Med not available

Hellllllo Nurse, BSN, RN · May 13, 2004

I had the same problem when I worked LTC. I just continued to chart "med not available." I am not going to lie for an employer.

Blackcat99 · May 13, 2004

:angryfire I got yelled at by my boss for writing the truth which was "med not available". I got tired of getting yelled at so I went to a different LTC. No I am not going to lie about a medication either. :angryfire

txspadequeenRN, BSN, RN · May 13, 2004

I feel the same way but here in Texas it is a med error if the med is not present to give. I usually just fix my MAR's to start the next day . We are required to have a 24 hour pharm ( that is closed from 9pm to 9 am ) but there is a oncall #. But that pharm isnt coming in to fill a colace. We have Narc and ABT ER box's.Just one more thing for us nurses to get yelled at for..

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.

txspadequeenRN, BSN, RN · May 13, 2004

One more thing you can call the family and have them pick up the RX that kinda takes some of the pressure off you. Have the day shift handle some of it mabey they can get it during the day.. Teamwork Teamwork Teamwork

:angryfire I got yelled at by my boss for writing the truth which was "med not available". I got tired of getting yelled at so I went to a different LTC. No I am not going to lie about a medication either. :angryfire

CHATSDALE · May 13, 2004

I Have Been In The Same Situation And We Are Also Required To Give A Meds And Are Not Allowed To "borrow" Shift Who Took The Order Should Order Med I Call The Pharmacy And They Are Required To Bring Out The Meds====they In Turn Raise Cain With The Don On Monday Am ---she Doesn't Like It But She Can't Tell Me To Enter A False Entry===it Is Up To Her To Put Pressure On Day Shift For An Unordered Medication

jkaee · May 13, 2004

What it sounds like you might want to do is meet with your nurse manager or DON and ask her exactly what you are supposed to do if you don't have a med in stock. If you can't write "not available", and you can't borrow from someone else, and you don't have an emergency pharmacy to call on off hours (and besides, like another poster said, what pharmacy is going to come out for a Colace?), they need to tell the nurses exactly what to chart and what to do in that situation. Keep on going up the chain of command until you get the answers that you need to do your job.

Also, another question I have is if you have an emergency med box? Our facility has an E-box that stocks several dozen different meds. I'm pretty sure that they don't have minor drugs in there (ie Colace) but in that situation I'd just borrow it from someone else.

You need to get on them to come up with a plan on what you are supposed to do in that situation. Don't let them leave you hanging!

Good luck.

CoffeeRTC, BSN, RN · May 13, 2004

I do 3-11 on the weekends and this has happened to me before. Most of the time it was for new meds ordered on Friday am. It all came down to on lazy (and yes she was lazy) nurse who couldn't fax her orders. But I digress, try figuring out why the meds are missing, order them as soon as possible, chart it in report and let the DON know. What is her/ his solution? If its something absolutley necessary, I will "borrow" it and give it. We have an E box with some meds (ABTx and cardiac meds) and some emergency narcs, but a lot of times the drug isn't in them. In that case call the pharmacy and insist they deliver it ASAP. (Your pharmacy shoud have a back up pharmacy if they can't fill the order at least in PA they have to).

What bothered me was when the meds were circled for a few days or even all week and not ordered. :angryfire

ps..If a med isn't given or refused shouldn't the doc be notified...do this a few times and I'm sure things will be changed :)

leslie :-D · May 13, 2004

that was a new thing at the facility where i worked....strict orders from the DON for us not to write "on order from pharmacy" or "med not available". we were told to contact the md for a different order...i still wrote "on order from pharmacy" but definitely called the md to let her know. then it was up to her if she wanted to order something else or if it was ok to hold.

rnmaven · May 13, 2004

It seems that there's a common theme of all posters re: this issue. The bottom line is that as usual, it seems that the blame falls on the nurse. The reality is that the system is wrong. We shouldn't have to scrounge around looking for meds, "borrowing meds" etc. I believe that this issue needs to be strongly addressed with the VP of nursing and risk management. Tell risk management that hospitalized patients are having their medication treatments delayed and you'll see something happen. It amazes me that the same hospital will spend 100's of thousands of dollars on a patient satisfaction survey or teaching nurses customer service "scripts". I would say that at most hospitals I have worked at (I work agency) the same thing happens. Either there is no pharmacy at night or it is very limited or there is the proverbial emergency box of meds for the supervisor to have access to. (and what exactly constitutes an "emergency?") If the patient is admitted at 9 PM and the pharmacy closes at 8 PM and the patient didn't receive their usual meds all day........they NEED their meds! Maybe their BP is high. Maybe the MD ordered an antibiotic........stat dose NOW. So why should we wait to institute care? It's negligent not to give the med and I am not going to "cover" for a hospital that is trying to get away with cutting costs at the expense of patient care. I either join the rest of you and call around the hospital to "borrow" or page the supervisor to raid the ER box........but even that delays med administration sometimes for several hours.

We need to take a stronger stand on this issue.

dotter · May 13, 2004

I work in a nursing home and yes we do have a back up pharmacy, emergency box, etc. As far as I know no one in this home uses the back up pharmacy. I don't know why. This is a small home 62 beds and seldom full. Ladies you just don't know the half of it. I'll be posting about other issues as I'm able. I borrow the med when I can. Most of the time it's the day nurses fault because she didn't make sure the med was ordered. We have stock colace etc. so that would be no problem. We have our main pharmacy but it's not in our town and the med is delivered once a day and that's it. After hearing some of your opinions I think the thing for me to do is leave the Administrator a note even tho it will be "tattling" on my part and probably make someone mad. I've always been taught that if the med is not there it's my responsibility to get it. Well it's just about impossible considering the hours I work. Also the med is not sent sometimes because it's not time for it to be refilled. Now I don't know what happens to it but the pharmacy is very strict about that because of billing. Thanks for all your opinions. I definately won't be signing for it again if I don't have it.

leslie :-D · May 13, 2004

no dotter, but with all due respect, even if it's not your job to order it, you really should. the noc nurse does the weekly drug order but a pt. shouldn't go w/o a med if it's one of the more important ones. can you imagine if we all took that attitude that it's not our job? i would submit concerns to the don, even if it's an anonymous note under her door.

leslie