Where do missing IV bags go?

[mentos]

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Don't you love it when a nurse calls 30min before an IV is due and says there are no bags left and the dose is needed right now, even though you sent up 3 days supply yesterday?

Where do these big heavy IV bags with HIPAA info on the labels go?? The trash, in a drawer somewhere, lost in the back of the fridge forever, someone's lunch bag?

 

[zelman]

Don't you love it when a nurse calls 30min before an IV is due and says there are no bags left and the dose is needed right now, even though you sent up 3 days supply yesterday?

Where do these big heavy IV bags with HIPAA info on the labels go?? The trash, in a drawer somewhere, lost in the back of the fridge forever, someone's lunch bag?

They look too much like Capri Suns. At least one or two is gonna get stabbed with a straw during each shift’s meal break.

 

[northeast-southwest]

They vanish into thin air

 

[PharmDBro2017]

Don't you love it when a nurse calls 30min before an IV is due and says there are no bags left and the dose is needed right now, even though you sent up 3 days supply yesterday?

Where do these big heavy IV bags with HIPAA info on the labels go?? The trash, in a drawer somewhere, lost in the back of the fridge forever, someone's lunch bag?

Gotta love it when you get a stat IV antibiotic for a baby in the ER, tube it up in <5min........ wait 10 min..... ER nurse calls frantic and pissed at pharmacy demanding the abx.

"I sent that up 10 minutes ago, go find it and ask your coworkers where it is".

 

[JustFillIt]

It’s like putting socks into a dryer. They certainly exist somewhere still but they are just gone. No where to be found.

 

[Xarelto-10]

Sometimes I heard stories that it gets lost in the tube system. Plan ops guys can explain that, not me.

Other times pharmacy did not actually send it or tubed it to the wrong floor by mistake.

Sometimes it is still laying on the pharmacy counter and someone is waiting for someone else to tube the med bc they are busy taking selfie.

Other times pharmacy techs just collect everything in a hurry and it is thrown in the credit bin, it is a vicious cycle.

Other times some nurse is too lazy to go to the med room, or the tube to check if it’s been tuned already. Or didn’t come to pickup med from pharmacy despite of repeated reminders, yet, 1 hr passed dose time, “why is not pharmacy sending the mds? Patient needs it right now Stat!”

This is part of the inefficiency that happens in the health systems today.No wonder why we spend so much but can’t show anything for it.

 

[Rockinacoustic]

They are covered with an invisibility cloak that magically disappears when I'm within 3 feet of the Pyxis machine.

 

[JustFillIt]

They are covered with an invisibility cloak that magically disappears when I'm within 3 feet of the Pyxis machine.

My current dungeons and dragons character actually owns a cloak of invisibility. I acquired it when my party slayed a fire giant. Maybe the bag had one of those? In any case it would need to pass a D20 skill check

 

[KARM12]

And then they magically appear in the pharmacy 4 days later as a "return" or "expired"

 

[owlegrad]

Sometimes I heard stories that it gets lost in the tube system. Plan ops guys can explain that, not me.

Other times pharmacy did not actually send it or tubed it to the wrong floor by mistake.

Sometimes it is still laying on the pharmacy counter and someone is waiting for someone else to tube the med bc they are busy taking selfie.

Other times pharmacy techs just collect everything in a hurry and it is thrown in the credit bin, it is a vicious cycle.

Interesting - I have never seen any of those happen.

 

[Leper Messiah]

In my 3 years as a hospital tech, in order from most common to least common:

1. The patient was transferred and the meds were not - often the old meds were intermingled with the new patient's meds for that room
2. Literally in the bottom of the tube station along with 5 other carriers of meds that have not been retrieved
3. On the counter within 10 feet of the tube station
4. In the med room, but in the fridge

 

[mentos]

Interesting theories. There is no tube system where I work. A tech physically brings them up and puts them in the med room! But the other patient specific meds never get lost, only the IVs.

 

[zelman]

Interesting theories. There is no tube system where I work. A tech physically brings them up and puts them in the med room! But the other patient specific meds never get lost, only the IVs.

Lends credence to my Capri Sun explanation...

 

[Rouelle]

A surprisingly (for me) significant percentage of the time, they are hanging on the pole infusing into the correct patient. Especially if it is anywhere close to shift change.

 

[rxkrafted]

From my experiences, these are usually what I find out:

its usually in the previous patient specific bin after the patient gets transferred to a different room.
lost and discovered in the patient's room
nurse accidently punctures a big hole in the bag and makes a mess so nurse makes up a lie and says they never got it to save themselves from embarrassment.
nurse looks into the wrong patient specific bin or the bag gets misplaced into a bin next to where it should be.
If its continuous infusion bag, one nurse will give the med way too late or too early and messes up the timing of the following doses.

 

[gwarm01]

Some other nurse took it out of the tube and sat it on the counter. Bonus points if they find and administer the drug while you are preparing the replacement, never tell you, then get mad when you tube down a new bag.

 

[Nguyen]

I don't argue with the nurses anymore. One time I was walking into my hospital for my shift and a nurse called out to me and said "why do we have so many Symbicort inhalers for one patient in our med bin?" I responded by saying you probably kept calling the pharmacy to send you up one everytime you couldn't find the inhaler due to your misplacement/shift changes. She said oh..... and went on her way. Yeah $300 bucks down the drain because nurses are too damn lazy to look/check their med bins/tube stations/pockets.

 

[njac]

Every hospital has medication eating goblins.

 

[owlegrad]

I believe they identify as nurses and SDN doesn’t tolerate hateful slurs.

 

[PharmDBro2017]

Watch this and you'll learn the answer OP.

 

[BidingMyTime]

All good answers. Many times, there is no explanation, the med just randomly shows up 2 - 3 days after the pt is discharged. Most often when I send a tech up to look for the IV, they find it either 1) in the fridge (when it shouldn't be refrigerated) or in the drawer (when it should be in the refrigerator) or 2) lying out unlocked on the counter above the drawer that it should be locked in (and then the nurse accuses the tech of having just put the IV there, because of course the nurse looked and it wasn't there before the tech came up.)

 

[Dred Pirate]

about once week or so the engineer guys bring us some tubes that were found in the tube system somewhere - maybe our system is old and full of holes

 

[samven582]

In my 3 years as a hospital tech, in order from most common to least common:

1. The patient was transferred and the meds were not - often the old meds were intermingled with the new patient's meds for that room
2. Literally in the bottom of the tube station along with 5 other carriers of meds that have not been retrieved
3. On the counter within 10 feet of the tube station
4. In the med room, but in the fridge

pretty much nailed it

 

[OmiPharmD]

A surprisingly (for me) significant percentage of the time, they are hanging on the pole infusing into the correct patient. Especially if it is anywhere close to shift change.

Had one of these this morning! "Oh, here it is being infused right now."
At least she told us...

 

[Pharmacy Kid]

In my experience, there are really good nurses and really bad nurses. You never remember the ones that are average, but I do my best to be friends with the good nurses.

 

[sakigt]

I had the floor call down about 3 times asking about a home med they couldn't find. After security came down (?!) asking me about it I went up to tear apart the unit. Emptied trash cans, pulled out the med bins, everything. I finally just decided to pull every med bin and found the bottle.....in....the....patients.....bin.

 

[rxkrafted]

I had the floor call down about 3 times asking about a home med they couldn't find. After security came down (?!) asking me about it I went up to tear apart the unit. Emptied trash cans, pulled out the med bins, everything. I finally just decided to pull every med bin and found the bottle.....in....the....patients.....bin.

That's the first place I would have checked if I had to go look.
Most of the time I go up there even though I tell them that these missing meds are in the pyxis and they still tell me they can't get it. Once I get into the med room, they magically have the power to retrieve them somehow.