Description of Event or Problem · 1
I AM NOT SURE IF IT IS THE FDA OR THE (B) (4) BUT THERE IS A REAL PROBLEM WITH OMNICELL MACHINES THAT DISPENSE NARCOTICS. I WORK AT A HOSPITAL THAT RECENTLY ADDED OMNICELL MACHINES. MANY OF THE ORAL NARCOTICS ARE PLACED INTO A DISPENSER THAT HOLDS 20 TABLETS OR CAPSULES. THESE ARE IN A CARTRIDGE THAT HAS LOOPS THAT HOLD THE TABLETS IN PLACE. WHEN A NURSE REQUESTS MEDICINE IT RELEASES 1 OR 2 TABLETS DEPENDING ON THE DOSE THE NURSE PICKS. HOWEVER, IF THEY ARE NOT LOADED JUST RIGHT THE NURSE GETS AN EXTRA 1 OR 2 TABLETS DISPENSED, AND THERE IS NO RECORD OF THIS AND NO WAY TO TRACE WHEN IT HAPPENED. A DISCREPANCY IS RECORDED WHEN THE PHARMACY TECH REFILLS THE CARTRIDGE AND FINDS THERE IS A SHORTAGE WHICH MAY BE 1 OR 2 DAYS AFTER THIS EVENT. THIS HAPPENS AT OUR 200 BED HOSPITAL SEVERAL TIMES A WEEK AND WHILE A NURSE CAN'T PURPOSELY ABUSE THE SYSTEM, I AM CALLED FREQUENTLY BECAUSE OF THIS HAPPENING. THE NURSE DOESN'T HAVE ACCESS TO THE CARTRIDGE, SO SHE CAN'T PUT IT BACK AND SHE CAN'T PUT IT IN THE WASTE BIN BECAUSE THE MACHINE DOESN'T' KNOW IT DISPENSED EXTRA. BASICALLY, WE ARE DEPENDENT ON THE NURSE BEING HONEST! NOT ALL OF THE TABLETS ARE DISPENSED IN THE "AS I CALL THEM POTATO CHIP DISPENSERS" MANY ARE IN LITTLE CUBBIES THAT EACH TIME THE NURSE CERTIFIES THE COUNT WHEN SHE TAKES IT OUT SO, THERE IS A FOLLOW UP EACH TIME A DRUG IS REMOVED. ALSO, THE NURSES DO A TWICE A DAY INVENTORY OF ALL THESE CUBBIES, SO DISCREPANCIES ARE EASILY DISCOVERED AND CURED. SOME AGENCY HAS TO OVERSIGHT ON THIS TYPE OF MACHINE.