Caught in the middle

[outbackannie]

A patient was admitted to the floor with cellulitis of the face. The doctor ordered Ampicillin 3 Gm IV q6 hr. Since the patient was close to 300 lbs.

this seemed to be an appropriate dose. He also ordered the same anti-hypertensive med that the patient had been on for several months to control

her hypertension. Her BP was 240/110 on admission. Our clinical pharmacist

refused to supply the medications because she didn't agree with the dosing.

The doctor was called and informed of the pharmacists concern. He insisted

that the patient receive the medications as ordered. The pharmacist still would not dispense the medications. What would you do as the nurse caring

for this patient?

[ckh23, BSN, RN]

Seems like there is little you can do as this is between the pharmacist and MD.

[sirI, MSN, APRN, NP]

A patient was admitted to the floor with cellulitis of the face. The doctor ordered Ampicillin 3 Gm IV q6 hr. Since the patient was close to 300 lbs.

this seemed to be an appropriate dose. He also ordered the same anti-hypertensive med that the patient had been on for several months to control

her hypertension. Her BP was 240/110 on admission. Our clinical pharmacist

refused to supply the medications because she didn't agree with the dosing.

The doctor was called and informed of the pharmacists concern. He insisted

that the patient receive the medications as ordered. The pharmacist still would not dispense the medications. What would you do as the nurse caring

for this patient?

Hello, outbackannie,

I would ask the pharmacist to contact the physician to advise him/her why this was an improper doseage. If he/she refuses, then I would call the physician back and inform him/her of the decision of the pharmacist AND the refusal of the pharmacist to contact the physician.

Other than that, there is nothing else to do. The patient will not get the drug because the pharmacy will not dispense it, and, you are relieved of any responsibility.

[allele, LPN]

I agree with CKH23, not a lot you can do. I'd happily hand over the phone number to the pharmacist and have them speak to the MD and discuss the problem. Our pharmacist are usually pretty good with calling the docs anyway.

[stidget99]

Doc and pharmacist need to talk. Inform the doc again of the situation - stressing the fact that the pharm refuses to supply the drug. I would also document the fact that you notified the doc of inability to give med due to unavailability - without further explanation. And then, when med becomes available or drug is changed, be sure to document when it is administered.

[sharann, BSN, RN]

Good advice.

Pharmacy seems to think that nurses need to call every doc for them for every reason. Sometimes they need tp buck up and call the doc and hear it from the horses mouth. I don't have time to play messanger to a passive agressive game of wills. You are stuck, just document as advised and perhaps an event report?

[rn/writer, RN]

In addition to all the good advice listed above, please inform your charge nurse of what is going on. First, she needs to know there is a problem that you cannot solve on your own. Second, she might hear about this from either the doc or the pharmacist if they call the floor with a complaint and charge nurses do NOT like to be surprised in that manner. Third, you need to have back-up and moral support as you try to sort this out. Fourth, she might have some ideas or be able to direct you to an official policy that deals with how to handle such a dispute.

Your patient is fortunate to have you looking out for him.

[meownsmile, BSN, RN]

I have no problem if the pharmacy calls and questions a dosage the dr has prescribed to suggest they call the doctor themselves and discuss it. Most generally they will. I dont have the time to be put in the middle of a telephone tag game between two people that ultimately have more authority to give the medication than me anyway. Let them hash it out and they can get back to ME.