Med not available - page 2

I work 7p to 7a every weekend. Almost every week there is some patient whose med is not on the med cart. Possibly because the med was not ordered or the pharmacy didn't send it for some reason. We... Read More

  1. by   dotter
    Nursepenny, things are very different in hospitals than in nursing homes. A 62 bed home is not going to have a stocked pharmacy like in a hospital.

    Earle, I think you might have misunderstood the situation. I'm there from 7pm til 7 am only on sat and sun nites. Yes I can order the med and I do when it's not there but I'm not going to get it until the pharmacy delivers again and that will be on monday evening. My main concern is that I was charting "med not available" to call attention to the fact that there was a problem because this has been going on for the almost 4 yrs that I've worked in this home. If was brought up in a meeting that we should not do that. I imagine the pharmacy consulant caught that when they did their review. I've noticed that the rest of the nurses just go ahead and initial the med like they have given it even tho they haven't. I just can't do that.
  2. by   Chaya
    Quote from dotter
    I work 7p to 7a every weekend. Almost every week there is some patient whose med is not on the med cart. Possibly because the med was not ordered or the pharmacy didn't send it for some reason. We are told not to chart "med out of stock" or "temp unavailable". There is no way I can get the med in on a weekend so what can I do to cover myself? I don't feel right charting that I gave the med when I didn't.
    Yeah, well, my answer to that one has been "excuse me, but are you asking me to falsify a record?" They got the point, not that much has changed. Also, I feel no hesitation borrowing something like a cardiac med as opposed letting the patient miss a dose or get it in the middle of the night.
  3. by   GPatty
    I smply write on the MAR "med not available~pharmacy notified". ANd I do order the med. Luckily, the pharm we use is open all night and will bring the med the next run (sometimes the next day) We have an EDK we use for meds also if we don't have them handy... if I use from the EDK, that is also marked on the MAR.
  4. by   CoffeeRTC
    Dotter...your problems sound like mine. I work in a 50 bed home and we have a major pharmacy (Omnicare) and our back up is CVS. We don't call the back up pharmacy..our primary uses that and will call them. I understand your situation...If you're doing 9 pm meds and find one missing...the soonest you'll get it delivered is the next day (our meds come in after 8pm each night excpt sunday). So really if you notice a missing med on sat night it probably wount be deiliverd until MOnday unless you beg them to send it.
  5. by   nurseduck
    I am a nurse consultant for a pharmacy and I would raise cain with my pharmacist if they made the LTC feel like they could not call after hours for an ER delivery for medications. A pharmacy that provides medications for a LTC needs to provide the meds 24 hours a day - 7 days a week. Our pharmacy is only closed on Christmas but even then will provide medications for a facility when requested to. That is the pharmacy's duty to fulfill their contract.
  6. by   dotter
    nurseduck, I don't know where you are but in the areas I've lived in 2 different states all the nursing homes use the big pharmacies and they only deliver once a day and if you get a new order on saturday you don't usually get the med until monday. That's just the way it is. I can fax the order or leave a message on the pharmacy voice mail to order it but it's not going to get to the home until monday. and usually it's the fault of the nurses at the home for not ordering it in time. I only work weekends and I don't want to cause a riot I just want to cover myself. I like julielpn's answer and I wonder if it's acceptable.
  7. by   nurseduck
    I feel terrible about this. We actually have two deliveries - one in the AM and one in the Pm for our buildings plus if they need to have something we provide ER deliveries. Of course we monitor the Er deliveries to see if we need to add it to theri ER kits but if the frequency isn't there our pharmacist either coordinates with the local back-up pharmacy or we send out a emergency delivery. ..... We also have deliveris for our facilities 7 days a week including Sundays. ..... I agree with the other responses that we as nurses need to stand up for our selves but we tend to not want to rock the boat but I worked too darn hard , just like every other nurse to put my license on the line for the boss. stick to your guns and chart the truth and what steps you took to provide for the resident. CYA!!!
    Quote from dotter
    nurseduck, I don't know where you are but in the areas I've lived in 2 different states all the nursing homes use the big pharmacies and they only deliver once a day and if you get a new order on saturday you don't usually get the med until monday. That's just the way it is. I can fax the order or leave a message on the pharmacy voice mail to order it but it's not going to get to the home until monday. and usually it's the fault of the nurses at the home for not ordering it in time. I only work weekends and I don't want to cause a riot I just want to cover myself. I like julielpn's answer and I wonder if it's acceptable.
  8. by   KrisV27
    I have discovered that though you may put your initials and "med not available", when the monthly MAR sheets go down to Medical Records, they write ME (mistaken entry) and "med found" and are pretty good at forging your initials and signature. This is because not giving a med is NOT acceptable. If they leave that "med not available" on the MAR the nursing home will get cited. Try calling Walgreen's or another 24 hr local pharmacy to deliver the med. If nothing is possible, you must try to call the physician and have him order an OK to hold the med.
  9. by   Blackcat99
    Quote from Kristen B
    I have discovered that though you may put your initials and "med not available", when the monthly MAR sheets go down to Medical Records, they write ME (mistaken entry) and "med found" and are pretty good at forging your initials and signature. This is because not giving a med is NOT acceptable. If they leave that "med not available" on the MAR the nursing home will get cited. Try calling Walgreen's or another 24 hr local pharmacy to deliver the med. If nothing is possible, you must try to call the physician and have him order an OK to hold the med.
    Thanks Kristen for this very important information. I didn't realize that medical records did this sort of thing. But yes I believe you. Nursing homes will usually do anything to not get cited.
  10. by   TBLPN
    I think this is the case in most LTC facilities. I know it is in mine. I too work 7p-7a weekends. Meds are constantly "unavailable". We aren't suppose to chart that, which is nuts considering it's the truth. We have problems with our pharmacy that we use. We all know this, we can fax an order or re-order three or four times and it will still take a week to come in. Our DON has worked on it, we've all called and harrassed the pharmacy, nothing changes. On the sly, although, not really ethical, we do borrow if the med is not available in the EDK, which they are normally not. Although, we never borrow narcotics. Pharmacy does have a real problem making a special delivery for colace or mylanta
  11. by   dotter
    TBLPN, I'm glad that you understand the problem. I really don't think some people understand. For one, when a patient is admitted they choose to use either the main pharmacy or one of their own chosing. If they choose their own pharmacy their family usually picks up their meds. We have patients who use different pharmacies that deliver. We can't just call any pharmacy like Eckerds and order the med. My question is how can I cover myself since I can't get the med? I'm wondering if nurseduck can answer my question?
  12. by   laughingfairy
    recently my state went to a pre-approval process for a LONG list of meds. All long acting pain meds, duragesic patches, cox 2 inhibitors, any poly pharmacy, and on and on.

    What has happened because of that is MANY meds are not available and everyone knows it. What we have begun doing (and I did this anyway) is calling the pharmacy, determing why its N/a. Was it reordered too soon, is it a pre-auth problem, not ordered, etc. Then notifying the doc for any new orders, AND writing a narrative nurses note. They can not ME that.

    Further more if they tell me that its a med error, not to do it etc. I write a med error report and/or a pharmacy error report as applicable. I do not borrow unless we are talking emergency!!!!

    Borrowing meds is illegal where I am, or so I have been told. And with this pre-auth thing there is no telling if the person will be approved and you will be able to replace the med for the resident borrowed from, then they would be refilling too early and the cycle goes on. Pretty viscious
  13. by   night owl
    We have what we call a "Doc-U-Med" closet which stores most meds we use at our facility. Each unit has a key to open it. We take a dose or two, depending on how many doses will be needed until Pharmacy can bring us the med. We sign it out and a copy of the pt's order must be left to verify it was ordered and that we had to retrieve it due to unavailability. In the computer it's charted as "given," but Pharmacy is notified that the Doc-U-Med had to be used. If the Doc-U-Med doesn't have a medication, first it's charted as a "missing med" which automatically submits it to the Pharmacy. Then we go back and enter that it was "Held." due to unavailability. The med is usually brought to the unit before or during the next med pass by Pharmacy. At report we make the next on coming nurse aware of the "missing/held" med and she gives it when it arrives.

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