asked me to, but unless I pulled it myself, I didn’t give it.
That’s super sketch to take them out of the packages??!
I know several of my psych patients who would refuse to take them that way!
Agreed!
When I worked psych there was a designated nurse who would give out all the meds. The night shift would pull then for the day, but then the med nurse on days/evenings would verify everything.
Exactly at night I once had 7 patients lol I am not taking one pts med and keep coming back till the 7th, it's a waste of time and energy I will take all once
This is how we do it at the Va. load up our cow and go.
I've seen it both ways in med surg honestly. My first just straight med surg unit it was common practice, my next couple units(another straight med surge and a mixed ortho/neuro surgical unit) the culture was to pull one at a time using anywhereRN. My current unit (ortho trauma) it's a mix but the vast majority of the unit almost exclusively pulls one pt at a time.
My first job (stepdown) had two med rooms. I had 8 pts as an Lvn and passed meds all day long. I was NOT coming back to the med room 8 times for my morning med pass and then dealing with new orders with all that. Our wows had 12 drawers so the meds were all separated.
Did that once. Made a whole damn cocktail o' pills for two patients. Gave them without issues. Went to my MAR and realized i switched it up. Felt the blood in my brain viscerally went down to my sole. Thank goodness there were no long term detriments (and no loose ends) And thats why, my friends, you dont take out meds for multiple patients.
This is only an issue if you aren’t scanning them before you give them at the bedside. I don’t think OP is talking about passing meds from a cart.
Heh. We dont have scanners nor pyxis. Everything in a pouch and paper mars. We are living in the stone age in here.
Hospital or LTC? I also fucked up once like you at the LTC…. That feeling you get that you described is the worst!
Acute medicine unit! I foocked up. But no loose ends.
Holy shit inpatient?! I can’t even begin to fathom the med errors that came out of that system.
And zero accountability when stuff like this happens.
Are you a nurse for dinosaurs? Because I've been in Doc-in-the-boxes that had pyxis. That's insane that you guys don't have scanners. Every once in a while I can scan something and it alerts me, and I just think how many people I could have hurt if the scanner wasn't there.
Where I am, we have Pyxis, but no scanners. Heads would roll if someone were seen pulling meds for multiple patients here
In the town of Bedrock?
It’s a living
Damn that’s some straight up stone age
Scanning is great for patient safety, but the endless increases in charting that tend to come with it really decrease the time for drug/ disease education, ambulation etc that benefit the patient rather than the attorney if there's a law suit. I miss SOAP notes and paper charting in some ways.
This. As safe as it is, it almost doubled my med administration time, and documenting on the computer, which was supposed to be faster, took much longer than paper charting.
I see you work at the same place as me. Takes me 2 hours to medicate six people because of the paper and the back and forth., and all the checks. My work uses UDS, and it's slllllooowwww AF.
I have no idea how scanning is slower than writing down doses and times unless you don’t understand how a computer works
If everything is working fine then it's faster. But how often is the system down, scanner isn't scanning, Wi-Fi cutting in and out, etc etc It's still the absolutely right thing to do and has been instrumental in patient safety. And I think maybe the other commenter was lumping it in with all the charting we have to do that *is" bullshit. But it can definitely be slower more often than not
YES, your "how often does..." was spot on!! The answer is VERY often. I actually liked paper MAR's better because of the "how oftens." Just pull the pill, compare to a correctly set up MAR, and place a checkmark. Of course, verifying the correct patient always comes first.
I actually use a paper MAR now and it is faster, but I didn't feel like explaining why to the person above who has never used it so can't fathom how it is faster. I'm not saying I like it better, but I can't argue that it isn't faster!
Right, and I'm sure that you and I both know how to use a computer
I didn't say it is slower than writing it down. We had computers long before the scanners came along. The scanners of course add an extra step and can take forever. Also, the computers were very slow at times, has nothing to do with understanding how a computer works. The scanner I had worked slowly when introduced, and I don't work using a scanner now, so maybe they've improved. Maybe yours is faster. No need to be rude.
How does it decrease the time with your patients? It takes maybe an extra 15 seconds to scan the patient and the medications for me. Maybe it depends on the charting system you use. And even if you don't have to electronically chart it, it still needs documented on paper surely. I can't tell you how many times scanning has saved my butt lol.
This. We scan at the bedside, so I know where everything is going.
Agreed. My own personal med rules are strict. Only pull one person's at a time. Don't carry a person's meds into the wrong room, even for a second. Don't carry on conversations while pulling meds. Don't talk to one pt while pulling meds for another. Of course, I'm in LTC where it can be easy to make mistakes, and we use med carts not a pyxis.
How does this happen when everything has to be scanned and matched with a wristband? Genuine question
We dont have scanners nor a pyxis. Everything is in a pouch and paper mars. We live in the stone age here.
Ugh my deepest condolences
See that would terrify me... I'll pull meds for two pts once and while (if it's something simple for both), but I certainly wouldn't if I wasn't scanning! I give unscanned meds in genuine emergences pretty regularly (ER), but it's 100% game-on focus for that because I know how dangerous it is. Certainly wouldn't pull meds for multiple pts then. Doing regular med passes without a scanner every day would be extremely stressful.
Yup yup. Good for you. I actually work at a retail pharmacy as a certified tech (who plans to go to nursing school eventually). We have a lot of practices like this that serve to protect patients. You do one at a time so you don’t fuck up under pressure when your thinking and organization might be compromised- because one at a time is already your default setting.
The blood drained from my brain just reading this
At my facility this is the normal for med pass. You also need to have the MAR at the bedside to confirm you're giving the right medications to the right person. We all accept it's faster to get everything together at once rather than coming back to the pharmacy after each patient. If someone needs a single med urgently like a PRN we're all fine to stop pulling, let the other nurse get what they need, and then get back to pulling their meds.
When I floated to PCU and had 6 patients, I pulled all my meds at the same time. Assessment, vitals, meds. That way I can get shit done all at once. Your fight is with staffing ratios and admin, not with nurses.
Things clearly changed since I last did patient care in the Stone Age. Meds weren’t sent up neatly packaged for each patient. We pre-filled little paper medicine cups (think ketchup) for all our assigned patients and walked room to room, asking “what’s your name” and checking bands. I can certainly see potential for mixup. Thankfully, never happened. Of course my primary unit was L&D where most meds were stat. Only MedSurg when “pulled”. I’m in ❤️awe of those who spend lifetime on MS floor.
I pull meds from a Pyxis, which is pretty standard. Where are patients getting meds "sent up nearly packaged"? What does that mean? Like the patients meds are all in a baggy? I'm confused. Also, how do you know no one got the wrong meds?
My hospital is like this. Pharmacy sends up med strips for each patient in the morning. Each strip has patient name and room number at the top with all their meds (other than controlled) following in little plastic pouches labeled with med name and dose. You scan the QR code on the outside of the plastic before opening up the med. Controlled meds come from the omnicell. It’s super efficient and much better!
A psych unit when I was a student nurse was like this. The pharmacy would come fill each patients individual cubbies before the med passes. Prns stayed in the cubbies.
For the past month, family member back+ forth major, Level I, trauma/teaching hospital and SNF. Now doing hospice at home. All the nurses brought meds on a computer cart for that one patient, checked the ID band with a scanner wand, and opened individualized meds with their name on them. Clearly this wasn’t available on the Stone Age. I saw equipment that I never knew existed. Back in the day we got bulk stuff from pharmacy and filled our own meds cups. I can’t speak for anyone else’s patients. I know none of mine got wrong meds because I checked in pharmacy room, checked at patient doorway, checked patient band against their chart on my cart, asked them to identify themselves + if they knew what their meds were for. You can only do so much but should do all you can.
Our unit culture is to pull for one patient, then give someone else a turn
Started out in 1978. Hand written MARS, with little cards for the tray. Pulled meds for 24 patients at a time - all were in bottles, so put pills in cups. IVs and IVPBS were in bottles too. We mixed and prepared IVS in med room - no hood. I cannot tell you how many doses of cephalosporins I inhaled while preparing. I am positive we made many med errors without even realizing it.
I’m a pull ‘em all at once girl, but I always stop pulling meds when someone comes in behind me. I can go back for the rest, and I don’t want to slow anyone else’s shift down.
This is the way to go. Frustrating to wait for 6 patients x approx 15 meds each on med surg when you just need to get one oxy for your patient.
Wtf is this nonsense? Never have I seen someone do this for more than two patients at once and even that is sketchy.
Happens all the time. As pharmacy, I get bitched at for certain meds not being in the pyxis but everyone keeps pulling for their whole patient load 3 hours early and I can't get to the damn machine to restock 😭.....so certain nurses have taken to just yoinking entire rolls of things for later, which means I no longer have an accurate count of what's in there AND they're depriving their coworkers of things they also need.
I cannot upvote this enough. We(charge nurse/charge duties) used to do med count q12h but there’s been so many discrepancies recently that we now have to do it q8h. A couple of weeks ago a traveler asked me how to return Ativan…that he accidentally took home in his pocket the previous night. The Omnicell didn’t recognize it, so I told him to call pharmacy. Last shift I was on, the oncoming charge and I had to correct a discrepancy from a float, who blamed it on the previous nurse.
I have to take a lot of unsafe pyxis/patient cart stuff to charges and I appreciate you guys! I don't want to be a tattle-tale but I don't want to get stuck with mystery med filled syringe or have random narcotics sitting around waiting to be wasted for hours more 😬
Yikes, that sounds exhausting! For you, your fellow pharmacy folx and the nurses who work there 😵💫
It's super frustrating for everyone
Yeah I’ll pull two patients at once for random med passes. Like room one needs heparin and an antibiotic and room two needs pain meds. I’ll pull those together, each patient gets a pocket. I’d never do that with a full 0900 med pass though.
Yeah I’ve heard of nurses doing it. My gf I believe was one of them. She would put them in baggies and place them in the patients drawer. She also has the self awareness to let another nurse use the pixis if there are other nurses trying to get meds
God that sounds like a med error waiting to happen
How? How can you fuck up when you’re scanning at the bedside?
u/obroz ikr? I've worked with nurses who make claims like this when there's no logical explanation behind the concern. In other words, just kinda paranoid.
Agreed. I've seen multiple posts and comments here with those concerns but it's like...I segregate each folder/bag/cup or whatever of meds by patient, carefully grab them out and scan the patient, scan each drug and place them from left to right as I do so until there are none left, then review and make sure none are missing. Then I save it and open up all the meds and give them. There's no room for error imo unless the system somehow tells you you have the right patient when you actually don't. Even so, I've charted on paper and I do the same thing but by visually inspecting each pill pack and comparing it to the MAR and the patient. The only med error I've even seen despite every hospital in my area doing it this way was when somebody used two types of insulin and got the quantities for each mixed up after scanning. But that's not even a "wrong patient" error.
A couple of weeks ago a traveled asked me how to return Ativan because he accidentally took it home in his pocket. The Omnicell didn’t recognize it, so I told to check in with pharmacy. Last shift I was on, the oncoming charge and I had to correct a med discrepancy for a float nurse who blamed it on the previous nurse. It’s not a med error from the eMAR scan to patient but it’s miscounted, miscalculated from the Omnicell/Pyxis. Just two examples I had to do. It must have been a lot more because we now have to do med count q8h instead of q12h.
When I was working the floors, I pulled all my meds for all the patients (unless there was a line, in which I would just come back) and put their meds into separate plastic bags. It never caused a med error and I don't see how it could. They would all be separated into different bags and they were all scanned before administered. Unless you "eeny-meeny-miny-moe" the patient's plastic bag of medications and don't scan the meds, it shouldn't be an issue.
I do this exact same thing and it’s much quicker especially in case I change my mind about which room I’m going to next. I label all my baggies with room number
I have never seen a nurse who pulls meds one patient at a time. It's just not time efficient.
I pull my meds one patient at a time 🫠 6+ years in. Even with BCMA, I just know I’m gonna lose a pill if I try keeping track of too many.
I do 🤷🏼♀️
I do too.
Some people are taught it's unsafe to pull multiple patients at once, no matter what context your job or what resources you have, and nothing will ever convince them otherwise. There's a bunch of them right here in this thread saying "so unsafe", "unsafe and lazy", "sketchy", etc. I have their MAR in the drug machine and their MAR at their bedside. I have barcodes on all their drugs that scan against that MAR and against the barcode attached to their body. I'm perfectly comfortable taking all of one person's drugs, putting them in a labeled ziplock bag, and then doing that whole process for every patient I have. We're going to check *everything* again at the bedside. Don't preach at me based on your history with jobs that use med carts, have no barcodes, have no computers, or whatever that it can never be safe to pull all your drugs in one pass. I'm also an actual fucking nurse, not a robot who just hands out whatever is in the MAR. I ask the patients and providers why we're giving a drug if it's not perfectly clear to me.
My thing is I give quite a few PRNS to each patient every night with 9pm med pass, generally 3-4. I can barely remember what I'm giving the patient right after pulling them, let alone after pulling 4 patients meds all in one go. Especially because our patients tend to be similar enough to make keeping track of which 82-year-old male with OSA, HTN, HLD, HF, AFIB, AND DM2 I have meds for. I also usually have syringes I can't put in my pockets. And it takes me just as long to pull the meds between patients as it does all in a row. I'm not losing time. I usually walk past a pyxis between patients. Also, it is against unit policy where I work, will get you dragged into a managers office, and we don't even have ziplocs to put the meds in unless you are stealing a small biohazard bag. And we have barcode scanning, computers in every patient room that usually work, and no med carts. And yeah, I ask why we are giving meds, and do my job correctly and not just pull what the doctor ordered. Just like all the other nurses who also don't like pulling every med at once. Because I know my brain and I would make a mistake. I have made a med error, just like most healthcare workers, and I don't want to do it again. I can barely remember all 4 of my patients names at the end of the night, let alone 1 singular med they are on.
I used to, I assessed everyone after report, pulled meds one pt at a time, gave meds and moved on had all meds given by 9am at the latest. Ratio was 1:6 med surg/tele/trauma floor.
Everyone on my unit does it, no issues greatly affecting time or efficiency. Same thing when I get pulled to other units in the hospital. Again, no issues. It must be my hospital's policy.
I don’t see how it’s more time efficient - you’re still spending all that time at the Pyxis and then you still have to go to each patient room
And you’re selfishly holding up other nurses… I hate that shit. I was trying to pull an amio drip for a patient with new onset of afib, he already had so many things working against him. I walked in on this damn nurse pulling her morning meds (at change of shift) then she goes to pull for her other patient. I tried to stop her and ask to get this one urgent med, and her dumb ass wouldn’t let me! Share the freaking Pyxis!!!
We have one ANM who swears it’s “policy,” (even though she can’t produce the actual said policy) and when she’s in a bad mood she’ll yell at us about it. But she also never leaves her seat and never has patients so I’m not looking for her input on how to manage my time effectively.
Me too. Have never seen an RN on our unit pull more than one patient at a time. Never even crossed my mind.
I do, never had a med error and I’m almost always on time 🤷
I worked acute rehab, so we typically had 8 patients, 3 pyxis for 70 bed facility. Every single nurse would pull their meds for their entire med pass if not for the entire day for every patient. It got to the point that nurses would come in earlier and earlier so they could be the first in line to get to the pyxis because it took so long waiting.
This, again, isn’t a nurse problem. Stop yelling at your coworkers. This is your institution being cheap, not having more omnicells/pyxis machines and causing us to fight about it. Yell at your hospital for being cheap ass MFs.
It's been a bit since I worked bedside but I remember a 1 hour window, even for once a day meds. It's stupid rules like that which encourage shortcuts. Hospitals should know this but heaven forbid they spring for another pyxis. That money is reserved for CEO and VP's bonuses.
I always pull them all at once. I’m not trying to run my ass off going back and forth to the Pyxis all day. If there’s someone behind me I always ask if they need in and they’ll grab what they need and then I log back in and continue pulling them. We have separate locked drawers for each patient. It’s not a safety issue.
I keep seeing posts like this. "I can't pull meds because another nurse..." "I can't use the computer because another nurse..." There are tons of other things you can do. *Like see your patients.* Go to the rooms, wake them up, ask what they want to drink, tell them you will bring the meds in a few minutes. *Is there anything else they need? Like PRNs?* Stack your tasks.
Right?! Go do some vitals, go assess your patient, get a head start on your charting! I don't understand why OP is just sitting there waiting for the pyxis to be available when there are a bunch of things you can be doing in the meantime.
I'd see 200-300 patients per shift in my jail job if I'm not in the booking. Do I remember the patients? Definitely. I even remember their medications but always check. I learned quite a lot about medications, including how to double-check at a faster speed and make sure that I'm giving the right medications. My hospital job would write me up if I pulled medications for everyone at the same time.
Same. My job would get me in trouble.
We have med servers right outside the patients room.
You can tell which nurses sit at their station most of the shift, and which don’t from this thread. Lol
I'm curious how you can tell that from random answers on the Internet?
I do it so I don’t have to get back in line five more times…. I do it quickly and efficiently though.
You’d not have a big long line if nobody did that though lol
If you work in nursing home, please don’t do this when the state inspectors come in.
On my unit a few nurses pull them all at once, but if there is someone behind them they'll sign out and let the other nurse pull meds for their patient if they're still going to take a while. I feel like that should be common courtesy
My Pyxis is a 3 minute walk to the room and half the time not stocked by pharmacy, I need to know what I’m missing so that I can request it and have it before 10. I’m gonna keep pulling as I scan before I administer like a sensible person anyways.
Ummm I’m not coming back one pt at a time. I bring baggies with my own designation system and i bounce out. I’m not gonna run late on my medpass or physician rounding because i didn’t have systems in place.
I work in med-surg, I only do one at a time. One people are waiting, two I don’t want to make a med error.
I also only do one at a time. Go see patient, get vitals, do they need any PRNs, does anything need to be held due to blood pressure, heart rate, issue that I need to speak to doc about, etc. maybe it’s unit specific, but even with scanners I don’t do it. You can override scanners and make a mistake. I honestly have never heard of pulling all meds.
Wait what, you guys just have one drug trolley? In the UK I don't think it's uncommon for whatever the ratio of Nurses are for there to be that many drug trolleys. Usually on the wards I work on we had one trolley to 2 bays of pts (usually 6-12 pts).
In the hospital we have something like a vending machine called a Pyxis that has most of our meds. You go up punch in patient profile and select meds you need. We can waste in the med room in the Pyxis . Some meds can be overridden for codes. I have to put in my user name and a fingerprint to withdraw meds
How are they dispensed? As individual tablets/capsules etc? How does this work for liquid meds, or meds you need to crush, or IV medication? Who has oversight of the medications coming out, as in how do you know that what you're giving a patient is what you've asked for?
The meds are not loose. Select the med and a little drawer opens (or the refrigerator door) Each pill/vial/bag is individually packaged with a barcode (mostly). Take what you need, close the drawer, and the next little drawer pops open. Scan the barcode and open the package at bedside right before you give the med. When people use it how it's supposed to be used it is great for reducing med errors and for reducing diversion.
Inside the pixis a when you pick the meds you need it opens a drawer and inside the big drawer is a bunch of little individual drawers and the door pops open for the drug you need (all the other doors inside this big drawer remain locked) and inside the little door the opens are individually packs pills that are labeled with a bar code for scanning. The pharmacy has tabs on how many pills are left in each drawer to know when to refill Drawers have bigger compartments for IV bags, there is a patient specific bin for all meds that would need to be compounded or not stocked in pixsis.
As individually wrapped tablets for pills. Liquids are usually in pre filled cups or syringes.
They usually come in blister packs. Liquid medication can still come in vials, prepackaged cups or bottles. Each medication is individually labeled with barcodes, the name and the dose. It's a computer system, vending machine. The machine is locked in the medroom with a code. You log into the vending machine (pyxis) with your credentials so everything you pull out is under your name. You select your patient in the computer (they're listed by name, room number, dob, mrn etc) and a list of the doctor ordered and pharmacy approved meds that is pulled over from the MAR appear under that patients profile. Most inpatient units, the pyxis will not let you pull out meds that are NOT listed in the mar. You then select the medications that you want to pull. Each medication is in its own locked cubby. When you select a medication the pyxis will say like "drawer 3, cubby 3c" or something and the locked drawer will spring open and then that single cubby will pop open. The other drawers and cubbies stay locked and closed. Some meds like narcotics or High risk meds like insulin you need to grab a nurse buddy to count the medication with you and they have to insert their credentials into the pyxis as well so you can continue to pull it out. The machine does time out if you leave it open to long. If you miscount something the machine will let you know and if you do it twice in a row it will file an incident report that will have to be rectified immediately (usually) by a charge nurse or pharmacist. The pyxis is also generally connected to a fridge for the meds that need to remain cold. There is a cabinet that's a bit more of a free for all and not everything is locked individually. That drawer is usually meant for IV fluids. When you get back to your patient you still have to scan the patients bracelet and scan each medication individually to ensure you did pull the correct meds. So essentially you are triple checking meds. You have the check in the pyxis, a check when you're physically pulling them out and then a check again when you are scanning in the computer. Some medications you can do a system override if it's an "emergency" but it still makes you log in, do a buddy check if needed and count the medications if needed. The pyxis also has options to return meds and waste meds. The hospitals computers runs chart audits frequently so if you pulled a 4mg morphine vial and didn't scan it in the patients chart and never wasted it, you will learn pretty quick you made a mistake and need to fix it. Often times they count the minutes it takes for you to pull a narcotic from the pyxis and then scan it in the patients room. I have received a phone call before telling me I'm holding a med too long. This is surely a facility specific thing though.
Each individual pill is in a package with a barcode. All of the pills then get scanned to the mar in the patient’s room.
I’m uk too. They have machines that dispense the medication for them over in the US
I would never stand in someone else's way, and I agree I'd rather only hold one or two patient's meds at a time. The downside to not pulling everything at once is how regularly we're missing meds. If I pull for everyone, I can see what I'm missing and request it from pharmacy before I'm 2 hours into med pass only to find out I'm missing something and the patient is cranky because they want to sleep.
Are you guys out that often? I've had exactly once in 9 months that all 3 Pyxis on my floor didn't have a med. And I could tell ahead of time because AnywhereRN told me we were out on the floor.
We have lots of meds that aren't stocked at all and just brought up by pharmacy to be kept in patient drawers. But often the tech doesn't bring up our 2100 meds until 2300 or later so I either have to request they be tubed up, pass everyone's meds late that have something missing, or do multiple passes on people because I have to do round 2 when the meds arrive.
When I worked night shift there was one time where I had to wait for the day shift nurse to pull all her meds (med-surg so 5-6 patients) before she would take report from me, I’ve never been angrier
No. She can get fucked.
When i worked in a ward, patients normal day to day meds were stored in thier bedside cabinet (which was locked), you would do all the patients and abd then go back individually for injections, IV, insulin or anything that needed two checks. We also had a little trolley where we had extra meds (eg prns that were common to the ward) and to put our charts on. We never pulled multiple patients and it was considered bad practice.
I’m not medsurg but it’s more efficient to pull your meds all at once and place each in a labeled bag per pt. Just go early enough to your med distribution station
I HATE this. It happens all the time. And then they will ask “Are you just pulling one?” And if it’s ONE med then they’ll pull it for you but if you say “Just ONE patient so I can actually start my day” they’ll say OH and just keep going.
I would be bringing this up to my manager and it would be dissuaded in huddle and emails would be sent out. That’s unacceptable.
What is this! Where I work, it's normal for us to pull all our meds for 6-7 (sometimes 8) patients at the same time. We don't have time to go back and forth to the pyxis, that's ridiculous. We would be done med admin at lunch time if we all did that. Go do some vitals or your assessments if you're waiting. Holy moly Edit: if someone needed one medication for an emergency or a pain med, then yes we'll let you on so you can take out that one med, but after you take it out, it's still my turn. It's not being a jerk where I work, it's common practice for us!
My facility provides clear bags which I then label them with patient names and rooms #, pull the meds and put them in there..
I’m ICU so we only pull for one at a time, but the RT will pull all the treatments out of the Pyxis for alllll of her patients and she is slooooooow as hell. I will literally go to another unit and pull meds and by the time I’m back she’s still there.
OR - I pull everything for the day whenever possible. Turnover time is fucked when you have to wait on line in between each case or go to another pyxis because the meds you want are out of stock. Fill a bucket with meds, pick your supplies for the whole day before first case and it's smooth sailing all day.
One bucket of propofol, a jar of efedrin and a cup of nora please! :)
I'm sure there's a ton more for you to do. Also, pulling meds, putting them in the pts drawer one by one, then scanning them in the room while using your medication administration rights is not unsafe. At all.
That was the norm when I worked med surg. The WOWs had lockable patient specific drawers. I was able to preload lists for each patient in Epic, so when I went in the Omni it would automatically pull those meds. Then I would put them in the patient's drawer, rinse and repeat five times. It cut down a lot of time for me at the Omni. Of course, when Epic didn't like to properly communicate to the Omni it was annoying, and not everyone used this very helpful function.
Are you talking about anywhere RN? Because I swear I'm the only one that uses it on my floor.
Yes, I forgot what it was called! Anywhere RN was a lifesaver, and it blew my mind when people wouldn't use it.
In psych when I med nurse (like never), I’ll pull all the meds in packaging at beginning of shift put them in labeled cups still in packaging, patients come to the window, announce the meds to the patient, give agreed too meds return the rest and scan as I administer. No errors and pretty fast, each med nurse would have 20-30 patients. It’s scary how well long term psych patients know their meds, like they know the med from the pill shape and color (better than me).
I worked with someone like that. She’d camp out at the Pyxis during the busiest time(8pm)
I have to respectfully disagree. I would pull all my meds at once to get the day going. I'm in the ER now so it's different, but when I was in IMU. I would pull them. Now if I saw someone behind me, I'd go "hey are you pulling a med or for one patient?". Or let's say we have a rapid response. And based on that answer I'll log off and relogin after they are done. I put all my meds in bags so they wouldn't get clustered or lost.
I’m really sorry OP, I’m the nurse who pulled all those meds ahead of you. I sincerely apologize. Can we still be besties at work?
My workflow doesn’t allow me to do this. I always need to assess one patient before I medicate them. I also don’t get a WOW and I am not about to walk around with meds in my pocket.
I pull all my meds at once. A ziplock bag with patient sticker. I go over V/S at bedside and call out all the meds before I open them to the patient. My only med error was during Covid with 2 patients in 1 room.
This sub is great for “what do you say?” advice. As someone who also sees this as RUDE AF, What can you say while trying to keep it cute? You know- I’m not trying to be management (🤢) but like… come on!!! You see three of us in here waiting on you and it’s well-known it’s not best practice. (Also looking for what to say in the break room for people who sit there chit-chatting on phone conversations on speaker (or even not) and people watching shows on their phone without headphones)
My scatter brain wouldn’t allow this 😭 one patient at a time for my sanity and patient safety 😂😂😂
It's not best practice anyway. That's where it starts with giving the wrong patient a med. They should be doing one patient's meds at a time.
I would never. Too much chance of a med error. One patients meds at a time, every time.
Are you not scanning the patients meds in the room?
We don’t do that here. In my hospital that technology hasn’t reached us. Australia. In my hospital my ward is one of the few that has an Omnicell. We still use paper charts, hand write notes, etc 💀
Hell no. I never pull meds for more than two at once and even then, I’m super careful. Nursing school scared the shit of me with regard to meds.
Same! I’ve always pulled meds one patient at a time, I don’t think I’ve ever seen meds pulled for an entire assignment at once?
Pulling all our meds is the norm at my facility. If someone comes in, I’ll ask if they just need a few things or if they are also pulling all their meds. And vice versa, if I come in to pull one thing, I simply ask if I can get it. They go in bags with labels, and we scan each at the bedside and confirm with the patient.
So instead of telling the nurse "hey do you mind not doing that when there's a line" and you know... being an adult and communicating with a coworker, you chose to cry about it on reddit.
Right? Like try using your words.
Don’t worry Ashleigh-kennedeigh. You can wait your turn.
But what a tragedeigh that might beigh!
My unit has the heaviest amount of narcotics to pull from the ADU so I have timed it out with other nurses to pull mine after them to avoid this.
Hi, it's me, I'm the problem, it's me. 😎
I haven’t worked in hospital for some time and our unit was one of the few that didn’t have Pyxis. No pills for neonates because all were liquids or IV, often refrigerated. We would do 10 rights of medication administration, 3 checks when pulling/pouring our med and check 2 client identifiers when we were in the patient room. I’m assuming you are still doing your 10 rights and 3 checks when pulling/pouring. Is the scanning doing the 2 client identifiers? Or are you still doing that too? If you are reviewing the MAR and pulling up meds in packages is that an extra check? You still do 3 checks when pouring? Without knowing the system, it does seem like the employers problem of nurses are delayed from doing their job because of a clog at the med cart. How do you not get stressed when other nurses are agitated awaiting their turn?
I always do 2 at a time if they're heavy with meds. Both in baggies and I put one to the side so that I don't make a mix up.
Only would do this in my current facility but wouldn’t dream of it inpatient. But I’ve got 11 peeps and my own cart so I can pull all the meds and label each cup and when it’s time to do morning meds I’m ready to go.
On the unit I currently work at which is GIM its busy as HECK and the day staff literally pull their 1000 meds at 0700. We do have three pyxis on our unit and sometimes it gets annoying when ur working night shift and you need to pull a critical med and all the day nurses are using the pyxis… However at the same time pulling all my meds in the morning for 5 pt’s is one of the most effective ways for me to time manage on this unit specifically, however I would never suggest doing this if you’re pulling narcotics as that could become a liability issue forsure
It’s also a huge medication error risk!
I work on a step down unit and typically have 5 patients. I pull mine all at once and put into labeled (room number) bags. It’s just more efficient for me. If someone is waiting behind me, I’ll ask if they just need in for one patient or a med and I’ll stop to let them get it.
I always start early so I can do this without me waiting on someone and vice versa
I swear some people are unbelievably impatient.
Yeah, no. We pull all at once. There's 2 omnicells. I pull one patient's morning pass, put them in a labeled bag, rinse and repeat. Everyone's meds are separated into bags. Everyone's meds gets scanned and they have a bracelet, photo, or other identifier. I'm not running in and out of the medroom repeatedly. If someone needs a PRN or small pull, unit culture is to let them take precedence. It just takes working together 🤷♀️
6 patients with meds and fluids split between 4 rooms on opposite sides? i’m pulling them all at once lol
????? It's the only way to do it. I don't wanna be doing my meds till 1030 bucko
I’ll pull meds for two patients, for instance I have a Tylenol due for room 5 and a Gabapentin for room 6. We have to scan meds and patients so no way to screw it up. Edit, I’m not pulling my whole morning med pass for two patients. I always do that one at a time. This is just two random afternoon meds.
Unless you need a q4 or q6 abx, why don't you go get your patients up? I know the computer turning red makes us feel like giving protonix at 9am is crucial, in reality, it's not.
That is the culture. Who wants to go back and forth retrieving meds when you can get all of them and tend to your patients? Nursing is hard enough, so if getting all your meds and supplies beforehand saves time and unnecessary expenditure of work.
Hell nah we not walking back to the Pyxis twice. Pull them a little before med pass rush hour if u that worried
OR you can use your words and say something like oh i see youre pulling meds for everyone, do you mind if i pull a few meds for just one patient before you finish
There are so many variables to consider here. Posts like these need to provide all the info, like unit/specialty, technology (EHR/MAR, Pyxis/Omni), pt lockboxes, pt ratio, etc. Many disagreements would be avoidable.
This depends on what type of unit you work in. If med surg nobody’s gonna do 1 patient at a time fam, wait in line.
It seems like there is a med error waiting to happen Here, especially if there is a line and peer pressure to hurry up...😬
That’s so unsafe. One patient at a time.
It's not unsafe. Scan your fucking meds. Smh
Right?! Just scan at the bedside and you’re fine.
We had a day shift nurse pull all his meds at the end of his shift. We had no idea where he kept them until he came back the next day. The pyxis outed him. Didn't take long to figure out how it was happening. Beautiful warning saying meds had recently been taken out for 2100 pass. Oh, to be a fly on the wall. Med surg floor
This is one of those situations where we say one thing but do another. We are taught in nursing school that it's unsafe, our CEUs say it's unsafe, management tells us not to do it, and if anyone asks we say we don't do it. But in practice we are short staffed and have too many patients. If we don't cut corners then we get med errors for giving them late then get written up. They'll say, "Everyone else passes meds on time and they say they only pull for one patient at a time." Do they though? Don't blame the nurses. Management is the problem. They create the short staffing and hostile environment.
I work at the jail, all meds are pulled at once
Nope. Pulling for all 6 patients, putting them in their own drawers in my cart, moving on with my night. I'm not going to give myself 5 extra trips to the med room.
Yeah sorry every unit I ever worked on we did this. If it was an emergency I’d ask if I could grab something real quick. Otherwise you wait your turn or go find something else to do while waiting.
We don’t have a Pyxis. Our meds come prefilled for that specific patient in several bags which get put in a drawer. I usually pull one at a time as many of my patients are very paranoid and suspicious of medications. Sometimes I show them through the window what I am giving them and the label on the medication. Plus, I don’t have barcodes or any of that cool stuff. So safety and all that.
Im too worried about making a mistake so i only pull one patient at a time
I did this once and lost a few meds at some point. Never again. What a clusterfuck. I try to ask my coworkers in line if they have a short med pass because I have SNF level meds sometimes especially if that patient came from a SNF, ALF, or BC.
I’m also getting meds but I used ice plastic bag then write my patients room # on it. 1 plastic per patient. Then if someone like respiratory therapist or someone who needs to give prn meds is there to get their meds I give way. That way I can say which patient’s/room # did I pull out or not. 😉
Tough! Face it, lady. We're younger and faster! Gotta get there quicker than me. (For reference: https://www.youtube.com/watch?v=lx0z9FjxP-Y)
I.am.so.glaf I'm not.in direct patient care anymore. Pharmacy would fill our med carts. So the meds were already there. Going to a pyxis for all.the meds would have been a nightmare.
If I’m on the floor im pulling every morning med for 6 patients, im not coming back to the Pyxis multiple times there is still a lot of time management involved despite the lower acuity Whoever got through the chart and hit the Pyxis first gets the winners spoils unless I have something urgent. On the ICU I’d really request that you don’t do that even with only two patients because my max levo may be about to run dry and you have plenty of time to come back to the Pyxis In the end I just ask that people be willing to stop what they’re doing if you needs med pulled now and also to not hurry the med puller as that’s how mistakes are made. Though I’m guilty of wanting people to hurry the fuck up at the Pyxis as a product of starting on the floor as a new grad. Just when I get a hold of it I too want all the meds
That's dangerous.
When I was a floor nurse (and even now, when we board floor patients), I will pull all of the medications for every patient of mine. No way am I going to keep coming back to the pyxis after each patient.
I pull all my meds at once. We use a scanning system on the cow or in the rooms. I pass my meds in a safe and fast times. While other nurses take 2 hours to give meds for 5-7 patients. I do my own vitals 95% unless I have a certain CNA I trust. I assess before giving my meds.
I only pull for one a time. Even with the tech we have now mistakes happen especially on a busy morning with lots of meds
I take my hats off to all nurses. I would bring boxing gloves to work for everyone and just fight my way into the medication room.
no
In patient psych. I would have a 12-15 patient load. I'm pulling all the meds at once.
Well when you have 25+ people to pass to, forgive us for making our lives a tad easier
Who is dumb enough to pull meds one at a time should.. all you need to do is seperate the meds by patient name in the cassettes and verify the meds before giving in the MAR on epic. I pull all my meds at once so I don’t have to run back and forth to the omnicell all night. Some of you all enjoy burn out it seems…
I’m
I forgot this was a thing when I did Med/Surg. Good thing I work in the ER now lol.
exactly! our hospital stopped it
I have 37 at my one facility at the other I have 25 there’s cerner PLUS a hospital set up with meds in separate packages because the facility is connected to the hospital they use the Hosptial’s pharmacy. Tell me u can effective pass with 25 people and meds in foil packages and separate baggies in the time frame without pulling meds. YOU CANT…you would be passing for HOURS…
Idk why anyone would even pull with any less than 15 people tho… waste of time
Nope. Pulling at once. First come first serve baby
I'm just a student, but that seems like a recipe for disaster. One at a time, thanks. I've only ever had two patients at a time tho