Dispensing? or Not?

[SassyRedhead]

We have a messed up system for orders currently at our work. Half of our workload is computerized, half is paper driven (including MD order writing). The physical paper order is sent on to pharmacy and then entered into the computerized system which links to Pyxis. Very messy and time consuming system. There are times when our orders (including now orders) don't show up in the system for 2-3 hours!

Here is my question. If a patient is on scheduled Atenolol 50 mg po BID, and the MD writes an order for Atenolol 50 mg po NOW because of acute hypertension, I have not been waiting until pharmacy gets around to adding it to Pyxis, I am grabbing the dose from the scheduled BID order. My rationale is that it is not a new med, the patient has been taking it with no problems and the problem being treated is emergent. Obviously, if this were a new medication I would be hounding pharmacy until it was entered.

I discussed my frustration with our 'system' with my supervisor within earshot of a coworker that tends to give her opinion on everything. The nurse, not my supervisor, stated that since I am not waiting for the order to be fully processed through pharmacy I am 'dispensing' and could be headed for trouble even though I have a dated, timed MD order.

Thoughts? Comments?

[LauraF, RN, ASN, CNA, LPN, RN]

I would think that they would have a policy on this if that is the way all orders are handled. I understand your position. But if you let it go down to pharmacy and dog them until they get it up to you, maybe you will be able to show the need for a change. Also if you are sending your orders down to pharmacy you are having someone double checking your orders. What if Atenolol isn't actually what it said and in your haste you gave the wrong medication. Just throwing out a possibility. Sounds like it would be frustrating.

[Jolie, BSN]

I don't know whether or not this would be considered "dispensing", but I do have a few questions that may help to put this issue in persepctive.

When a med is ordered "stat" or "now", what time frame is allowed by your hospital policy? Does that mean within 1/2 hour, 1 hour or what? If pharmacy is not getting the meds to you within that time frame, then there must be a system in place that allows you timely access to those drugs. What is that system?

Do you have stock meds that you are able to access independent of pharmacy for "stat" or "now" drugs? If so, then that seems comparable to what you are doing now. If using stock meds is not considered "dispensing", then it seems to me that using the patient's own timed meds would not be "dispensing" either.

Sounds like an issue for your manager to work out with the pharmacy director.

[SassyRedhead]

I am looking for the Policy and Procedure regarding stat/now medications, and haven't laid my eyes on it recently. But I believe that those meds are to be given within 1/2 hour.

Regarding our stock meds, yes, we can override the Pyxis for certain stock meds. But frankly, our access to many common medications is woefully inadequate. Another issue which I have brought up to my supervisor with no results.

Maybe I just need to start writing incident reports to risk management.

[WV_heart_RN]

your system(or mess) sounds soooo much like what we deal with too. same set up. doc writes orders, faxed to pharmacy, tick tock tick tock, no meds, wait a little longer,......

i have done exactly the same thing you have and would do it again if need be. it was decided that we did not need to have stock meds on the floor. they even took our tylenol!!! no atropine, dig, lopressor..... we have to wait for it.

we have had to hound pharm for drips needed to slow down a heart rate!! when something big time is going on i will get the proper order and if i can find the meds on the floor the patient will not wait.

i agree with what you are doing.

[Kymmi]

If whatever drug is written as now or stat is available in override thru the dispensing system on the floor then it is available to you to give. Our system has several meds which we have access to on a emergency basis however our pharmacy is pretty efficient when it comes to adding meds to the profiles and getting them to us. The above writer states they do not have tylenol or atropine available. I can not understand how the basic "emergency" drugs cannot be available within the unit. I would think it would be a patient safety issue to have to wait for true emergency drugs.

[banditrn]

We had something like that at the hospital I worked at. If I got an order for a 'stat' med, I would call the pharm and tell them that the order was on the way and I needed it NOW and I would come there to pick it up.

[Antikigirl, ASN, RN]

Interesting...if a pt has the medication already in stock for them, and you are giving it stat...I don't consider that dispensing, I consider that following MD orders and if they want to get picky...I am simply changing the time of the med to cater to therapy, which RN's can do!

If it is someone elses med you are using..big no no! That is not only dispensing...it is technically stealing. The patient is charged for that medication and was dispensed to them...I know that is rather picky considering I am sure one would replace the same med...but it can be considered as stealing since it was purchased and for another patient who technically 'owns' that pill...

When I have a STAT or NOW med, I not only send it to pharm, but call in 15-30 minutes if it has not arrived. If needbe I can send a CNA or Nurse Tech down to get it (but considering we have a tube system that is rarely needed).

If it is a pixis thing...we can override with the Charge nurse or pharamacy personel.

Worse comes to worse, you call the MD and tell them that due to the pharmacy and order delay the medication is being delayed and what they wish you to do. Many times I see stat on common drugs being more of a 'give it soon' than give it 'now'...but since they did write it as now...better communciate with them..that is our jobs :).