No 24 Hr Pharmacy

[MDRRAJ]

Our hospital doesn't have a 24 hr Pharmacy yet. Apparently it is difficult to recruit hospital pharmacists when working outside of a hospital is more lucurative. My questions are: Who dispenses the medications and Do you have to profile these meds before dispensing? What about potassium and k-phos?

[Spidey's mom, ADN, BSN, RN]

I work at a small rural hospital and we have one pharmacist who can't obviously work 24/7.

The nursing supervisors would access pharmacy after hours and mix meds too. Narcs are off limits - the pharmacist would make sure everyone had enough narcs to make it through the night or weekend. Or we would call the DON or CEO to come in to open up the narc cabinet.

Now we are part of a pilot program through UC Davis Med Center where we have pharmacy access when our pharmacist goes home. It is a pain though.

steph

[AfloydRN, BSN, RN]

When I worked in a smaller hospital, our pharmacy closed at 6 pm. For any other meds, house supervisor had to get them, or more often than not, gave us the key to go get it ourselves. Needless to say we made TONS of trips to the pharmacy a noc. We did keep an ER/ Anesthesia kit on the crash cart which was helpful. I remember mixing up my own meds in the pharmacy and laughing.

[KellNY, RN]

wow. i can't imagine not having pharmacy 24/7!

But we're a large hospital, so it would never work

[manna, BSN, RN]

Similar here - nursing supervisor has access to a limited amount of drugs after pharmacy hours. Here in ICU, we have a stock drug cabinet and can mix certain drips in emergency situations only.

[RNinSoCal]

We are a smallish (census usually around 100-125 for the whole hospital) with no 24 hour pharmacy. We use pyxis, the meds that are not in pyxis are either in the med cart or the fridge. The supervisor can access everything that does not have to be mixed by a pharmacist. This is the first place I have worked that uses pyxis and I like it!

[adrienurse, LPN]

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[TazziRN, RN]

We have only a daytime, M-F pharmacist also. Ours aren't even local, they drive in for a week at a time and stay in town, then go home! They try to keep each unit stocked with enough to get us through, but if there's something needed the house supe can access the pharmacy. Only the DON and one other admin person can access narcs.

[Lacie, BSN, RN]

I was a house supervisor in a small rural hospital for years and no pharmacy at night nor on weekends. We had the pharmacy keys and would take the little yellow slip from the orders, unlock pharmacy, obtain the med, drop the yellow slip and deliver the med to the nurse. If it required mixing the nurse who had the pt was the one to mix and administer it. We didnt mix and expect another nurse to administer what we mixed. We didnt do narcs or the TPN orders but each unit had plenty in the lock box, if there wasnt then it was the units fault for not notifying pharmacy in plenty of time it needed stocked. It's pretty common practice in your rural areas or very small hospitals.

[crb613, BSN, RN]

I work in a rural area & we don't have pharm at night...We do have a pyxis. It is hard when you get admissions at night....no meds. We have to override & that takes two nurses. If the meds are not there the charge/house supervisor (same person) has a key to the night closet. Sometime they are not there either. We mix everything from abx to K+ at night. I always have another nurse double check my math, watch me draw it up & mix....we both sign. If you mix K+ always shake the crap out of it!!! & don't ever set the vial down.

[AliRae]

Wow- I never realized how lucky we are! I work at a large teaching hospital. We have a main pharmacy that's staffed 24/7. But we also have a satellite pod for the children's hospital, and since I'm in PICU, it's right on our floor. I work days, so there's always someone in there and they'll run meds out to us at our rooms when we get new orders. At night we have to go through main pharmacy, but we also have floor stock of emergency meds and some common ones like lasix etc that we can use in a pinch.

[jannrn]

I went from a large teaching hosp to a small one, no ER here so simpler in that respect. Pharmacy is M-F 8-6 or something like that. Pharmacy is on-call but they are so expensive to call in and one nurse made a comment on how they thought it might be advantatgeous to them to stock us short sometimes.... good pay for them!!

For the computer medications we have a place (far away) called Cardinal Health who staffs pharmacists at night to add things/correct the pt medication profiles. It has been a challenge... but sometimes they get it and sometimes you wonder where they went to school!!

Every so often I go to our (1 other) unit to find something or to the PACU Pyxis instead of calling the pharmacist in.

we can probably have about 30 in-pt at any one time and that includes the other unit.