Many hospitals use a Pyxis machine to dispense medication and use the information from the Pyxis to spot trends in the medication of patient as well as diversion of narcotics. Over the past several years, I often get telephone calls from nurses accused of diversion when their dispensing of medication to patients exceeded the norms of other nurses. Nurses’ medication habits differ. Some nurses tell me that they aggressively dispense pain mediation in accordance with doctor’s orders as they do not want their patients to suffer from pain.
If a complaint is filed against a nurse, it seems that the hospital’s first course of action is to check the Pyxis machine to see if the nurse’s medication habits are consistent with other nurses in whatever unit the nurse is assigned to. For instance, if the average nurse dispenses four milligrams of dilaudid per shift and you dispense 10 milligrams of dilaudid per shift, you actions may be scrutinized more thoroughly.
I recently had a case where a nurse from a hospital in a rural area was dispensing significantly higher amounts of pain medication than the other nurses in his unit. My client was administering the medication in accordance with doctor’s orders; however, the trend in the unit he was assigned to was for a nurse to administer a portion of the vial of pain medication, and retain the remainder of that vial to be dispensed later in the shift. My client would administer the medication, and waste the remainder of the vial. The Pyxis machine picked up on the fact that my client was pulling significantly more vials of pain medication than the other nurses. When a nursing supervisor who had a disagreement with my client saw this, my client was accused of diversion. He was called into a meeting with several supervisors and risk management and asked to explain why he administered significantly more vials of pain medication that the other nurses. Often when this happens, the nurse is not shown the patient charts. They are asked to defend their actions without the benefit of reviewing patient charts. When dispensing pain medication, it is important that you note pain levels for the patient and it is extremely important that you waste any narcotics with a witness and follow hospital protocol for this procedure.
If you have been accused of diversion, it is important to contact an attorney right away who is familiar with the disciplinary process for nurses.