giving meds late when it's not in pixis

ontheway2crna · Dec 12, 2014

Dont listen to that nurse. It is pharmacy's fault, too bad! And document it as such. We have an option in our emar for "medication not available". There are many reasons a medication may not be available and no one may be at fault.

ixchel · Dec 12, 2014

I get more irritated every time I open this thread. I imagine someone told that nurse to do that at some time and there somewhere was some miscommunication. There would have to be. No way management would think it's fair for a nurse to fudge documentation when legitimately, the pharmacy dropped the ball. And I stand by my initial response - if pharmacy screwed up, they should take the heat. I get so irritated if I have a 1900 vanco followed by a 2000 zosyn (which gives me a miniature window to hang the zosyn on time) and the zosyn isn't even on the unit yet. You better believe I'm clicking "med not available". I don't care if I am new - it's the truth and I'm not about to lie on documentation.

Patient refused?! Omg!

Anyway, don't mean to hijack. Just saying stick to what's true and what you feel is right. If someone tells you something that doesn't sound right, ask the unit's educator or manager, or see if there is a written procedure for when each option would be appropriate.

dah doh, BSN, RN · Dec 12, 2014

I chart med not available then reschedule the dose & request it from pharmacy so it leaves a paper trail. Sometimes I need to request it more than once so I'll write 2nd request & follow it up with a polite phone call. Once a pharm tech told me it's available in the overflow area...I told her it's unacceptable to expect me to leave a patient care area to walk up 2 floors to get a routine med that should be provided with morning pharm rounds! After talking to the actual pharmacist, the med was sent to me and I was told that the pharm tech was new and the pharmacist would talk to her.

MunoRN, RN · Dec 12, 2014

The suggestion that you should give a false reason for an inability to give a med on time, to hide the fact that the pharmacy staff are overburdened, and that you're somehow helping out pharmacy staff has to be one of the most asinine things I've ever heard. The whole point of having a charting option for "med unavailable", "delay from pharmacy", etc is so that the pharmacy department can prove they are overburdened and back up their requests for better staffing. Hiding that administrators have not sufficiently staffed to ensure that meds are delivered on time only hurts the pharmacy staff, not to mention patients.

firstinfamily, RN · Dec 12, 2014

If the option is listed as "not available" then use it. Nursing should not have to take the blame for something that is not their fault. It takes everyone working together to make this process of patient care work. If the system is broken somewhere it will show, but only if there is documentation to prove it. YOu should never falsify a medical record, if the pt has not refused the medication and it is not available, then it is not the fault of the patient!!! Enter "not available" and follow it up with a call to pharmacy to see if they received the order!! IF this is happening on a continual basis, notify Risk Management.

Birdy2 · Dec 12, 2014

This nurse was orienting me. She has worked there for 8 years and I've been told by everyone I can trust what she says. I was pretty upset myself when she told me I couldn't put that. I will be on my own next week and I'm just gonna document it as not available. I had already planned on talking to someone else about it but just didn't know who. Thanks for all your opinions. Glad I'm not the only one who thought that was crazy.

greenerpastures · Dec 12, 2014

We don't have an option for "med not available" - must be pharmacy had that taken out! We have options for just about everything else though except - "person has 4 antibiotics IV scheduled at the same time and they aren't compatible" - I THINK THAT SOUND BE AN OPTION! I can't tell you how many times I've had to ask for things to be rescheduled because I couldn't run that many pumps/IVs at one time.

LuvScience · Dec 12, 2014

I use an EMAR system in LTC. Our system also has an option for "medication not available" but we have been cautioned not to use it. If a medication has not arrived from pharmacy by the time it is due then management expects us to notify the physician and get an order to administered the medication at a later time or "when available". It's incredibly inconvenient for us but management prefers to pretend that nothing is ever late.

morte, LPN, LVN · Dec 12, 2014

I use an EMAR system in LTC. Our system also has an option for "medication not available" but we have been cautioned not to use it. If a medication has not arrived from pharmacy by the time it is due then management expects us to notify the physician and get an order to administered the medication at a later time or "when available". It's incredibly inconvenient for us but management prefers to pretend that nothing is ever late.[/
get that order in the first place, "pcn, 500 mg, po q6', begin when arrives from pharmacy"

imintrouble, BSN, RN · Dec 12, 2014

I have found in most areas of my life, it's just plain easier to tell the truth.

If I give a med late, and it's my fault, I click on "late administration".

If I give a med late because I don't have it, I click on "not available".

If the scenario doesn't fit anything, I click "other", and explain in the comment section.

psu_213, BSN, RN · Dec 12, 2014

TThe whole point of having a charting option for "med unavailable", "delay from pharmacy", etc is so that the pharmacy department can prove they are overburdened and back up their requests for better staffing.

I'm glad someone finally said this! At the previous hospital at which I worked, there was only one pharmacist working at night. It would take forever to get meds up to the floor for a newly admitted patient at night (it was't a heck of a lot better in the evenings). I would send requests down to create the infamous paper trail (or the "electron" trail as it may be since it was all done on the computer). If the med was not up on time, when I gave it, in the comments section of our EMAR, would chart "given late since med was received from pharmacy at 2130" if the med was due at, say, 2000. If it were a more serious med (such as a cardiac med, as opposed to a multivitamin), then I would write an incident report. This was not blaming pharmacy, not throwing them under the bus. This was covering my rear and, hopefully, making more people aware of the inadequacies of the system…and to get more pharmacy staff!!

psu_213, BSN, RN · Dec 12, 2014

This nurse was orienting me. She has worked there for 8 years and I've been told by everyone I can trust what she says. I was pretty upset myself when she told me I couldn't put that. I will be on my own next week and I'm just gonna document it as not available. I had already planned on talking to someone else about it but just didn't know who. Thanks for all your opinions. Glad I'm not the only one who thought that was crazy.

The other issue with charting "patient refused": suppose it was a cardiac med and the patient has some sort of bad outcome that could have been prevented with the med. Now family, was at the bedside comes forward to say "the nurse never even offered Joe that med, how could he refuse it?" Would that nurse continue his/her charade? Admit to lying on the record? Continue the lie when under oath? Charting false information is a really bad idea!