Using the E Box for meds

Specialties Geriatric

Published

Most facilies have an E Box for meds. One for reg meds and one for controlled, right?

I'm familiar with Omnicare Pharmacy.

New admission comes in, orders are verified, prescriptions from hospital faxed to pharmacy.

Pt is stage 4 cancer with mets everywhere and was medicated before discharge. Orders were sent to nursing home in advance and included MsContin 90 mgs and a Morpine IR for breakthru.

Procedure at my facility is if you need the meds before the delivery (they would be requested STAT due to the nature of the illness and need for pain control) I would fax a request to use the Ebox for the narcs. If your box only contains 30mg tabs for the Ms Contin...wouldn't that be okay? and if it wasn't, wouldn't you call the doc and pharmacy back to clarify?

If you didn't have these meds in the Ebox...what would you do? How long would you let the resident go without pain meds?

As far as the non controlled meds...do you start the resident from the Ebox....tylenol, senna (high doses of narcotics), coreg, elaquis, lipitor.

So...what would you do?

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Specializes in Gerontology, Med surg, Home Health.

If you have 30 mg tabs you could give 3 to equal the 90....

I would get a one time order for what ever pain med was comparable to what the patient needed.

Doesn't your ekit have liquid morphine?

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Specializes in Hospice + Palliative.

when we get a new admit with narc orders, we make sure that the discharging facility is sending scripts for the nrcs. As soon as the admit comes in with the papers, we verify with doc and then fax the script to the pharmacy, and input the order into our eMAR. The pharmacy will immediately send an authorization fax back with an auth # so that we can pull from the EDK. If (on the rare occasion) the ordered narc isn't available in our EDK (it happened to me recently when the roxanol had been taken for another admit, and pharmacy hadn't been in yet to re-stock) then the next option is to take it from another unit's EDK. I've never experienced an order for which we didn't stock the narc at all in any EDK - but I suppose in that case, I'd call the doc/NP and pester to see if we can sub something else that is available immediately just until the pharmacy delivers. There have been plenty of occasions where someone has had an order for a higher dose than what is in a single tablet - in that case, you just pull the number of tabs that will meet the dose (ie: recently had an order for a pt with oxycontin 80 mg - we stock 10mg; so I had to pull 8 for just that one dose!) The pharmacy will take that into account when sending the authorization back, and so the allowed # to pull with that auth # will be higher (for instance, with that 80mg oxycontin, the allowable pull was 24 - enough for 3 doses. Except that we only have 10 stocked in the EDK at a time!! But pharm delivered STAT before the next dose was due anyway)

For non-controlled meds, anything house stock (tylenol, senna, aspirin, florastor, etc) they get from the cart, and then everything else gets pulled from the EDK.

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Thank you for the validation. I have 20yrs experience in LTC as a RN. Now it is my time to be "that family member". Actually, this is the second family member that has needed LTC. I think I have a very realistic view of what goes on in a LTC facilty and havve actually worked in the facilty in question (10 yrs ago..and I do realize things change)

Uncle is the patient in the senario. I helped get all the things ready for discharge from the hospital and made sure scripts were sent and orders were faxed before dc so that they would be able to get things ready. Also he got a dose of a prn right before he left the hospital.

I will be following up with the DON tomorrow. Right at admit he didn't have much pain (medicated right before dc from hospital) Prn is availble every three hours. Given his medical history and dx, most people would assume that he would probably have a need for more prn doses within that window and should assess pain in that window. I know how difficult is could be to get the meds from pharmacy, but that is why we have our E boxes. Being told that they don't have the med, then being told that they don't have the dose isn't acceptable when it wasn't true. When I asked if they could call the doc to see if they could get something else ordered she said that they can't. What about offering him a tylenol and getting the rest of his meds?

I dunno. I would love to hear what they have to say in their own defense.

As a weekend supervisor who fills in and works the floor and deals with these exact issues, I'm just blown away. Blown away.

Thanks for letting me vent.

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Specializes in Hospice + Palliative.

I'm so sorry that your uncle did not get adequate pain mgmt :( That is just unacceptable! there is no excuse to let someone be in pain if you are able to alleviate it, but are unwilling to do the legwork. I would definitely speak with the DON - and if you don't get a satisfactory response, I might consider filing a complaint with the state. Pain is one of the things they take very seriously in Surveys...

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We work with omnicare also. I know we run into problems a lot when the order says (for example) OxyContin 80mg give one tab PO every 12 hours. Because we stock OxyContin 10mg tabs in the ekit, and the order says to give ONE tab of 80mg and not eight tabs of 10mg we cannot get an auth to take it from the ekit from the pharmacy. However, this is easily fixed by calling the physician and having him write a one time order to give eight 10mg tabs.

We are the only unit in our building that has a narcotic ekit so we often run into the situation of not having the specific drug ordered (like morphine or dilaudid). In that case we order the med STAT when they arrive, which takes up to 4 hours to arrive. If they are in a lot of pain before it arrives we can either offer Tylenol, or if we absolutely have to, get the physician to call in an order for something we have out of the ekit.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

So sorry to hear that you encountered that situation. If people are not in the frame of mind to concentrate on what's most important, for whatever reason, there are many "reasonable" excuses that they can come up with. However, knowing that a patient was unnecessarily in pain should get them to do the right thing and fix the situation. The ideas you got for the one-time order to cover different dosages, alternate meds, everything should be explored. These are the situations that make long-term care nurses look lazy or uncaring. I hope that it was addressed and has been taken care of since then. Sometimes the pharmacy system is such a pain in the butt.

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In our facility the protocol for taking controlled meds from the ekit is that we have to call the pharmacy and speak directly with the pharmacist to get authorization to pull from the ekit. For a new admit we HAVE to have the signed Rx in order to get the ok. If it's for an existing order that we have run out of for whatever reason the pharmacy will only allow us to pull from back up if they have a current signed Rx with doses remaining on file. Our pharmacy sucks and all too often a new Rx is needed on an existing order but they won't let us know until we've used the last dose!

It is completely unacceptable to allow a patient to be in pain simply because the needed pain med is not available. The nurse needs to either get on the phone with the doc to get an order for a one time dose of whatever is readily available or demand that the pharmacy deliver the needed med immediately. A patient's pain should never be ignored or brushed aside.

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I completely agree that a patient should never have to wait for their pain medication. That being said in my last job, there was only 1 'medication officer'. That was the ADON. She and only she could call the pharmacy with a verified script for narcs. Ridiculous. I was told that was the new regs for narcotics. If she didn't answer the phone (I worked 2nd shift so she would already be gone) our new admits would be in real trouble. And it happened constantly. I only lasted there for 2 months.

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