Smart Nurse vs. Dumb Pharmacy, Round One. DING! - Page 5

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  1. Oct 13, '10 by
    I have proof that no good deed goes unpunished. I will never forget the day that I went to hang up an IV antibiotic for a LTC patient. I noticed that there was no dose for the next shift. So I decided to be a do gooder and let the pharmacy know right away so they could get it ready. The pharmacy was furious. They said they had already sent it and that the problem was me and I just couldn't find it. They demanded that I get another nurse to check the refrigerator too. She checked the refrigerator and couldn't find it either. So during the huge LTC morning pill pass I was interrupted 10 times to receive 10 angry hostile phone calls from pharmacy still insisting that they had already sent it.
    wooh, Plagueis, cosmicsun, and 1 other like this.
  2. Guide
    Oct 13, '10 by
    Quote from cosmicsun
    Hi. I can't read the whole post, but I got through the first paragraph or so, and the first thing that comes to mind is WHERE IS THE DOCTOR. The Nursing Home Doctor to write orders for the new admits....?

    The only solution I can see is that there absolutely has to be a doctor there until all new admits are complete for the day. What if a patient comes in with a low BP like you indicate, what if the orders are not complete from the hospital, and don't nursing home doctors assess the patient and write their own orders?

    There should be a policy that new patients cannot be accepted unless there is a DOCTOR THERE!

    I think it would make your life a whole lot easier, and better care for the patient.

    It actually sounds negligent that a doctor wouldn't be there. I think there needs to be new rules as far as transfers go....

    Good luck.
    That scenario sounds great in theory. In practice, however, I have never seen an MD admit a patient to any nursing home I've ever worked in, nor would I know what to do with the extra time and energy such an arrangement would provide. Why, I might be able to use the bathroom........take an actual meal break.......maybe even spend a few minutes with a resident who needs a little TLC. Wouldn't that be wonderful?? :heartbeat

    Seriously, though, the reality in small facilities is that the medical director has his/her own practice elsewhere, making it impossible to be in the building much of the time.....let alone when an admission comes in. What we end up doing is chasing down the primary-care physician or the on-call, getting telephone orders and then obtaining whatever meds the resident needs from the emergency box (assuming, of course, that the E-box is stocked and that the med isn't something out of the ordinary). If for some reason we cannot access the PCP or the on-call won't give a T.O., we call the medical director as a last resort. All of which is very frustrating and time-consuming, but it's the only system we've got.
    wooh likes this.
  3. Oct 13, '10 by
    my sympathies to you....it's almost the same thing at where i work, but our pharmacy REQUIRES a signed script before they "allow" you the privilege of getting into the narcotic box.
    VivaLasViejas likes this.
  4. Oct 13, '10 by
    I absolutely have had days like that in LTC. I could visualize every single player, every phone call, and have made more than my share of Grrrrrrr's at pharmacists for the exact same thing. I loved it and enjoyed reading the post. Thank you for such a refreshing drink of sanity. LOL
    VivaLasViejas likes this.
  5. Guide
    Oct 13, '10 by
    Glad you enjoyed it.

    Ironically, the single fly in the ointment at the new job I'm starting Monday is the pharmacy......actually, the pharmacy [I]changeover[/I that we're doing in December. I've gone through this a couple times before, and it's a cluster-mug of the highest magnitude. What an unholy mess it is when every single person who handles physician orders must fax every single new order to BOTH pharmacies, so that the old one continues to provide the meds while the new one is completing each resident's profile. Then the old pharmacy comes in and takes your fax machines and med carts, and the consultants you're used to go away, and nobody seems to know just where the heck everything is or when it's going to arrive. AAAAAAARRRRRRRRGGGGGGGHHHHH!!!

    That said: I'm glad my new place is going with a new pharmacy. I may have had to turn down the job if we were continuing with......yep, you guessed it..........XYZ Pharmacy!
  6. Oct 14, '10 by
    Just a quick note to tell you how much I enjoyed the story. It's almost 3 in the morning and I needed that laugh before I could sleep. Thanks.
    VivaLasViejas likes this.
  7. Oct 14, '10 by
    Quote from Blackcat99
    I have proof that no good deed goes unpunished. I will never forget the day that I went to hang up an IV antibiotic for a LTC patient. I noticed that there was no dose for the next shift. So I decided to be a do gooder and let the pharmacy know right away so they could get it ready. The pharmacy was furious. They said they had already sent it and that the problem was me and I just couldn't find it. They demanded that I get another nurse to check the refrigerator too. She checked the refrigerator and couldn't find it either. So during the huge LTC morning pill pass I was interrupted 10 times to receive 10 angry hostile phone calls from pharmacy still insisting that they had already sent it.
    We must have the same pharmacy at my LTCF that you have. Moreover, the we-already-sent-it line often applies to other refills that we faxed days ago, but still haven't received, despite numerous phone calls to the pharmacy. We keep all of the receipts when we received meds from the deliveries, and there were times when I even mentioned that we don't have a receipt that shows that Reglan, for instance, was delivered, but the pharmacy still angrily insists that it was.
    VivaLasViejas likes this.
  8. Guide
    Oct 14, '10 by
    Quote from Plagueis
    We must have the same pharmacy at my LTCF that you have. Moreover, the we-already-sent-it line often applies to other refills that we faxed days ago, but still haven't received, despite numerous phone calls to the pharmacy. We keep all of the receipts when we received meds from the deliveries, and there were times when I even mentioned that we don't have a receipt that shows that Reglan, for instance, was delivered, but the pharmacy still angrily insists that it was.
    If I had a nickel for every time that's happened in my LTC career, I'd have been able to retire at 50.

    One ALF where I worked had the misfortune to be hooked up with a pharmacy that wasn't too swift when it came to hiring their drivers. I mean, some of these people were tres creepy---they'd slip into the facility at three in the morning and scare the living daylights out of the caregivers. And we always suspected that there were a couple who scored five-finger discounts because every time they delivered meds, there was something missing (hint: it was never Cipro or Lasix).

    Eventually my boss got tired of my complaints and 'fired' this pharmacy, but the new one was almost as bad, frequently claiming they'd sent some med or another when they hadn't. "Customer service" was a joke, and some of the time we literally had to call the head office and talk to the CEO to light a fire under their rear ends. Now, I know that processing bulk orders for thousands of people in many facilities can't be the simplest task, and I believe these pharmacies start out in the business world with the best of intentions. Trouble is, they get too big, too fast, and that's when everything goes in the dumper. JMHO.
  9. Jan 3, '11 by
    Amen!! Been there done that in every specialty area I have worked in over the last 20 years--the amazing disappearing physician, the whatever department that doesn't really understand that you do not have time to answer their questions that if they just took two minutes and thought it through they would figure out the answer, etc.
    VivaLasViejas likes this.
  10. Jan 4, '11 by
    And I thought my Pharmacy was the only one that did that. Oh how WRONG I was.
    VivaLasViejas likes this.