sticking your neck out for a pt?

  1. First of all, I'd like to apologize for this being so long, but I have a situation that i would like to share & maybe get some opinions on. I am a home health casemanager & have had an ongoing problem with a patient's pharmacy. We make weekly visits to a patient's home (who lives 20+ miles from our office) to fill the pill box & monitor med compliance. Normally, 20 miles wouldn't be a big deal, but it's the only patient in this area. Since admission, the nurses (including myself many times) have had to call the pharmacy re: undelivered meds. This has been an ongoing problem, & I finally took all I could stand yesterday. The patient had an antibiotic called in from the MD office, I called the pharmacy & they promised it would be delivered by 2pm. I arrived at this patients home @ 2:30 to find NO MEDS!! keep in mind this was an extra skilled nurse visit specifiacally to add this new antibiotic to her pill box. I called the pharmacy & asked why he had promised me this & not delivered. He was very hostile & rude to i reacted in the same manner. i regret losing my cool now...but you know what they say...hindsight is always 20/20. This was the straw that broke the camels back. I called the patient back & asked her if she was serious about transfering to a new pharmacy & she was all for it. ...i called the MD office & let them know that the patient wished to change RX also. Then i called another pharmacy & got the ball rolling to switch things over. Problem started when The owner of the old pharmacy called the patient & asked her if she "really wanted to change or was it that nurses idea?" Needless to say, she told him she didn't want to change & was satisfied with his service. The pharmacist then called my supervisor & filed a complaint against me. I don't know how to feel...I called myself going to bat for my pt, she is forgetful & unable to take these meds without us due to poor vision..(family doesn't help out @ all)...From now on, i will not stick my neck out for the patients.. This will go into my personel file & I'm up for an eval this month..wouldn't you know it? What do you guys think? Have you had a similar experience with "caring too much"? thanks for letting me vent...i feel better.
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    About bravegirlamy

    Joined: Jul '02; Posts: 38
    home health nurse


  3. by   hoolahan
    Been there! bThis sound sooooo exactly familiar!!!! Don't know if your problem was w a certain huge chain pharmacy that starts w E, but that was who I had the beef with. Same EXACT thing happened to me. I even went to the pharm to pick up the meds several times myself, but big diff of only 3 miles away.

    It is tough b/c it is a 20 minute ride!
    Here is what I did, I went on the web, and reported the pharmacist and the CONSISTENT poor service to the coporate president. My e-mail got routed a few times until I was contacted by the regional manager, who expressed that they have had many compaintes about this site, but they have been unable to find a replacement. I emphasized in my e-mail that in my position, I regularly set pt's up w new pharm's , and unfortunately I would not be referring this chain any new biz, and if at all possible, I would recommend the pt's switch, and even go so far as to suggest my agency not accept anyone for prefills who uses their pahrmacy chain.
    The coporate person apologized and took my complaints, but nothing changed.

    If your notes document the lady's confusion or forgetfulness, all you need do is write a formal written rebuttal to the file. AS for the pharm, it is a coporate type? If so, report the PhD, he is taking advantage of that lady's forgetfulness, in the form of financial abuse as far as I am concerned. Negligence too if she cannot be given her meds properly.

    AS for the pt, well, you will have to be firm. Call before leaving the office, and if the meds aren't there, don't go. Have your agency send her a letter stating that they will be unavailable to assist with emergency prefills due to the unreliable delivery services of her chosen pharmacy, it is not reimburseable by the insur co. and she would be responisble for the payment of the visit.

    Your agency should be backing you up! If they don't, I'd be pizzed!!!!!! Don't accept criticism when it is unwarranted. Stay away from the whole tempers thing in your letter, and if it comes up, deny it completely. So what? He was rude to you first.

    The REAL issue here, is your agency made a visit which is potentialy non-reimburseable, at great cost to the agency w travel and your time, and the pharmacy promised to deliver and didn't, compromising the treatment of the pt!! Make sure that you address any c/o unprofessionalism in your letter as an attempt to distract from the real issue of the unreliability of the pharmacy. Don't admit anything.

    If you are guilty of anything, it is 1. being gullible enough to believe that this known-to-be reliable pharm would have the med there w/in 30 min of the agreed-upon time (Was it close enough to pt home to have picked it up?? May make your life easier, even tho time consuming) and 2. A "crime" of passion, in caring for your pt's passionately.

    Don't stop going the extra mile, just stop for the problem ones. And don't qaccept that lying down. That is crap!
  4. by   bravegirlamy
    thanks for the advice, i really needed to hear someone else's take on this. I will defintely write a rebuttal to his complaint. I have loved home health for a while now, but I think it's starting to get to me.
  5. by   hoolahan
    I know that feeling! Sometimes you would come home and feel as if the weight of the world was on your shoulders. It can be really hard.

    What I would do when I stat feeling fried is beg another nurse for some trades, she could give me a few cases she was weary of, and I could give her a few whom I just couldn't bear to face again, at least for that week.

    It was a good way to get a break, and sometimes you need to break that cycle of dependency a pt develops with you, so they realize you will not always be available, and they will have to look inward for some strength.

    Hope that makes sense and doesn't sound too cold-hearted. I am def not a cold-hearted HH nurse, but you have to protect yourself a little too to survive in HH!!
  6. by   canoehead
    Wonderful suggestions, I didn't have anything to add, but you guys are the greatest.
  7. by   SeptSue
    Be objective, logical. After arriving at a new patient's home for a.m. insulin, but there was no insulin in the home, I decided that in future I would phone new patients the day ahead to ask if they had their prescription filled (some thought that the nurse brings the insulin). When the person would say no, then we would start the phone calls (better than arriving at the home and discovering no insulin). I have numerous examples of variations of this topic - the medication's not in the home - and yes, people do have to plan ahead. The nurse is one person who can provide information for the patient about options. The pharmacist used poor judgment by being rude and hostile to you, yet you had to call about the situation. For your file, write up your account of what happened. Best of luck, I'm sure you'll be able to sort through this.
  8. by   bravegirlamy
    thanks for the advice, sue. It helps to know I'm not alone with these situations.
  9. by   vinni
    I'm a new nurse putting in my med/surg time. Here's a 'trick' I use personally that has gotten me results. I would write my letter of complaint to the offending party, and cc the office of the president of the party's company and also the appropriate state agency that has responsibility. The 'Office of the President' letter is usually responded to by an executive secretary who then sends her/his lighting bolts from her office to the line staff to 'Fix it! or else!' then they write a letter to the state agency and to me explaining what they have done to take care of the problem,

    This has worked for me with power companies, Blue Cross/Shield, insurance companies, and other forms of organized crime. Although I haven't yet had to do it, a further option would be to prepare a Letter to the Editor or such other media contact and send a copy to the president's office as a heads up letting them know what your next move would be if you were not given satisfaction.

    I dare say that you might not have a problem with this pharmacist ever again.
  10. by   nurseT
    Was your visit purpose to set up a med box or new med teaching? It is my understanding that m-care does not consider med box set up a skill and will not pay for that visit. All nurses know that med box set up does take alot of skill and m-care uses labels like "maintenance" to get out of paying. We have to get creative and lable the visit as med instruct or system assess and do the meds while we're in the home. How does you're agency discharge a pt knowing that pt can't fill med box and m-care won't pay for maintenance?
  11. by   hoolahan
    NurseT Medicare won't pay for this service, but Medicaid does, at least in NJ it does.

    In my area we have a Parish Nursing agemcy that serves those who live alone or do not get Medicaid, to do prefills of medi-planners. So, when we think we will have that situation, we let them know as soon as possible so the pt can get on the waiting list, about 2 weeks long.