medication strip packs

Wow..that system sounds like hospital/acute care almost....and a LOT of man-power/time placed on your pharmacy.

I worked an acute-care setting in Texas (before moving to WA) that used that system. Their rationale was that 'orders changed frequently' & it also cut down on 'borrowing'; therefore, billing errors.-THe day-to-day system enabled the pharmacy to accommodate frequent changes in orders, without having a lot of waste ---However, more times than I care to even mention, the meds weren't in the cart when it came time to pass...either orders had come across afterhours & the pharmacy hadnt known about it, or some other reason....and we were waiting, tapping our toes, for the pharmacist...who rechecked the ENTIRE CART, drawer-by-drawer...which drove me crazy! Heaven help us if a pharmacist was ever late for work, or called in ..and we were left waiting for their replacement to arrive! .......and Coumadin was only provided ONE tablet @ a time. No exceptions....because the pharmacy insisted on reviewing PT/INR results before dispensing a dose.

The LTC facility I work @ now uses a large, LTC pharmacy that works with 30-day 'bingo cards' for all routine meds..and are "expected" to initial each dose next to the # we pop out. The prn's/narcotics come in the same style, with either 30-60-90-120 pills to the card, depending on the frequency of use and/or order.

This, too, has it's drawbacks..."borrowing" still occurs...its a reality of LTC, whether 'the powers that be' acknowledge it or not. If "Resident A" runs out of a medication before the date that the pharmacy has in their computer to refill the drug, they WILL NOT send it! Instead, we get a little 'nasty-gram' saying ---"Medication not in cycle for refill..Please reorder as scheduled".

Despite the pain of initialing both the MAR and the cards, it holds less-than-honest nurses accountable in regards to their med passes. It's sad to see how many nurses sign off "Yep, I gave those pills"...and you KNOW that they weren't given...either the resident was being difficult or whatever--and they simply glossed over giving the pills.

Most of our OTC pills are house-stock, in bottles from wherever the Central Supply orders them from. Some residents do get OTC's in the bingo cards though...not sure why (or how much their insurance/payment source has to pay for tho$e)

Bingo cards are my favorite...as long as the nurses stay on top of pulling the re-order stickers and everything stays current.

That's pretty much the system we have where I work too. Thurday is always the day we get our big drug order in, so I always dread working a PM shift on a Thursday!

Our facility has a pharmcy rep come in on the first of the month with all of the meds in large cardboard filing-type boxes. The rep checks against the MARs to make sure all the meds are there, and then the boxes get locked up in the med room...

Until the third of the month, when each charge nurse changes out all the cycle cards for whatever med pass they are responsible for. (For example, I do all the 9AM and 2PM cards because I work 7-3. That way, the nurse who is responsible for those meds puts them away, in room order. PRNs/Narcs (even routine ones) are ordered/come in as we run out, and we receive 3 deliveries a day.

It's not a perfect system, but it sounds a bit easier than some others have it!

When you all are talking about the pharmacy "changing out the cards" or delivering a big box of meds, I am not sure what you mean. Does the pharmacy deliver a month's worth of meds for everyone in one big delivery?
At my LTC, there is no routine monthly or weekly delivery. Every med in the cart needs to be individually re-ordered by a nurse when it is running low. When the bubble card only has a week's worth a pills left, we need to order it--it would not automatically be delivered.
It sounds like other places with their automatic delivery would be so much more efficient than the disorganized way it is done in my facility (and every other facility in this area...)

Yes, we receive a month's worth of meds at a time, except for Medicare meds, which come in 14 day supplies and have to be reordered as needed. At any given time, only about 10% of my patients are on th 14 day cards. I cannot imagine having to reorder as needed for everyone...to much room for error, since there seems to be weeks where the pharmacy is SO SLOW in delivering!

The meds in baggies is what they do in acute care around here. My facility (and I'm pretty sure all the others in this area) use the blister packs with 30 day (or 7 for Medicare) supplies. Each card has a sticker that is removed and placed on a form to be faxed to the pharmacy for re-order. We have pharmacy come in several days a week to deliver, but a nurse checks the meds in and whatever nurse is responsible for the cart puts the meds in their shift's drawer by resident name.