new nurse in LTC questions

[fairyluv]

I am a new LPN I got my lic. in sept 2012, I started working at a Nursing Home. I have only been there a few months. there was a new resident and this new resident had an order for 2 narcs, one was delivered the other was not, pharm said they needed the dr to write a rx for it before it could be filled. The nurse on the previous shift said she called the doc and that he said he would be in later that day to write the script. I left note on docs communication sheet reminding him of the script, DON seen the note and asked me about it. I told her what the other nurse told me and that the doc said he would be in later. She told me if it had been that long then I need to stop my med pass and call the other doc for the facility to have him fax the script to the pharm. and that if state were here and we didn't have the meds that were ordered it wouldn't just be on the facility but the individual nurse as well. So I called the other doc to get script and he called pharm. 30 min later the original Dr. came in and wrote the script, I told him what the DON had me do and he was not happy about that. Said he would be having words with her about that because it's inappropriate for her to do that. If it were an emergent situation then he could understand but this was not an emergent situation. Now my question is, how would this come back on me that we didn't have the meds because we needed the doc to write the script ??

[SuzieVN]

Tough situation, and it's common. What is the medication policy- for example, how are orders received, transcribed, sent to be filled? What are the time parameters- for example, there's usually a time frame, such as 2 hours, in which an antibiotic must be started. What med require a signature before they are filled. If they require a signature to be filled, do they also need a signature to be started from the emergency box? What is the policy if that cannot happen? What is the policy for meds that are not available in the cart, and haven't been ordered (and obviously, not given?), and say- it's a weekend, and the pharmacy is closed, and won't send the med? Follow the policy to the letter- it's a frequent reason for actions against a nurse's license. Whatever you do- don't even think of 'borrowing' any med from another patient- that can lead to charges of theft, prescribing without a license, and all kinds of icky stuff. Might ask your DON for an inservice, and clear guidelines?

[SuzieVN]

P.S.: Don't fall into the trap of signing that you gave a med, but didn't, just because your place might have a policy that 'saying a med is not available is NEVER to be done'. Lots of nurses don't really realize that every prescribed pill sent from a pharmacy has multiple checks and balances, and can be accounted for- not only narcotics. That means it's not hard to determine whether you really did give a pill/med that you signed for, that was not really available. Again, follow the policy to the letter, and also document your attempts to obtain a med that you can't obtain, in the event you are ever accused of 'not following policy', or 'failing to obtain a required med'. Good luck.