PHARMACY PROBLEMS?

jammin246RN · Mar 10, 2011

Why do you schedule lovenox always at 2000, other meds at 2100, then the 2200... and in the morning it is 0600, 0615, 0630, 0715. Really does anyone think that the nursing staff will make 4 nursing med passes on all 7-8 patients in the space of 1 hour? When asked about the 0715 med which falls at the end of our report but we must be in report at 0645, however we only have 1/2 hour to give the med.... So we ALWAYS have a med error on each patient because night nurses have to give the 0715 med. When asked if we can change that time to say 0800 or 0600 we are told it is to be given with meals... Well since the patient determines when their meal is, they order it and it gets delivered, and cannot be delivered prior to 0715 since dietary isn't open. When asked about that we are told that it is the old standard meal time, and they go by that. It's like the pharmacy director or whoever makes those decisions has no common sense. Or the doctor orders a now dose at 2000.... the pharmacy approves it for 2000.... and doesn't deliver it until 2350... so it looks like I have been sitting on my hands for 4 hours. However pharmacy has talked with IT about removing the comment that says not given med not available from excuses.... So we would have to put that in our long notes reguarding the med availability.

rkitty198, BSN, RN · Mar 10, 2011

I would like for our Pharmacists to call the MD when there is an issue with a med order.

It is very difficult to get a call to be asked "well they ordered 100mg of (enter antibiotic name) and it isn't therapeutic, can you call the MD to clarify?"

I did not order the drug and it is very hard to play phone tag between a doctor and another anciallary department.

Its easier to eliminate the middle man so that the patient gets the care they need.

If a patient is recieving lets just say Remicade, and the pharmacy times it for a specific time. We have to get a chemo nurse to administer the drug and it may not be until the next shift. Don't mix up the drug and send it up on the time you specify because I don't want to waste the drug (its only good for 3 hours or so after mixing). Just ask and we can get a time that would be good to administer it.

Our pharmacy also just sets chemo in a bag and leaves it on the counter in the med room, but that is an issue with our policies- and a safety issue, another story :)

I LOVE our pharmacy!!! We have a pharmacist on our floor from 9-5 and it makes such a difference in safety of drug administration. You guys are the best!

caroladybelle, BSN, RN · Mar 10, 2011

Several issues.

If you as the pharmacist enter an order for antibiotics that are stat/now, and put the time in there for the exact time you get the order, please get the med there by at least 30 minutes of the time you scheduled it for, especially since you have the tube system.

I get tired of getting yelled at by MDs for "overdue" meds, when pharmacy put them in for 0745, and they have not been received or even made by 0900. It makes nursing look bad, when the issue is with pharmacy.

And write me in as one nurse that gets tortured by the PharmD/MD pass the buck, ring around the rosie phone tag game. We have POE, so handwriting is not that major an issue. If you as a PharmD disagree with the MDs timing/order/choice of ABX/dose level, don't call the nurse when what you need is the MD. I do not channel to the MD with my psychic powers/ And I personally believe that nurses shouldn't have to "interpret" handwriting discrepancies. If the MD has that crappy handwriting the several educated pharmacy staff members cannot figure it out, that MD needs to be called out because s/he is a dangerous practitioner, and pharmacy is better able to do so and be taken seriously.

There have been way too many errors out there due to crappy handwriting and HCWers having to "interpret" handwriting. And it should be unacceptable to tolerate or cover for this. Though many administrators push nursing to coddle MDs in this issue.

And last but not least, if a med is not available, please tell us and give us a clue as to what we have in the formulary that can substitute. I have repeatedly sent requests for meds (pharmacy does not answer their phone), just to get told after the MDs are off, 10-12 hrs later that it is not available.

Caffeine_IV · Mar 10, 2011

Stat orders not being stat.

Putting antibiotics that have long running times at the same time or back to back. If my vancomycin is due at 2000 and it runs for 2hours. My levaquin should not be down for 2100.

Please get clarification orders from the doctor yourself if at all possible. Sometimes you may have a knowledge about the dosages available or appropriate intervals that we may not know as quickly.

That said, we have some great pharms and I really appreciate them. They answer a lot of our questions and have a positive attitude. I respect that they are really busy and it is a difficult job.

**canoehead, BSN, RN** · Mar 10, 2011

My pet peeve is when nursing staff isn't qualified for something while the pharmacy is open, but we do it all the time on holidays and weekends. Like stocking Pyxis, mixing meds, dispensing 1-2 days worth of outpatient medications. Or when a patient needs a drug, the doc is unwilling to change the order, the pharmacist refuses to come in on overtime because of budget concerns, but it's against policy for the nurse to mix the med. In that case the nurse acts as the middle man, or puts her butt out on a limb and administers the med anyway.

I'd like to echo the others in saying that it's easier and clearer when the pharmacist calls the doc directly with a concern instead of having the nurse call. I don't understand why involving a third party is easier for anyone, maybe someone can enlighten me.

Excess paperwork can be an issue. In one hospital we had to go to the pharmacy for each individual dose once the Pyxis ran out (sigh). Regular meds had to be signed out with how much and the patient's ID info- what a pain. Narcotics had to be signed out in two places, signed in to the unit in two places, and a second RN or doc had to sign as a witness twice. If the Pyxis was going to run out (and it did, every weekend) we needed to be able to sign out 10-20 pills at a time....but that would be dispensing. But going one at a time was OK.

nerdtonurse?, BSN, RN · Mar 10, 2011

If I've got a patient that's on dopamine, dobutamine, levophed, obvious BP issues just from the meds ordered, and we're going thru the meds at 100cc/hr on dayshift, we're not going to suddenly downshift to 10cc/hr at night. It is not fun to be mixing cardiac meds in the middle of the night, sending the house supervisor all over the hospital trying to find enough vials to mix the med to get you thru the next hour with a pt that's so unstable their BP and HR go crazy if you look at them hard. It's gotten to where if we have a pt that's on levophed for BP or cardizem or a beta blocker if their HR's rocking along, we do rough math and figure out how many bags we need before pharmacy goes home at 2000. And they act mad that we call them and ask for the med....