LTC and Pharmacy deliveries

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    I am a new LPN I got my lic. in sept 2012, I started working at a Nursing Home. I have only been there a few months. there was a new resident and this new resident had an order for 2 narcs, one was delivered the other was not, pharm said they needed the dr to write a rx for it before it could be filled. The nurse on the previous shift said she called the doc and that he said he would be in later that day to write the script. I left note on docs communication sheet reminding him of the script, DON seen the note and asked me about it. I told her what the other nurse told me and that the doc said he would be in later. She told me if it had been that long then I need to stop my med pass and call the other doc for the facility to have him fax the script to the pharm. and that if state were here and we didn't have the meds that were ordered it wouldn't just be on the facility but the individual nurse as well. So I called the other doc to get script and he called pharm. 30 min later the original Dr. came in and wrote the script, I told him what the DON had me do and he was not happy about that. Said he would be having words with her about that because it's inappropriate for her to do that. If it were an emergent situation then he could understand but this was not an emergent situation. Now my question is, how would this come back on me that we didn't have the meds because we needed the doc to write the script ??
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  3. 9 Comments so far...

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    Good question. I know that at my LTC facility that we are always asking the doctors to write scripts for narcotics. However, I don't see how the nurses can be blamed because the doctor doesn't send scripts to the pharmacy. I am thinking that it is totally the responsibility of the doctor to write scripts and send them to the pharmacy.
    fairyluv likes this.
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    I had another issue tonight..concerning the same thing with a totally different doc and different pt. pt has narc 15mg TID..family wants pt to have prn pain meds for breakthru pain. nurse on previous shift said doc was aware of this and he would be in later on my shift to write script. by 7pm doc hasn't shown. so I call and leave him msg on his vm. no call back after an hour. so I call the DON and she tells me to call the other doc, "don't let him lie there in pain" I call the other doc and he refuses to call in script. Pt's reg doc finally calls me back at 8 30 and says he will call pharm to get narc 20mg prn. he calls local pharm and our contract pharm (which is in another state and 4 hrs away). Local pharm says they can't deliver til contract pharm confirms it. I call contract pharm and get vm so I leave msg. Then I call our Admin (per his request when we can't get meds) and he calls contract pharm. contract pharm calls me at 9 30 and tells me that local pharm is sending the narc via cab driver. I finally recieve the narc at 10 30. I did not leave until 12 45 am. I charted a big long note in the nursies notes about this whole pain pill delivery fiasco. I'm doing all this while trying to pass meds. I started my med pass at 7:30 and finally got done at 10:45. first of all..I don't really think the pt needed additional pain meds cause he never really acted like he was in pain. He never said he was hurting, nor did he ever ask for anything, and he can talk and tell ya what he wants. His family comes in and they are the ones concerned about his pain. Soon as they leave, pt starts crying and moaning and yelling for his wife. He has only been at our facility for 2 days and this is the first time he has done that. So once again I am made to feel that it is ultimately my sole responsibility to obtain these pain meds. when I have no control over the situation. All i can do is call the doc and get the order. I cant control the pharmacy nor can I make the doc write script when the DON and Admin thinks he needs to. It seems like no one else wants to deal with these pain med scripts and just pass it on to me. it gets really frustrating. It's a lot easier for dayshift to obtain these scripts when the docs are at there offices and the pharmacies are open, than for me to have to bother 2 or 3 docs at home just to get someone to fax a script to the pharm.
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    You're perfectly fine! The DON is only correct if it is an emergent situation or there is not documentation that you have made reasonable attempts to contact the MD for the Rx. Writing the script later in the day and waiting for the meds is fine if it's not emergent.
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    Quote from indiechic
    You're perfectly fine! The DON is only correct if it is an emergent situation or there is not documentation that you have made reasonable attempts to contact the MD for the Rx. Writing the script later in the day and waiting for the meds is fine if it's not emergent.

    Not sure I totally agree - kinda depends if it is a routine scheduled pain med or a PRN. If it is a scheduled medication...as the nurse on duty, it is your responsibility to get that medication or to notify the Dr. why you can't administer it as ordered. The Dr. must get you the script or must give you the OK to hold the medication until it can be obtained.

    With that said, ideally it would be great if the day nurses could anticipate this happening and get the ball rolling while the Dr and pharmacy are open during normal business hours. (Still searching for the perfect world).
    stardust80916 and sallyrnrrt like this.
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    Depending on your states' pharmacy regs your facility could also contemplate obtaining a narcotic ekit and/or nurse agency letters from the prescribing physicians. Both of these solutions would ease the obtaining of controlled drugs after hours when necessary. However both solutions still require contacting the physician at some point in order for them to write the necessary prescriptions.

    Also I want to reinforce what Nascar Nurse has stated that if this is a routine/scheduled controlled drug (not just a pain med but also a mood altering or seizure med, etc.) surveyors expect there to be no interruption in the availability. This requires everyone to be vigilant in ensuring that refills and/or new prescriptions are obtained and sent to the pharmacy in a timely manner.
    lucinda1518 likes this.
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    only in a perfect world
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    (Still searching for the perfect world)...if only the world was perfect
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    IMHO If the fella needs breakthrough meds that frequently it's time to up the dosage on his long acting narc to provide better pain control
    .You are doing exactly what you need to do-getting the meds to the patient asap.If the doc fails to act the facility can be held accountable.Docs hate to call in scripts for each other because that stuff is tracked by the feds. Our facility has been dinged by the DOH in the past for "delay of treatment" due to unavailable meds and GET THIS-the med was a frigging MULTIVIT.The DOH saw it was marked "not admin-not available" and they started digging around and saw a trend so we had to come up with a plan of correction and now that long standing issue has finally been resolved,every single nurse passing meds had better make sure an unavailable med is on order,delivery is pending or the doc is aware it is going to be missed.People would let that go one for several shifts and never take the initiative to call the pharmacy.
    Your DON will get those docs in shape.
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    [QUOTE=txredheadnurse;7252243]Depending on your states' pharmacy regs your facility could also contemplate obtaining a narcotic ekit and/or nurse agency letters from the prescribing physicians. Both of these solutions would ease the obtaining of controlled drugs after hours when necessary. However both solutions still require contacting the physician at some point in order for them to write the necessary prescriptions.

    Which is why, when you receive report, be sure that you ask 'have there been any new med (or tx, or anthing) orders on your shift', and if yes- insist that that nurse has gotten signatures, ordered the med, transcribed the order, informed the patient or got consent from the power attorney- in general, hold her accountable! and etc- so you don't get stuck like this, over and over. Be familiar with your pharmacy policy- it will say when a med has to be started, based on category, how to get stuff after hours, in detail- follow that to the letter, and you will protect yourself from allegations, such as was said:"Don't let him lie there in pain".


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