Blister Pack Blues & The Dreaded Med Pass

[croppyRN]

I was hired as a staff RN 8 weeks ago at a LTC/rehab facility and I am climbing the walls about the med pass. My two reasons for climbing are:

1) I have too many residents

2) Their medications are always missing

Not a single shift goes by that I am not playing "treasure hunt" searching for the missing blister pack of Simvastin, or some other drug. One nurse told me to "borrow" from another residents supply, anything to "get through the med pass." But after a few times of doing just that, I realized this "borrowing" was just plain stealing and I refused to do it any longer. The end result? My residents often do not receive one or two of their medications. This is not acceptable. I try to keep on top of the missing medications, but I am already stretched to my limits as regards shift time. With so many residents (average 28) I am barely getting their meds passed. You know it's bad when you feel smug about actually getting those dry eye drops in. It is pathetic.

Does anyone else have this problem? Please do not tell me to go to the DON. She will "take the matter under consideration", nothing will be done, and I will have a black mark on my file for being a "trouble maker". Not that my DON is a bad person, but these things have a way of leaking out, and everyone that reads these boards knows how quickly the grapevine spreads.

I guess my reason for posting this is to see if this is a common problem or just the result of disorganization at my facility? Is the pharmacy company partially to blame? I don't have the answers, but I do have a concussion from banging my head against the wall.

[debRN0417]

Pharmacies are contracted and paid by the facilities in order to provide medications and services for the facility and the residents. Sometimes it is an ordering problem, that meds don't get ordered like they should, but I have found that in some cases it is the pharmacy that is to blame as well. There have been facilities that have documentation that a medication was not available and they called the pharmacy more than once to get it and it was not delivered. There was even evidence the facility submitted the order and the pharmacy said "well we didn't get it". Unfortunately it is ultimately the facility's responsibility to have the medications. The administration/corporate should be lighting a fire under the pahrmacy to have the meds when they are needed. They should ensure when a nurse calls, that a medication is delivered within at least two hours. If not, then they should start looking for another pharmacy. The bad thing is the pharmacy doesn't get cited, the facility does. I wish there was a way the pharmacy could get a citation and a fine for each of it's issues just like the facility does, then maybe they would be a little more responsive and the "well we didn't get the order" bullcrap would stop.

[Forever Sunshine, ASN, RN]

I recently was written up (my first one I was ******) for not giving a med because pharmacy didn't deliver it on time.

I regret signing the write up and should have thought it over but I did sign it and made sure I wrote in big thick letters so it goes through all of the pages that pharmacy did not deliver the med and they were notified MUTIPLE times over the course of several days by not just me but other nurses who had that assignment.

I can't wave a magic wand and have them delivered right then and there.

[LTCangel, ADN, BSN, LPN]

Our facility also uses blister pack doses that are delivered in a box for a months supply. All nurses on all shifts will pull the sticker off when the box is empty or almost empty. These stickers are put onto a pharmacy order sheet and faxed to the pharmacy. The pharmacy delivers meds about four times a day, including at around 11 pm and 5 am. Sometimes though if a med does not get delivered in a timely manner, pharmacy has to be called.. sometimes the fax didn't go through or if it's a new med it can be a matter of getting it precerted first. this happens most often with antibiotics such as Zyvoxx or the doc ordered Prilosec but the resident's insurance will only pay for Nexium. We have Unit Managers on each unit during the day and since I work night shift I will pass these issues to her and she will usually get it taken care of. but it's everone's responsibility to make sure that the meds are there for the patient. It may be ok to borrow one dose of a med from another resident but after that the meds that were ordered should have been delivered. The most trouble I have seen is when we get a new resident and it seems to take forever for their meds to get to the facility. Or it's a new order and it needs precerted, sometimes multible calls have to be made to pharmacy. I've also learned to look in the very bottom drawer of the cart before I order meds. sometimes they've already been ordered and that's where the new boxes are stored.

[Not_A_Hat_Person, RN]

When I worked in an ALF, the residents could order meds from wherever they wanted. The VA was the worst at delivering meds on time. We finally started reordering meds the minute they arrived. The VA's computer system would auto-schedule delivery, and they would arrive on time. If we waited until the med was running low, the med would run out before we got it.