A question about patient medications and charges, help please?

[SmilingBluEyes]

Where I work, (in a Labor/Delivery/GYN unit), there is an issue that never seems to be resolved. When we medicate patients with meds such as plain tylenol, simethicone, ibuprofen, stool softeners, or tucks/dermoplast, it seems, people are not scanning/charging for them and we are losing money and accountability.

We use Meditechs' EMAR system as our means to "scan" and charge various medications for our patients. Anyone familiar with this program, knows how very cumbersome it is----at least our version is. We have to drag around these computers on wheels and scan bands to give their meds. So, often, when a patient gets a simethicone, people tend to blow off scanning/charging for it, and just do a narrative note that the med was given as it takes so long to get it done in EMAR.

Now of course, for narcotics, these are ALWAYS scanned/charged appropriately for obvious reasons. But these other medications are being "lost" due to not being consistently charged. Patients are getting tylenol, simethicone, colace, etc. and the unit is eating these charges. And as you can guess, this is adding up to an ugly figure.

What is being discussed/proposed between my mgr and pharmacy, is we keep locked versions of "SAMS PACKS" (patient self-administration med packs) in each room. In other words, we would have a locked box that contains commonly-used medications like Motrin, Tylenol, Simethicone, Toradol, Tucks and Dermaplast (NO narcotics obviously)----and then Pharmacy would restock these boxes after the patient is discharged and missing items would be charged to the patient in that room for that time frame. It is thought this would reduce the numbers of "disappearing" medications and costs that can't be recouped due to not scanning for them-----and help make staff a bit more accountable as to whom receives what meds during their stay.

Now I/we are not looking to reinvent the wheel. I just want to know if anyone here does anything like this and if you do, how does it work? Did it fly with JCAHO, if you were surveyed, having such a system in place?

If anyone can tell me about how you do it where you work---please respond here or by Private Message ASAP so I can bring projected ideas/pitfalls to my manager when I work later this week. I am open to any suggestions/ideas that would help here!

THANKS SO MUCH!

[Nursonegreat]

when i did postpart and nursery, we did use the SAM packs also. it worked wonderfully....we werent running for every colace, motrin, etc. the pts had a log sheet so they could keep track of the meds then we placed the sheet in their chart on DC. pts would be taking these meds at home and have to self medicate...we instructed and documented. would also check and see how often they are taking, during rounds, so that we are sure they dont do it wrong after all the new info flown at them.

[Elvish, BSN, DNP, RN, NP]

Where I am the PP orders (p vag del) are written for Self-med kits which contain all the above mentioned items. The packs are put together by pharmacy & stored in our Pyxis (or whatever med-dispensing machine is on the unit). That way we just give the whole pack to the patient & the whole thing is charged to them & we don't lose money.

I have my own issues, as I think has been discussed on the OB thread. I don't like not knowing when my pt is hurting. And I think it's a waste to be giving Lansinoh to bottlefeeding moms, etc. But maybe this is something that would help you guys. I could see how what you're doing could be frustrating.

Good luck!

[SmilingBluEyes]

I hear you. In having the locked boxes, we would actually be made aware of what patients are in pain and what is being used, or not. That and the issue of having open meds in a patient room, the potential hazards of this----would be a non-issue if we used locked boxes/containers for these meds and gave them as needed.

[SmilingBluEyes]

I guess I am left wondering if such a system (the locked boxes in each room) would fly with JCAHO. We are due a survey anytime, I know.

[anne74]

I did my OB/GYN rotation in nursing school at St. Vincent's Hospital in Indianapolis. They had this lock box set-up, and it seemed to work well. I don't know specifics, and I don't work there or anything. But maybe you could call them and find out. Seems like that would be a win-win situation - pts get their meds exactly when they want, and nurses are freed up to take on other tasks.

[SmilingBluEyes]

THANKS !!! that sounds like what I am looking for.

[TracyB,RN, RN]

Where I used to work, ALL meds were kept in the Pyxis, so if you wanted something like colace or tylenol, you had no choice but to charge, as you had to hit the pt name on the screen, the med name & qty you were pulling.

Where I'm at now, OR, we have a med frig that is NOT linked to Pyxis. We have charge sheets IN the frig & pull one when we pull the med from the frig, throw a pt label on it & then throw the sheet in a bin on top of our Pyxis. Pharmacy picks up the sheets when they come to restock... Pretty archaic.

[SmilingBluEyes]

Oh I miss Pyxis. Had it 2 different places. This place I am at now, too cheap to get it, I guess. We are relegated to signing out narcs on an old fashioned sign-out sheet, doing counts before and after every shift, and digging out meds from patient drawers on old med carts, taking them and scanning them into Meditech .....it's slow, inefficient, and as I said, we are inconsistent on making sure scans are done. There HAS to be a better way (short of buying a Pyxis system)! What a mess.

[TazziRN, RN]

We have stock meds that come in multi-dose containers, like suspensions and elixirs, etc. They are not kept in the Pyxis. We chart the amount give and at the end of the visit we have to hand-charge those meds. We have a charge sheet that is pre-printed , all we have to do is fill in the number of units to charge per item.

If you like, when I go back to work this weekend I can grab a charge sheet and scan it to you to look at.

[SmilingBluEyes]

THanks Tazzi, that would be great!

[TazziRN, RN]

Okay. I go back to work Saturday, I'll grab one and scan it to you that night. Can you send me an email so I have an address to send it to?