Non controlled drugs that require double check

  1. Never heard of a double signature to sign meds out of Pyxis but Lyrica here (US) is controlled so we have do a count when we remove it. Some hospitals do require co-signs at bedside with heparin and insulin drips as well as certain high risk meds such as chemo. Co-signs for regular non-controlled meds sounds like overkill and a waste of time.

  2. Yep. Someone fucked up and fucked someone up. That is why my former hospital’s pharmacy dispensed liquid vanc by the dose and not by the bottle. 😬

  3. Can confirm. We used to not lock up tramadol until security kept finding stacks of boxes out on patrol of the grounds. Presumably “staff” were distributing the stocks for private gains (aka selling it on the streets)

  4. This may be unique to the NICU (US), but I just pulled Gabapentin from the Pyxis and it required a second nurse to pull the drug from the Pyxis. They also had to verify the waste.

  5. Gabapentin is a control in many US states, even though it’s not controlled by the DEA, as it can be fairly easily abused.

  6. I work in Sydney. We have a omnicell which is a more heavy-duty Pyxis. And a separate S8/S4 DD cupboard. Pregabalin and quetiapine have been in our locked DD cupboard for about 18 months or so now. We double sign any injections (clex/heparin) but not apixaban or xarelto tablets. Also we are supposed to double sign and observe the injections…. But who tf has time for that. Especially working short these days

  7. ?!? Why?? A while ago I was prescribed gabapentin for anxiety and that shit did nothing for me, it also didn’t give me a high or anything “fun”, like why would anyone abuse it? Does it get people high in higher doses or something? So many of my patients are on gaba for neuropathy and I never once thought I had to worry about it being abused

  8. The only time nurses need a double sign is when they’re wasting part of a controlled med (e.g., we stock 0.5mL syringes of lorazepam in the Pyxis, but the dose is only 0.3mL).

  9. For a while our inpatient psych had us counting nicotine lozenges. Every time a patient asked for one we had to do a count on 150-200 lozenges and verify the count in the omnicell. Turns out nurses were pulling a strip of 10 at a time to “save time” but it resulted in the omnicell reporting it had 100 and there actually only being like 3 lozenges.

  10. Can’t say I believe that. I have both been caught about to make a potential error and have caught errors when doing checks for antibiotics, insulins, warfarin and even oxy checks.

  11. I work psych in Vic, so maybe it's different but we certainly don't double sign olanzapine or quetiapine, those are drugs we use all the damn time.. we also don't double sign gabapentin or pregabalin

  12. Fun story. We had a 90 yr old combative dementia patient who would sundown so hard. She grabbed the wrist of another nurse who had an IM zyprexa loaded and pushed it into my cheek. I was helping hold her still, but the aide let her hand go loose. Ah good times.

  13. For about a month my hospital arbitrarily decided we needed a second RN to double check heparin gtts. Not rates changes or boluses, e had to have a second RN to sign off on just spilling a new goddamn bag. I think they realized how stupid that was after enough people complained. But that was just infusions. I can’t imagine trying to find another RN every time I was giving a SQ injection or fucking apixaban.

  14. I'm in rural Aus, our policy is all paediatric + all injectable meds + S4Rs/S8s + warfarin etc are all double nurse checked. We also get a lot of verbal or telephone orders so they all need a double check too.

  15. The hospital I’m at requires 2 nurses for almost everything! Propofol needs 2 nurses but a fentanyl drip doesn’t. Cartizem, cardene, levo, neo, iv potassium and magnesium all require a second signature. It’s crazy!!

  16. I have to have paracetamol checked. How fucking absurd is that. Nevermind the fact that I'm regularly the only nurse registered or otherwise on the floor. I need a new job.

  17. ED nurse in Sydney here (no pyxis). Lyrica, gabapentin, quetiapine are locked in out S4 cupboard and need to be in the DD register and double signed, but olanzapine etc is still on the shelf and doesn't need one. S/C anticoagulants need the double sign too but orals dont

  18. Can confirm. Any injectables need a second signature. Plus S8/S4 and some chemo meds need to checked also. We do bedside checks on my unit for S8/4 meds usually, but it tends to wane when we are hella short and we know patients are in agony and are hanging out for their meds

  19. For the longest time my former hospital’s RNs required a witness for all subq insulin. They eventually eased up on that policy, but given that my unit had the highest average number of diabetics, med pass rounds took for-fucking-ever, and everyone’s insulin was late. The nurses were always stressed out because of it.

  20. NICU- we co-sign everything. Multivitamins, iron, caffeine. For Pyxis pulls we need a witness for narcs and sildenafil. Why sildenafil? Wtfn.

  21. I'm in Victoria, the only anti-coags we need checking are clexane, warfarin, and heparin. Gabapentin, Quetiapine, and Olanzapine are all just on the shelf with the rest of the meds.

  22. Thanks for the response. like most things nursing, i find it odd the varied rule sets across different countries, states and health services - you'd think the evidence, risks and policy would align closer.

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