Am I in the wrong Nursing home?

[MelissaLPN]

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,

[debRN0417]

Borrowing medications is against the law. Call and report them. Don't risk your license. Nuff said....

[Forever Sunshine, ASN, RN]

Whenever I work I always look through the cart to see if I can reorder any meds. Even if theres at least weeks supply left. Its just not worth the hassle to not be able to give it because its not there.

[gentlegiver, ASN, LPN, RN]

You should have a day set for a weekly med order for the Pharmacy. If not talk to the DON to see if you can get one set up. Meds should be ordered when you have a 1 week supply left, because you are behind (meds missing) it might take time to get the system caught up by doing daily orders (daily orders usually take 24 hours to recieve). When you send the order in (daily or weekly) keep a copy of the order & and the fax showing the time & date it was ordered. I had a pharmacy that always said we never sent the order in to them, until I was able to show the order & fax, suddenly they started "recieving" my orders.

[NotFlo]

I have read multiple threads about this issue lately. Probably because in my own experience some amount of "borrowing" is ubiquitous to long term care. You can leave your current facility because of this issue but don't be shocked if the next one does the same thing.

Doesn't anyone have online ordering? I love it. Daily I take five minute at the computer, I click and get a list of every drug for every patient on my floor that is available to be reordered and I click the check boxes. I get a screen when I hit send that will tell me right away if there are any issues...if a med requires authorization, was reordered too soon, etc. and I can get right on the phone and resolve any issues immediately.

This has resulted in way, way less borrowing of meds and I know that my cart will always have everything I need for my patients (only exceptions...new orders that were received on second or third shift and not faxed at all or faxed too late to be in by the AM, new admissions that come in on second shift where the supervisors love to wait til 6am to fax to pharmacy even if they had the orders verified by the MD at 4pm the night before...resulting in my running around like an idiot trying to get the 55 medications together for the three new admits in the AM).

I get whatever I can from the ebox but I'm not letting patients go without cardiac or other vital meds that aren't available in the ebox.

If you aren't going to give a medication you MUST notify the MD and get the order to hold until available or substitute for something that is available etc.

The WORST thing for the state to see is something circled and "med not available" written on the back of the MAR. This will get the facility in major trouble every time and isn't acceptable. You need the order to hold.

There are always going to be issues like this in LTC where there is no onsite pharm and the pharm is several hours away.

[WeirdNurseKelly, BSN, RN]

All of the other posters have some good advice. I wouldn't borrow meds. I would circle the med that wasn't given and write the reason. Med not available, pharm has not delivered, ordered (insert date here).

I am an RN and I often fill in for the medication aid where I work. We have 2 pharmacies we order from. Both of those pharmacies have order sheets in which you can write multiple residents and multiple meds on it. I grab one for each pharmacy when I start my shift. That way if I need to order any meds I can just write it on that sheet, along with all info (Rx #, residents name, medication, dose, etc.). Then at the end of the shift I fax what I have to the pharmacies. If I see that ANYTHING is running low I order it (7 days or less), unless it is time for cycle fill (pharm automatically refils our rxs at the beginning of each month). There is a whole process to that.

I also write ordered and the date on the med cards, bottles, etc. That way other aids will know when they were ordered so there is no double ordering of meds. I have noticed that a lot of times the reason why meds arent there is because the aids DONT order them on time. We have a few lazy ones, well................one particulary.

Also, maybe it is a good idea to set up a note pad labeled "Meds Communication Log". That way you all can write down what was ordered so everyone can see the bigger picture. It can also be used for change in med orders, or where you can write "so and so is having difficulty swallowing meds, please use pudding per resident request", or "so and so now has an order to crush their crushable meds".

Maybe bring these ideas to the table. It has helped a little bit where I work. But there are just some people out there that are there to pass the meds and go home. They do the very minimum amount of work. Which can be frustrating, and irritating, among other things. Good luck.

[noctanol]

Seems like you are part of the problem to. You called an off location pharmarcy at 9:30 pm and expect them to get the medication there on time. I believe if you or another nurse would have called earlier then the medications would be in on time. Bring that up with your fellow nurses and see if you guys can work it out. Why dont you suggest a house account so that you can get medications from it instead of "borrowing" . Be part of the solution.

[CoffeeRTC, BSN, RN]

There is another thread on this and a pharmacy thread on the LTC fourm.

How often do you work? If you are ft or more than just prn, why don't you check your cart before you start the med pass and try to order the meds that are low or you will need that night. You can also call the pharm and get them sent stat (for us it is about 3 hrs for a stat delivery)

"borrowing" meds on a regualar basis is wrong. System error and it leads to a buch of other errors.

As far as leaving this LTC...what about the other issues? Is this the only issue you have with the facility? Yes, it can lead to others, but the grass isn't always greener.

[MelissaLPN, ASN, LPN, RN]

Seems like you are part of the problem to. You called an off location pharmarcy at 9:30 pm and expect them to get the medication there on time. I believe if you or another nurse would have called earlier then the medications would be in on time. Bring that up with your fellow nurses and see if you guys can work it out. Why dont you suggest a house account so that you can get medications from it instead of "borrowing" . Be part of the solution.

I dont see how I can be expected to know the medication is missing until I go to pull it? I float and work on 5 separate halls (plus I am PRN). I pull and administer over 300 medications per shift, when would I have time to search my cart for these medications in advance of my shift starting?

[ktwlpn, LPN]

There really is no way to know you need something until you are ready to pull it-the previous nurse is responsible when he/she administered that last pill they should have made sure another box was in house or called the pharm.You can't go through each MAR and the med cart prior to your marathon med pass-that's ridiculous.

[vald96]

right practice is to call the physician any time you can not administer the ordered meds. you should not run out if its routine meds.refill 3 days before,should be available in each station e kit. which your pharmacy can provide.Your don can actually take care of those simple issues.Do not borrow medications substandard practice and its your license not anybody else protect it......

[windibird36]

I was an RN in a nursing home and they are all the same and they are very unproffesional and they dont care about your license and if the med is not there, I would circle and leave it until they get the right medicine and I would also explain to the family what the facility is doing to their loved ones, but I quite my job cause I couldnt stand the pressure of possible losing my license and they way the facility treated their residents, and I have worked in 3 nursing homes, ALL THE SAME. Sorry for the bad news, but really think about what your doing, and its your license not theirs.

[CapeCodMermaid, RN]

Windibird-not all nursing homes are the same. We had problems with our pharmacy not delivering meds on time. The nurses would be on hold for close to an hour.....then I got involved. I called the person highest up the ladder at the pharmacy and complained to him. I asked him his supervisor's name and phone number. We have many fewer problems now.

The pharmacy should be able to customize an ekit to suit your needs. We have a psych med ekit since most of our admissions are on high doses of antipsychotics. The pharmacy even added a few drugs because my consultant knows what the docs prescribe most.

You can't really borrow meds. I know everyone does it but that doesn't make it right. Surely no one is going to die from a missed multivite or trazodone. Circle it, call the pharmacy and reorder, call the doc and notify that the dose has been missed.

The docs don't have any more pull with the pharmacy than we do.