Is this comon practice where you work?

[Amysuenu]

Hello all. I wanted to post a question to all of you and get some feedback regarding a situation that occurs on a regular basis at a facility I was recently employed at.

Ok, this facility receives it's medications from an outside pharmacy, but does carry certain commonly used floorstock medications. I was working as the med nurse on this unit and a new order had been written for a patient for a med that we don't have on floor stock due to it not being a common drug we use. I was told to remove this exact med from another patient's drawer and give it to this other patient. I felt very uncomfortable doing this and would not follow through the request. This goes against what I was taught in nursing school and also didn't feel it was ethical. My other concern was who is this patient paying for this medication that want me to give to this other patient. I addressed this and was given a look of a complete idiot! I was concerned with this fact. I was told not to worry about it and I could just replace it at a later time. This leads to another problem, the same nurse is not consistently the med nurse and we are often assigned to another unit, if the census is high.

Is this standard practice where you work? I never came across this situation w/ my previous employer. Also, since this situation arose I have since been terminated and the reason I was given was due to a med error; however, that med error was never discussed prior to my termination, nor did I actually see the paperwork related to this.

[netglow, ASN, RN]

Oh, OP sure wish you had been told what your error was. That is wrong, wrong, wrong. Could have been mild to quite serious. How are you going to resolve it for yourself without knowing.

[CathyLew]

We always borrowed, as long as the order has been verified. The patient does not get charged for a med until the medication is given to the patient, so the meds in the patient drawer, even if from an outside pharmacy, have only been charged to the hosptial, not to that patient.

The borrowed med is replaced as soon as Pharm gives it to us. This is more of a convienience to the nurse, so you don't have to go back into that patients room again and again to play catch up on meds.

[systoly]

I've worked in facilities where this is common practice and I've worked in facilities where it is considered theft. Some of the problems I've seen with borrowing are: forgetting to pay back, the meds come from a different supplier and look different, practicing witout a license - meaning when the patient's (the one who received the borrowed med) supply comes in a tablet is taken out and placed into another bottle (the bottle the first tablet came out of) rather than ordering a separate bottle with the med to be re payed and an extra label, it becomes everyday practice and reordering in a timely manner is neglected, because " we can just borrow ", the patient or family of the patient the med is borrowed from is never asked about it, those are just some of the many problems that come along with borrowing. It just isn't good practice and I won't do it routinely. If a supervisor, family member or anyone else feels that the med can't wait until the pharmacy delivers it then they can go get it. There are a few instances when I have borrowed meds: Several times when two patients were on the same hospice service and the med in question was provided by hospice and hospice asked if I would do this in order to save them an extra trip and hospice and I made sure it was properly documented. Giving stat lasix (albeit PO) before transferring to ER for acute CHF. I believe there are instances where borrowing is appropriate as long as it can be properly documented.

[Plagueis]

I work in LTC, and borrowing seems to be a common practice. When I was on orientation, I was told that we were not allowed to write "med not available" on the MAR, as the facility would be cited for that. Borrowing was justified on the basis that the resident needs the med now, and if someone else has it, and the pharmacy won't be delivering it for hours, then it's okay. Plus, it would be a med error if the med was given late because we waited for the pharmacy delivery.

Of course, most of the borrowing could be avoided if meds were reordered before they ran too low.

[NurseKatie08, MSN]

For me, it depends on the med. Our e-kits cover just about every possible med most new admits need. If meds are properly reordered there is typically no need to borrow except in the case of a new admit. In that case, if it's a blood pressure med, yes I will borrow it if it's not something included in the e-kit...if it's simvastatin, they can live without it until tomorrow. If it's NTG for someone having chest pain, then you bet your sweet bippy I'm borrowing it.

[FLArn]

Yes, omitting a med is a med error. However if the nurse documents it properly it is a system error and not the NURSE'S error. Being a med error, this does require the MD be notified; if the MD's get enough calls about this maybe your facility will change its pharmacy policies. Calling the MD gives him several options - allow the patient to wait until med is available, use an available med that has the same action or send patient to ER for eval and treat. None of the solutions to this problem are in my scope of practice since I may not prescribe nor dispense medications (giving one patients med to another ) Does this make me popular -probably not- Will I still have a license at the end of the day --you betcha!

[GooeyRN, ADN, BSN, CNA, LPN, RN]

We borrow. Pharmacy encourages it. They are only there on day shift 5 days a week. They are not there weekends, 3-11, 11-7, holidays, etc. We still get admissions and new orders when it isn't dayshift M-F. They have us put a note in a box that we borrowed from another pt so that the correct patient can be charged/other pt credited. If we don't do this, we have to find a driver to go to another hospital (in another city) to get the medication. Doing that sometimes 15 times a day can get a little crazy. So it is only done for more emergent things that we can't borrow.

[Ruby Vee, BSN]

we borrow. if you quote me, though, i'll deny it.

we borrow, too. always have in every job i've ever worked.

[GLORIAmunchkin72]

Our pharmacy does not deliver until about 9PM or 9:30PM. If you need a med before that and you don't have it you're pretty much out of luck. By the time the meds arrive and are properly checked off it's quite late and the resident is sound asleep and doesn't want to be bothered but we do wake them depending on what they're supposed to have. Apparently if you don't have it you don't have it. I usually chart 'waiting on pharmacy' and then enter additional documentation when the med arrives.