Med not available

[dotter]

I work 7p to 7a every weekend. Almost every week there is some patient whose med is not on the med cart. Possibly because the med was not ordered or the pharmacy didn't send it for some reason. We are told not to chart "med out of stock" or "temp unavailable". There is no way I can get the med in on a weekend so what can I do to cover myself? I don't feel right charting that I gave the med when I didn't.

[laughingfairy]

recently my state went to a pre-approval process for a LONG list of meds. All long acting pain meds, duragesic patches, cox 2 inhibitors, any poly pharmacy, and on and on.

What has happened because of that is MANY meds are not available and everyone knows it. What we have begun doing (and I did this anyway) is calling the pharmacy, determing why its N/a. Was it reordered too soon, is it a pre-auth problem, not ordered, etc. Then notifying the doc for any new orders, AND writing a narrative nurses note. They can not ME that.

Further more if they tell me that its a med error, not to do it etc. I write a med error report and/or a pharmacy error report as applicable. I do not borrow unless we are talking emergency!!!!

Borrowing meds is illegal where I am, or so I have been told. And with this pre-auth thing there is no telling if the person will be approved and you will be able to replace the med for the resident borrowed from, then they would be refilling too early and the cycle goes on. Pretty viscious

[night owl]

We have what we call a "Doc-U-Med" closet which stores most meds we use at our facility. Each unit has a key to open it. We take a dose or two, depending on how many doses will be needed until Pharmacy can bring us the med. We sign it out and a copy of the pt's order must be left to verify it was ordered and that we had to retrieve it due to unavailability. In the computer it's charted as "given," but Pharmacy is notified that the Doc-U-Med had to be used. If the Doc-U-Med doesn't have a medication, first it's charted as a "missing med" which automatically submits it to the Pharmacy. Then we go back and enter that it was "Held." due to unavailability. The med is usually brought to the unit before or during the next med pass by Pharmacy. At report we make the next on coming nurse aware of the "missing/held" med and she gives it when it arrives.

[Chaya, ASN, RN]

We have what we call a "Doc-U-Med" closet which stores most meds we use at our facility. Each unit has a key to open it. We take a dose or two, depending on how many doses will be needed until Pharmacy can bring us the med. We sign it out and a copy of the pt's order must be left to verify it was ordered and that we had to retrieve it due to unavailability. In the computer it's charted as "given," but Pharmacy is notified that the Doc-U-Med had to be used. If the Doc-U-Med doesn't have a medication, first it's charted as a "missing med" which automatically submits it to the Pharmacy. Then we go back and enter that it was "Held." due to unavailability. The med is usually brought to the unit before or during the next med pass by Pharmacy. At report we make the next on coming nurse aware of the "missing/held" med and she gives it when it arrives.

That's the best way I've heard of for dealing with this problem (starting with actually recognizing that a problem exists).

[donmomofnine]

WOW! When this happened at our facility, we switched pharmacies. There is a lot of money to be made by the pharmacy, and if they can't offer services needed, then I go somewhere else. We have a pharmacy that would deliver colace if needed, although I encourage staff to borrow in that situation. Our pharmacy comes in weekly and pulls the labels on meds that need re-ordering way in advance. When we are getting an admission and it's late in the evening, we require the hospital to provide meds for the next day, so as not to make our pharmacy run out in the middle of the night. You know what? The hospital wants to get rid of the resident enough that they always do send the meds!

[nurseduck]

You cover yourself by documenting. If you don't have the med, your document what you have done to resolve the issue ( notify family, notify pharmacy involved, notify supervisor, notify doctor, etc) If the nurse notifies all parties and nothing is done then they are as accountable as you are. I am sure you worked very hard to obtain your license and I would not do anything to jeopardize that. We need all the nurses we have and obviously you are a darn good nurse or you would not be on this website trying to find answers to your problem. If the problem is with your main pharmacy then I agree with donmomofnine, your facilty needs to make changes in your pharmacy provider. Our pharmacy site is open or on call 24/ 7. This is health care and any facility/ pharmacy has to be available and provide service 24/ 7 too. Patients are sick 24/7. Nurses work 24/ 7 so pharmacists need to work 24/ 7 too.

TBLPN, I'm glad that you understand the problem. I really don't think some people understand. For one, when a patient is admitted they choose to use either the main pharmacy or one of their own chosing. If they choose their own pharmacy their family usually picks up their meds. We have patients who use different pharmacies that deliver. We can't just call any pharmacy like Eckerds and order the med. My question is how can I cover myself since I can't get the med? I'm wondering if nurseduck can answer my question?