Understanding the Role of the Pharmacy

  1. I have started at a Psych Hospital Pharmacy as a Certified Pharmacy Tech (I am an LPN Student), for the most part the Nurses have been very nice and supportive towards my career endeavors. As with any place of work there are some bad apples. We don't use any Pyxis type system its all drawers and the like.

    A couple of rants:

    My Boss is the Pharmacy Director, he is = in statue to your Nurse Manager, I don't mess with him. Don't expect me to do something for you, and then play dumb when I tell you who my boss is. Would you Mess with your Nurse Manager? I don't think you would unless you like to risk losing your job on a daily basis.

    I don't tell you how to do nursing processes, don't tell me how I should order a certain drug when its Non-Formulary, which leads me to......

    If I don't have drug A, I simply can't substitute it with something similar without a WRITTEN MED ORDER from the MD or NP. For the same reason you don't give Tylenol 325 MG in place of Aspirin 325 MG per the Cardiologist. No Pharmacist with half a brain is going to put his or her license on the line over your crap.

    Don't call down to the Pharmacy yelling at me like I am a dumby, Would you like the Doctor to treat you like that or even better your fellow nurses?

    We save your ass on a daily basis, those sloppy Med Orders in handwritten or typed format, do contain errors at times, which you would not have the time to pick-up. Imagine if you had to do all the work we have to do down in the Pharmacy before you gave the Meds? Imagine if you had to physically walk down there and get the Meds. That said.....

    You the Nurse are our last line of defense and have saved our ass a few times as well.

    The Pharmacy Department will catch you if your diverting drugs (I know most Nurses don't do this, anyone can including the Pharmacy Dept.) you will mess up :trout:

    The Med Room is an extension of the Pharmacy. No Eating in there, no hanging out in there, its strictly for Med Business. What if you spill your lunch on some Meds, that vary from $.05 a tablet to $5 a Tablet?? Your NM and the Pharmacy are going to be pissed, so is the Med Nurse. Do all your eating and nail filing, and internet searching somewhere else not in the Med Room.

    These are a select few people.

    Most Nurses at this facility have given me no problems at all.

    Never under estimate the Pharmacy Tech who delivers the Meds. He or she can be your best friend. Some Nurses I leave notes reminding them where I put the Floor Stock Drugs (Things like Benadryl, APAP and Injectables), which save you a few minutes and a little less worry knowing that you have enough Haldol injections available in case the whole floor were to need them. Some Nurses I literally run away from, Pharmacy isn't a game, if your in your 50s and didn't learn what a Med Order is in Nursing School, then its time you reread that chapter!

    Rant Mode Off
    Last edit by drmorton2b on Jan 5, '07
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  2. 12 Comments

  3. by   Hoozdo
    Quote from drmorton2b




    The Med Room is an extension of the Pharmacy. No Eating in there, no hanging out in there, its strictly for Med Business. What if you spill your lunch on some Meds, that vary from $.05 a tablet to $5 a Tablet?? Your NM and the Pharmacy are going to be pissed, so is the Med Nurse. Do all your eating and nail filing, and internet searching somewhere else not in the Med Room.


    Rant Mode Off
    Yes SIR. I promise not to file my nails in the med room.........as if I have time to file my nails, do internet searchs, or even eat at work.
  4. by   SCRN1
    Maybe you can answer a question for me. Where do all those faxes go I (and others) send down to pharmacy? I can't tell you the number of times I've gone to give a med and it isn't there or listed on the MAR. I then called the Pharmacy and they said they never received the fax. There have been some I've sent more than once & they still say they didn't get it. Or what about the forms I've filled out to get a med changed on the MAR and night after night, it doesn't get changed on the MAR. So, I have to keep having to change it each night when I check of MARs for the next day?

    That said, I do understand how busy the Pharmacy must be since they're having to take care of meds for all patients throughout the whole hospital. I have no problem with anyone in our pharmacy except one person and when they're working, that's usually when I have most of the problems stated above. Same thing with the last hospital where I worked. Just like with some nurses, most do their work as they should. But you always have some who slack off.
  5. by   drmorton2b
    [quote=SCRN1;2004080] Maybe you can answer a question for me. Where do all those faxes go I (and others) send down to pharmacy? I can't tell you the number of times I've gone to give a med and it isn't there or listed on the MAR. I then called the Pharmacy and they said they never received the fax. [/quote=SCRN1;2004080]

    Usually the Faxes go into the storage, similar to what would happen with Prescriptions in a Retail Pharmacy, they are filed in Drawers, and then eventually put in Boxes and into long term storage somewhere

    As far as the other stuff happening it depends on where your working and who is working in the Pharmacy. Sometimes the fax machines crap the bed or come in garbled, sometimes the people down on both ends of the equation in the Pharmacy are lost.

    At our hospital the Nurse Copies down the Med Orders by hand to the MAR which is on a Card-Ex (Something that I haven't seen since Saint Elsewhere) from the Med Order.

    There are some Pharmacists who don't enter certain things into the computer, that I have to figure out (things like the Number of Tablets to Dispense, not too hard), they while they are checking the order, they will say oh no, I met to put in 50MG BID instead of 100MG BID, things like that slow us down. Most of the time in a psych environment its the Doctor Changing stuff d/cing etc. or stupid crap like excessive writing, instead of writing BID they will write Take at 8AM then 8PM, now imagine that with 10 Meds. Slows down the order entry process.
  6. by   Tweety
    It's always good to get the perspective of another department. I know nursing isn't the easiest department to work with. I know you're not really nurse bashing, but expect a little flack because I think you might get some.

    For instance, if Pharmacy isn't a game, why do you play favorites and leave some nurses notes, restocking their areas, and run from others? I don't care if you're my best friend. Just do your job professionally and I promise not to eat you. j/k
    Last edit by Tweety on Jan 6, '07
  7. by   UM Review RN
    I guess my biggest complaint against our Pharmacy would be that in an emergency, we can access and give Lasix, but not Cardizem.

    I don't know who makes the rules, but when I have to wait three hours for Pharmacy to send up a stat Cardizem drip on a patient who's in A-fib with RVR, I consider that a problem.

    The majority of the time though, our Pharmacists are excellent, helpful, and very much appreciated by us nurses. We do try to have a respectful, professional relationship with all the staff in Pharmacy, because they are probably the most understanding of the importance and responsibility we both have regarding medications.
    Last edit by UM Review RN on Jan 6, '07
  8. by   jennyfyre
    I usually love our pharmacy folks... but today.. ARGHH. We are "mostly" clinician order entry at my hospital, however, orders from surgeons are still allowed to be written if they are pressed for time (which is always). I totally don't mind the pharmacy techs asking me if I recognized the signature or asking me to refax something... but today after I faxed some orders down to Pharmacy, they sent the fax back up to my floor with a note that read " How often does the MD want this antibiotic?" The MD had written for 3 doses, but not the time. I wrote back that the MD was not on the floor (he's a surgeon) and wrote down the MD's pager number so they wouldn't even have to look it up. I sent it back to Pharmacy. I got a very irate phone call from the tech who just wanted me to answer the question... how often.... she didn't want to bother a surgeon! I am the HUC... just what did she want me to do... as far as I know neither HUCs nor nurses can "fill in the blanks" for physicians. She even said she was going to take it up with our NM about my floor always being so uncooperative. Sigh... yeah I could have guessed the correct timing.. but just who would have been in trouble if I was wrong!??!
  9. by   jimthorp
    Quote from Angie O'Plasty, RN
    I don't know who makes the rules, but when I have to wait three hours for Pharmacy to send up a stat Cardizem drip on a patient who's in A-fib with RVR, I consider that a problem.
    I can't count on two hands the number of times I've had to wait >24 for meds on a new admit nor the number of times I've had to wait 8+ for a stat med order. :angryfire

    We switched pharmacies a few months ago and frequently run out of meds. So here I have a resident who has no perscribed cardiac meds available. Do I make the legal decision or the prudent decision? I choose the latter.

    Our pharmacy is so pathetically incompetent we have gone days for new orders to be filled, have recieved the wrong dose with correct order on box, received the correct label and order on box but a totally unrelated med in the box, and even narcotics for a resident who is not even in the building. :angryfire

    I don't understand half of what the OP typed.
    Last edit by jimthorp on Jan 6, '07
  10. by   drmorton2b
    Some Facilities that use "Contracted Out Facilities", this doesn't include a Long Term Care Facility that has "stable" patients, that don't require alot of Med Changes or the need for an in house pharmacy. The facility I worked at was a Contracted out Pharmacy at one time to a big Pharmacy Company that involves Birds :-) Problem was Corporate wanted the hospital to pay ex amount of $ for this and if they wanted more pay more. Needless to say the CFO found out that they were spending (Fairly said about $8K a month more then they would spend if they had there own in house pharmacy run by the Hospital) and the Pharmacy Contract Company wanted more money next year just because they wanted to raise rates. Needless to say the Hospital no longer uses a contract company, this is becoming a trend now.

    As far as STAT orders taking forever, its politics at its best. If the Pharmacy Director isn't on his or her toes then things will fail. A Good Pharmacy Director is like a good Nurse Manager. Some people as in any profession like to stir up stuff. There is this one RN that every one says is mean to the Pharmacy, well I have found him to just get nervous about giving the Meds on time, etc. and he needs reminders to send down orders, however he is the nicest and most caring Med Nurse I have ever seen towards the Patients.
  11. by   RobCPhT
    WOW it sounds like you guys are having a lot of pharmacy problems. I am a pharmacy coordinator for LTC and a nursing student so I see things from both sides. Do you have any type of issue capture/formal complaint forms for the pharmacy? Getting the right meds to your patient is a top priority and if that isn't happening you need to file a complaint. If the director of pharmacy isn't responsive you may want to take it to the state board.

    On another note I will tell you faxing is really not an efficient way to send orders. They get lost and are hard to read. Maybe try calling the order in instead sometimes.
  12. by   Tweety
    Quote from RobCPhT
    WOW it sounds like you guys are having a lot of pharmacy problems. I am a pharmacy coordinator for LTC and a nursing student so I see things from both sides. Do you have any type of issue capture/formal complaint forms for the pharmacy? Getting the right meds to your patient is a top priority and if that isn't happening you need to file a complaint. If the director of pharmacy isn’t responsive you may want to take it to the state board.

    On another note I will tell you faxing is really not an efficient way to send orders. They get lost and are hard to read. Maybe try calling the order in instead sometimes.
    Calling doesn't work in a hospital, the phone would ring off the hook.

    The only forms we have are medication incident reports. Perhaps we should use them more often with these types of delays.


    It's not necessarily a good idea to have forms allowing other departments to report each other. Too much tit for tat would go on. Only supervisors and managers can "write someone up" and it's best to keep it that way. But I agree, delays of 8 hours for important stat meds needs to be addressed.

    My favorite is when I fax a missing med request on a med about once every hour or two, and make a couple of phone calls. Eight hours later someone with a brain answers "we don't have an order for that med, could you fax the original order again, we never got it". Gee it would have been nice for someone to tell me they didn't have the original order, say about two phone calls and three faxed reqests ago??

    On the other hand nurses can be difficult. They think they are the only nurse and the pharmacy deals with and everything should stop when they want something. I realize there is a pharmacist shortage, and just like I think to my demanding patients "you're not my only patient!", the pharmacy has their issues as well.
  13. by   UM Review RN
    Quote from Tweety

    On the other hand nurses can be difficult. They think they are the only nurse and the pharmacy deals with and everything should stop when they want something. I realize there is a pharmacist shortage, and just like I think to my demanding patients "you're not my only patient!", the pharmacy has their issues as well.
    True. One pharmacist and I got quite close due to all the med questions I would ask her, and she sometimes had to let phone calls go unanswered because the NICU med orders that had to be done under very sterile conditions, so once she started, she couldn't pop out from "under the hood" (whatever that meant) to answer the phone. Some nights, just one Pharmacist and no tech for the whole hospital.

    I DO appreciate what a tough job these Pharmacists have and I have nothing but respect for them.
  14. by   drmorton2b
    It takes a dedicated Pharmacist to work in a hospital setting, mainly due to the pay rate. A Pharmacist might make $35-$40 an hour doing Hospital type work, where in retail pharmacy it can be from $45-$50 an hour.

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