Dispensing medications

  1. I work in a really small ER in a really small town which does not have an open pharmacy from Saturday afternoon until Monday morning. We don't have a pharmacist available to dispense medications.

    Any of y'all in a similar situation? We used to just give a dose (or doses) to go, but that's not the safest thing to do and pretty much violates the nurse practice act. And our administration has recently told us we cannot dispense any meds - ever. What do you do in your ER?

    Many thanks.
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  2. 17 Comments

  3. by   OBNurseShelley
    you mean to tell me you can't give ANY MEDS? Even just to send them home on??? what the heck? What if they're in pain? I can't imagaine having to work like that, but then that's why i work ina huge teaching facility and a large town.
  4. by   flashpoint
    Your pharmacy situation sounds just like ours. Our policy allows the physician or mid-level provider to dispense enough medication to get the patient through until there is a pharmacy open. According to the rules, the nurses can get the medcation out of Pyxis, put it in a bottle and label it, but the physician or mid-level has to actually hand it to the patient and give medication instruction (not that it ever works that way, but we try). Also we are not allowed to dispense anything that can be obtained OTC of there is a store open to buy the OTC med, so from 2400 - 0600, we can give one dose of tylenol, advil, etc, but no more...we give a dose in the ER and one to take home The fact that we don't dispense OTC meds makes a lot of patients really mad...I understand their point, but why should insurance pay for things like tylenol or aspirin? We also see a lot of people get pretty upset when they have to buy "embarassing" things like mag citrate or Fleets instead of us just giving them out.
  5. by   TazziRN
    I work in a 22-bed facility (plus 6 ER beds). We have a pharmacist two days a week, who fly in from southern CA and stay in a motel overnight. We have two drugstores in town, both of which roll up their part of the sidewalks by 9 pm. During the night we will dispense enough meds to get the pt through to the next morning, on the ER doc's order. If the med prescribed is something that our drugstores would have to order, we'll sometimes give the pt enough to get them through a day or two...again, on the doc's order.
  6. by   jeannet83
    Cotjockey- Ditto for our facility

    Jeanne
  7. by   ernurse4life
    we have ERTH (emergency room take home) supplies of meds that at the physician's discretion can be dispensed to the pt at discharge. we service many pt's from the airport, who have been pulled off airplanes d/t illness and need something to hold them until they reach their destination. these meds are pain, abxs, and mag citrate. if it's anything else, social work comes in and obtains the meds via voucher from an outside pharmacy and then they are dispensed to the pt. PIA, but sometimes, something is better than nothing.
  8. by   canoehead
    Our pharmacist makes up packets of meds that are commonly needed and the docs/PA's are the ones that physically hand them to the patients.
  9. by   tony summers
    Must be very different over here in the UK as we will dispense the full course of medication for a patient when our pharmacy is shut. The dr or nurse practitioner will prescribe from an abbreviated list of meds that are relevant to A&E and then our nurses will dispense this if pharmacy is shut.
  10. by   debi87021
    I work out on the navajo reservation. Extremely small hosp. 6 bed ER. Ok, i guess i have it lucky, cause this is IHS facility we have a pharmacy located inside the hospital. Our pharmacy allows us to dispense meds, not just for a few days, or "till morning", but for instance an antibiotic....usually taken for 7-10 days, we dispense (on doc's orders) the full course. Doc has keys to pharmacy at nights to be able to get some of these meds. I personally do not go into that pharmacy. I only dose out the meds as instructed. And btw, we give out OTC's too, tylenol, motrin, you know stuff like that. Anyway, that is how it works for this IHS in the middle of nowhere navajo land.
  11. by   petiteflower
    We are in the same situation. Our pharmacist makes pre-packs of common drugs, and if something else is needed then the ER doc has to go to pharmacy and package it himself. And to do that the doc has to write a script for the pharmacy. It works out ok most of the time.
  12. by   gwenith
    The Aussie Outlook.

    A couple of years ago here in QLD they changed the threapeutic goods act (AKA the drug administration act) so that nurses could no longer dispense but could only SUPPLY three days worth of medication. There was also restrictions on who coul dsupply i.e. only remote area facilities.

    There was a lot of outrage form the remote area nurses (one DON from an gem mining area maintained three days was not enough because his patients only swung down out of the trees once a month).

    Rural and remote area nurses were peeved because of the restrictions which were obviously included after lobbying from the pharmacy group within the metropolitan area.

    For once though we DID something about it. A letter writing campaign and discussions with the local members of parliment got the law amended within 6 weeks of being passed! A record for parlimentary action!

    Repeat after me.......... We are powerful we CAN change the way things are. We are powerful we can change the way things are.
  13. by   teeituptom
    Here we cant dispense we can only administer, nothing to send home.
  14. by   atownsendrn
    Our ED is a lot like Cotjockey. We (the nurses) can get the meds out and label them, then the MD must sign the label and hand it to the patient. We will give them enough to last until the pharmacy is opened. If we have to reconstitute antibiotics (especially for peds pt's that you know the parents won't get filled) we will give them the bottle. About a year ago, administration and the hospital pharmacist at the time decided that we would not dispense anything. It was horrible!!!!! So the ED staff pulled together and really became patient advocates. And now we can do as above.

    So RainbowSky, I agree with Gwenith - we are a powerful voice. And we must all be patient advocates. Get you ED nurses together and protest this decision.

    Good luck!!!!

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