Am I in the wrong Nursing home?

[MelissaLPN, ASN, LPN, RN]

My facility expects me to "borrow" medications. Should I leave? We are currently under new management and new DON/ADON but we have the same immediate supervisors. No one else cares about whether they borrow or not. I used to write " unavailable" but I received notes directly stating I should have borrowed from another nurse(this is from my current supervisor). Our pharmacy is not able to provide the medications in time. My coworkers are no help because they just borrow themselves. Medications are missing for a week, no one calls pharmacy. Can I get into any trouble by just circling the medication? Just a scenario, a lady is missing her trazadone, call placed to pharmacy at 9:30pm. On call pharmacy returns phone call by 10:30pm. They state it will come in on the" night run" which for us means 5am. Its not in the e box, it wont be there on my shift. What should I do? Call the MD at say 11pm to ask for an order to hold? Our MD can take up to 5 hours to call us back. Is the whole system flawed? Am I spinning my wheels for nothing? Would another facility be better? I am unsure and do not have supportive co-workers. Should I just continue doing all I can and stay employed or would another facility be more helpful?

Thanks guys,

[RNTOBE_1970]

Most facilities has an emergency box, with commonly prescribed meds. You can sign out a missing dose that way.

[MelissaLPN, ASN, LPN, RN]

In my facility none of the medications missing have been in the e-box. Trazadone, lipitor, metoprolol, ect.

[NaKcl, BSN, RN]

I don't work in a nursing home, but,,,

that sounds not right!!! you don't borrow other patient's medication.

Regardless of what your supervisor told you, ultimately it will be your responsibility, and it will fall on you.

I thought about challenging myself working in a nursing home, but

the more and more I hear from you guys, who work in a nursing home, I am not sure if I want to do that....

[FLArn]

If you have called and tried to obtain the meds, circle for your dose and write "not yet delivered from pharmacy". Then call the MD so he knows that you were unable to give the med. The important thing is to document what you did to try and obtain the meds, do NOT borrow meds, let the others do as they choose. If pressed by your superiors ask to see the written facility policy that allows you to borrow meds. No written policy - no borrowing. Next, look for a new job! Best of luck to you, Always protect your license.

[ktwlpn, LPN]

My facility got dinged by the DOH a few years ago-several nurses would consistently document that a med was "not available" but not take any further action. Someone circled am lasix for 6 straight days! Your system may be flawed or it just may be that nurses are not ordering the meds on time and following through when a med does not arrive. At this time we have a sticker on each box with the 'order now" date on it. The inherent problem with this system is weekends (we all know they come every five days) and holidays. If you do pull a label too soon to take those things into consideration the pharm is supposed to just flag it in their system and send it when it's due.Sometimes they don't follow through.

Other problems in our system are pharm unavailability and the pharm needing prior authorization.They don't call us-they send us a fax.Sometimes the fax does not come through until after business hours which causes another delay in filling the script and can make us short.

As someone else said you should have an emergency box available for your use. After the DOH came in we wrote a policy-if a med is missed due to un-availability the MD must be made aware.Even one dose of something like a multivit. Many of my co-workers with regular units will borrow from another resident's supply and replace when the med is delivered but we really are not supposed to do that. Bottom line -if a facility can't provide basic care like routine med admin then there is a problem .Everyone needs to be accountable-but many just don't care. I work with many nurses that never check the med carts, never order meds, date anything upon opening or dispose of outdated stuff.They float from unit to unit and just don't care. You can strive to do better..You DON and ADON need to be working with staff and the pharm to figure out what is going on.The unit managers or charge nurses need to follow through with the pharmacy.This is a problem in many LTCs.

[Crispy Critter]

At the nursing home where I worked, we frequently got late admissions. Sometimes the e-box didn't have what we needed,and it always seemed to be the same drugs. We talked with our pharmacist and she said that we could request to have drugs permanently added to the box when we saw the need. Why couldn't your pharmacy just add what you commonly need to the ebox list?

[j464335]

You see this ALL the time in LTC facilities... I WOULD NOT BORROW MEDS, CYA!! If state came in... Ohh,it would be bad!

Of course there is no reason to find another job...probably be the same way there too!

I like the suggestion from FLA "Ask to see the facilities written policy".

Look at the positive side of it, after you call the Dr. every shift for a few days he'll get P.O'd and he will let the facility know that this is a problem they should get taken care of, lol

[MelissaLPN, ASN, LPN, RN]

I agree that calling MD will make a point but I will be the only one repeatedly calling. ( this of course is ok if it means protecting my license but wont make me popular fast) So if the MD does not call back before the end of my shift is it ok to just chart that I tried?

[BrookeeLou_RN]

Majority of LTC's are this way.. The ones that are not have one thing in common...a nurse who wanted to fix it.. so be that nurse...set up a meeting with management , then the pharmacy, let them create a second e-box or get better delivery of meds. And if the policy is to call the Doctor do it,, after a few calls they may HELP fix the problem! Call the on Call supervisor first.. Yes it is more work for you, and yes the regular staff who have been borrowing will think you have lost it.. but it is them also who do not want to take the time..

And what about the patient who did not get Trazadone,, she is on it for a reason and I bet she wants it.. and someone is paying for her to get it....now it is a multivitamin maybe she would not fuss but if anemic , her labs could change and then before you know it the cost of caring for her will go up which means LTC's profit will go down or if non-profit they will have less to put back into business.. Can you see how this snowballs into the whole problem with healthcare system in general????

And if you work to fix your LTC's med issues,, who knows you may get looked upon as a leader and move up the food chain one day or at least learn hpow to problem-solve.

[j464335]

CYA... I would do EXACTLY what the facility has in it's policies regarding the matter. Then, if someone wants to get mad and fire you... you have recourse.

I always do for my patients what I would want someone to do for my mother.

You NEVER know which residents has Dr's or Nurses in the Famly.. What do you think would happen in that situation?? Every Nurse who failed to give that Med properly will be standing in court with their right arm in the air,lol

[j464335]

One other note... what happenes when the Pharm makes a medication error? Who is at fault the Pharm, or the Lic. Nurse who administered it?

Get's even more tricky when the med error was on Mr. Jones who never recieved the med, but Mrs.Smith did!

Hope that makes sense to you....

You just have to look at this from a legal stand point.. I don't mean to be "Debbie-Downer" but, I have yet to come across a LTC facility that gave a crap, everyone is lazy. So I would not count on anything ever getting resolved..you just have to find a acceptable way to deal with it while your there.