Eval and treat with pharmacy

[srvjamz]

It seems slowly but surely that nursing has changed from taking orders just from physicians to lots of other healthcare providers..we have moved into taking orders from APRNs, PAs, RT, PT and (a new realization to me) pharmacists. The old after 3 doses vancomycin trough has now moved to whenever pharmacy says.. a critical value on a trough with a call to the physician results in being told.."pharmacy handles that." Its not that I object to pharmacy involvement in these things (vancomycin as well as lovenox dosing).. I am just curious as to how other nurses feel about it. If you noticed your patient was on their 8th dose of vanc.. who would you call to get a trough? If you get a critical on vanc.. what is your hospital policy on who gets called? Of course, your nurse practice act means that you are responsible to question each and everyone of these disciplines issuing orders. Do you feel your hospital policies are keeping up with these changes?

[AGACNPTX]

We have pharmD's in our hospital. They handle antibiotic dosing, order/monitor vanc and dig levels, adjust drugs for renal function etc. I love it because the pharmD is located in my unit so it saves me a lot of phone calls. I think it is safer as well

[SouthernPoint]

Pharmist's are Doctors.. In all honest I have no problem taking orders from them. Sometimes I would rather take their orders vs ARNP's, PA's or Floor MD's.

[srvjamz]

I agree that I also do not have a problem taking orders from them.. I think my real issue is how as nurses we take orders from an increasing number of disciplines and it did not used to be that way. Vancomycin in particular is on my mind as something that has changed. I had a critical vanc lab value and for all intents and purposes my call to the physician seemed irrelevant. I am calling pharmacy with critical lab values and not the doctor?

[MunoRN, RN]

I'm not exactly new to nursing but I've never known anything different. Managing vanco dosing off of labs, renal dosing, warfarin dosing, that's why we've had pharmacists for as long as I can remember. When I have mentioned these things to a physician they typically have no idea how to adjust things, and they'll sometimes point out that's why we have pharmacists.

[morte, LPN, LVN]

is it compliant with your nurse practice act? and can you confirm that the person you are talking to is legally entitled to order?

[SierraBravo]

I agree that I also do not have a problem taking orders from them.. I think my real issue is how as nurses we take orders from an increasing number of disciplines and it did not used to be that way. Vancomycin in particular is on my mind as something that has changed. I had a critical vanc lab value and for all intents and purposes my call to the physician seemed irrelevant. I am calling pharmacy with critical lab values and not the doctor?

That sounds bizarre to me that you have to contact pharmacy about vanco levels. The provider should be notified, who should then possibly contact pharmacy for dosing advice and potential adjustment. In a few instances I have seen a pharmacist change a dose of an antibiotic without notifying the provider, but in the great majority of cases the provider is directly involved. Not all pharmacists have a doctorate degree, there are still plenty of RPh's working in hospitals.

[MunoRN, RN]

That sounds bizarre to me that you have to contact pharmacy about vanco levels. The provider should be notified, who should then possibly contact pharmacy for dosing advice and potential adjustment. In a few instances I have seen a pharmacist change a dose of an antibiotic without notifying the provider, but in the great majority of cases the provider is directly involved. Not all pharmacists have a doctorate degree, there are still plenty of RPh's working in hospitals.

I'm not getting the rationale of why the physician would need to play middleman. Pharmacists don't have to be pharmD's to adjust dosages per protocols, even RNs regularly adjust dosages of medication based on protocols without ever notifying the MD.

[toomuchbaloney]

In my view, if there needs to be a collaboration between the MD and the PharmD it is not the responsibility of the RN to initiate that. Most of us have no problem referring these questions to the PharmD for guidance and orders, at least in my experience.