Every time I work at my SNF there's an expired pain med order

[Nola009]

...that hasn't been renewed throughout the week. I only work weekends (& not very many at that), and this seems to happen every time I work. Staff that has been there for years don't see this as a problem. Many will give tylenol even if there's no current order, because the patient was on say norco or percocet previously. Then they never call to get another narc order and here I am on a Saturday night, trying to reach the doc. I think this is so inconsiderate of EVERYONE involved. Does this happen where you work too? What would you do? I'm only prn at this place btw.

[Here.I.Stand, BSN, RN]

Generally this wasn't a problem when I worked in aLong Term Acute Care Hospital since there's always at least one MD in-house. You might get more responses in the LTC forum.

[Nola009]

:up:True.... I was looking for SNF because it's a little different than LTC. Will move it along....thx.

[Here.I.Stand, BSN, RN]

Gotcha. :) But yeah, since LTAC is an actual hospital that's one issue that doesn't happen.

Now that I think about it though, when I did work SNF (I worked on the "Transitional Care" unit--we had mostly subacute rehab and hospice pts), we had issues w/ running out of narcs. We had one NP who was good about leaving paper Rx's in the pt's chart if she was going to be gone for a while. It was always a pain when we ran out over the weekend though because they needed a hard Rx vs. the provider calling in a refill, and we didn't have the provider in house over the weekend. Whenever I was on on Thursday or Friday I'd count how many pills the pt had left and how many they could possibly take before Monday, and if we'd come up short I'd make sure to let the provider know... not all of my colleagues did though. Lots of times I got stuck telling the pt that I'm sorry they can't have their Norco yet because you're out and it's going to take some hours to get the pills into my hands.

[CoffeeRTC, BSN, RN]

Yes! Total PITA

[txredheadnurse, BSN, RN]

This happens when nurses refuse to look past their shift, their list of tasks and take a few minutes to think ahead. When I was doing consulting one of the things I preached and preached was making a good guestimate as to the number of daily doses used and reorder or ask for a new order when approximately five days worth of pain meds were left. This leaves plenty of time for the prescriber to send a new order to the pharmacy or give the paper script to the facility and the facility sends it off to the pharmacy.

The second part of this is making sure when the order or refill has been sent that it is received at the facility. In the better facilities I did consulting in this info was included in the shift to shift verbal report and was on the 24 hour report until it was resolved. That way there is no excuse for not having the medication available; ie I didn't know a refill had been sent and hadn't come in yet, or I didn't know a new order was needed etc. Saves time in the long run, stops having to try to track down providers after hours or on the weekends and saves having to pay stat delivery fees to pharmacy for last second refill. Most importantly it is for the welfare of the residents who don't have to literally suffer through an interruption in their pain management.