Published Jun 5, 2009
I work in a LTC facility on the 3-11 shift. Many times the MD will write an order for a patient and the day nurse will write the med to start that eve without confirming whether or not the pharmacy will be able to deliver the meds that eve. Most times the med have not been delivered by the start time and the night nurse and the NS insist that I borrow med from patient taking the same med. I do not feel comfortable with this. they do not want us to write med not available. Please tell me what are my options? What happens to the 5 rights for giving meds( right patient) when I borrow?
I have 2 suggestions. The first is that the day shift nurse who gets the order needs to be more proactive in making sure that the medication will be delivered by the evening shift. The second is that the administration time needs to be changed to reflect when the medication has actually arrived for that patient. If the medication is not available at the "scheduled" time then it must be documented "not available". Unfortunately, as nurses we cannot predict when a medication will be delivered. As long as it is not a life threatening situation then waiting until the patients medication is delivered is the appropriate action to take. Please remember that it is YOUR LICENSE that you are putting at risk by "borrowing" medication from another patient. You will be the nurse who goes before the BNE for a hearing not the night shift nurse or the day shift nurse.
Our hospital pharmacy provides forms to fill out when we borrow from another pt. If no one is on that drug then we just write NA on the MAR and the pt gets it when it does arrive.
What about the EDK box? Every wing in my facility has one and we simply take the med out of there and put in a slip.
evilolive, BSN, RN
We take from our E-kit if the med is available in the kit. We have a rather sizeable one, so there's a lot in there, even a bunch of various IV fluids.
If you do paper charting like my facility still does, I'll generally date the left side where the order reads, and let the staff fill in the appropriate date/time box when the med does arrive, and 'arrow' after the fact. New admits' meds generally come on the late run from the pharmacy, so starting them the next day is the main option.
It might be just my geographical area but where I come from borrowing meds is just a fact of life. I would be screwed if I didn't borrow meds when necessary. The first choice is always the e-box, but if it's not there, then yes, we borrow.
This is accepted practice here. We have had inservices regarding proper med administration where we've been told by the staff development co-ordinator and DON that we are to borrow meds if possible rather than document not available.
VivaLasViejas, ASN, RN
One word of caution on 'borrowing' meds: NEVER attempt to do so if the med is a narcotic!!
Technically, borrowing from another patient is bad practice and, in the strictest sense, illegal. That patient, or his/her insurance, has paid for those meds and in a perfect world, they should never be given to some one else. IRL, however, almost everyone has been in a situation where a fax comes in from the PCP after pharmacy hours are over, you need to start the med at HS, the E-kit doesn't have it, and you just happen to have another pt. who's on the exact same medication........so you pop it out of that pt's bubble pack rather than write "on order" or "med unavailable".
The reason is, the state absolutely hates to see "unavailable" on the back of the MAR and will dump all over the facility where there is a pattern of them. They are all about making facilities as 'homelike' as possible, and part of that is making meds available to patients as if they got the script at their doctor's office, filled it on the way home, and started it the same day. So, we borrow. It's not right, but when faced with a choice between the lesser of two evils, we usually select the one with the least potential for harm.
thank you all for your response to my question. My concern is the 5 rights to med admin was design to protect the patient and the nurse. If the med I borrow is an antibiotic and my patient have an adverse reaction to the med. if needed will the facility support my borrowing meds.
I ask because a nurse borrow meds for a pt, the pt had an adverse reaction, and not 5 min later the pharmacy was on the phone to inform the nurse that they would not recommend the med for the pt because of a past reaction. good thing it was a minor reaction and the md recommended that the pt stay on the med.
When I think of the many ways this could have turned out - I am afraid to borrow.Even if the supervisor put the med in my hand- if it does not have the pt name on it I'm afraid to give it.
In LTC borrowing is never acceptable. The nurse taking the order should either start the med at a time when they know it will be available or inform the physician of what is available as a substitute until the med is delivered. If you have a med to give and it isn't there, the supervisor needs to call the physician. Borrowing or indicating "not available" will get you in trouble.
I have also been told that if the resident you are "borrowing " from is on medicaid/medicare it can be viewed as medicaid/medicare fraud. Like VivaLasVegas stated, the ins. co paid for the meds with the intent for the designated resident to recieve it. I will get the med out of the EDK or call pharm and have it drop-shipped to the facility. Like dmb219 stated we are not allowed to put not available either, it is the "residents right" to have the meds available as ordered.
I've never seen it written in our residents' rights information that they have the 'right' to have a medication at the drop of a hat. It really isn't a right. It would be nice if we all were close enough to our pharmacy to get the meds we need immediately, but for most of us, it's not the case.
We have a very large Ekit. All our docs have lists of what is available in the kit and they all also know how long it takes for meds to be delivered. If they order a medication we don't have, we include in the order "Start first dose when available from the pharmacy."
Borrowing from one person to give to another is not good practice. Clinical concerns aside, most insurance companies only pay for a 30/31 day supply. If you borrow from Peter to give to Paul, then Peter will run out of HIS meds too soon and you might end up having to borrow from someone else.
PsychNurseWannaBe, BSN, RN
The nurse who accepts the order should be reasonable when assigning admin times. If I get an order at 14:00 (work until 14:30) then I would start it for tomorrow unless I have it in contigency. If I need a med that is not carried in the contigency boxes, then our pharmacy will contact a local pharmacy and cab it over. But not many places are willing to cab meds, so I guess it goes to administration time is the only thing you should manipulate. Borrowing from others is not wise. It is actually considered a med error in our facility.
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