No pharmacist at night?

[blondy2061h, MSN, RN]

I've seen a couple people mention lately that their hospitals don't have pharmacists at night. This seems crazy! How exactly does this work? Who do you ask if you have a question about a med? Who clears and dispenses new drug orders? Who do you call if you're missing a med for a patient? Who restocks crash cart meds if someone codes? What if your pyxis is broken or out of a med?

I just cannot imagine running a hospital with no pharmacist available 24/7.

[racing-mom4, BSN, RN]

We have no pharmacist at night, ICU can over ride any med and we even mix our own drips if we need too, if there is a certain med we dont have in the ICU/ER pyxsis we will call pharm in to get it, They are on call 24/7, but they only work 7-7. Certain things like a new abx may not get started till 7am if the order comes in after 7pm.

I have never worked in a hosp with 24 hour pharm so I dont know any different, but it is really not that difficult.

[SuesquatchRN, BSN, RN]

We have an "emergency kit" that can be accessed.

If an order needs to be filled one nurse pulls, another checks, both sign off.

[loriangel14, RN]

We have no pharmacy at all where I work. We are a smaller site of a larger hospital in the next town.They are only open during day shift there as well. We can order stuff to be sent up during the day and at night we have a night cupboard that we can access in case of emergency.

[ChaosRN777]

We have a pharmacist who stays until 6pm, and a Pyxsis type cabinet, and a schedule of who is "up next" (which usually falls to the closest one, becuse several live in the next state), most of my units have "stat drawers" for common meds that could be ordered in an emerging situation.

My population is intermediate to long term chronic psychiatric adults (320 to 360 census).

It is only problematic when the medical attendings stay late and write orders after 5pm.

[RNperdiem, RN]

I remember before the days of PYXIS going down to the pharmacy after hours to look for meds. The house supervisor would go with me and she had the keys to unlock the pharmacy.

It took quite a bit of time to find what you needed sometimes.

The pharmacist locked up at 10pm.

Luckily the hospital was quiet at night and the trips to pharmacy was not that common.

[FireStarterRN, BSN, RN]

I worked in a small, critical access hospital and at night the nursing supervisor acted as pharmacist.

[flygirl43]

Try calling the pharmacist 10 minutes after their shift. You have an order for 30 mg oxy qid and theres none on the cart....you page the pharmacist to come in to dispense so the ppt isnt writhing in pain....you get the "attitude" My response was.....we are a team here....this pt is very uncomfortable...I dont appreciate your attitude...but I would appreciate you being a team member to provide this pt with adeauate care!!!!!!! Boy did the appologies come flying!

[Vito Andolini]

I worked in a small, critical access hospital and at night the nursing supervisor acted as pharmacist.

That's how we do it. I have often wondered about the legality of this. The supervisor must go to the Pharmacy, obtain and DISPENSE enough doses of the med to make it until a pharmacist is next on duty. However, pharmacy law in my state clearly states that RN's in my state are not allowed to dispense. We administer. So...?

Many times, we are told to "borrow" from another patient, which is also totally a violation of law, as I understand the law. You know how you are told you may not share your prescriptions with anyone else? Why is it ok to share an inpatient's Rx with another patient? It is like this everywhere I've ever worked but I do not understand why it isn't illegal.

Once in a great while, the Pharmacist has to come in. We try hard not to call them in, out of courtesy, although they do get call pay. Another case of Nursing being at the bottom of the heap? Sup cannot get the controlled's but this should not be a problem where I work.

I don't get why a pharmacy can't have a pharmacist work from 7-3 and another from 3-11 and another from 11-7. What is so hard about that? They can divide up the work, I'm sure. On weekedns and holidays, they could have an R.PH or Pharm D work an 8 hour shift of the pharmacist's choosing, thereby overlapping at least 2 shifts. Or the laws need to change so that nurses are covered to dispense.

Our supervisors also have to cover for psychiatrists when a patient goes into restraints. A face-to-face eval is required within an hour, I think. If it happens while the doctors are present, they do the eval. If not, though, the supervisor does it. Then, if the patient is in restraints long enough (4 hours, I think, or 2, not sure), the doctor is required to do that FTFE. There is a doctor on call, probably getting call pay. Do you think they ever actually come in, though? I doubt it. Not in the middle of the night, I'd bet. So, how are they covering themselves? What liability does our facility have? How about the RN who would know if a doctor is or is not doing the FTFE as required? What is that nurse's liability? I don't work Psych so don't know exactly how they handle it but a friend in that unit was worried about this last year.

[ChaosRN777]

Our supervisors also have to cover for psychiatrists when a patient goes into restraints. A face-to-face eval is required within an hour, I think. If it happens while the doctors are present, they do the eval. If not, though, the supervisor does it. Then, if the patient is in restraints long enough (4 hours, I think, or 2, not sure), the doctor is required to do that FTFE. There is a doctor on call, probably getting call pay. Do you think they ever actually come in, though? I doubt it. Not in the middle of the night, I'd bet. So, how are they covering themselves? What liability does our facility have? How about the RN who would know if a doctor is or is not doing the FTFE as required? What is that nurse's liability? I don't work Psych so don't know exactly how they handle it but a friend in that unit was worried about this last year.

I can only address New York State requirements, and my facilities interpetation of them. Doctor must be present for a restraint. They have to document time called & time arrived ("actual time of restraint" and "Ordered time of restraint"). in my facility they have gone as far as saying no 4 point restraints without prior authorization. Those authorizations are few and far between. We use LS, locked seclusion. The policy is that it can not happen unless the nursing supervisor is there with the psychiatrist. In the real world that is not always an option, given that we have 15 wards spread out over 5 buildings, and maybe four or five acres within a fenced "compound".

A seclusion is only allowed for one hour with a FTFE by the psychiatrist & can be extended for a second hour, Must end and if there is no other option, the "whole process starts fresh with a new event packet".

(my opinion of this process follows: )

[RNsRWe, ASN, RN]

like jls, we have our evening/night supervisors get us meds from pharmacy as needed. Orders received after hours, or for new admissions overnight; we get whatever meds are crucial for then and put 'daily' meds on the daytime shift, after pharm opens.

It works. Not great, but it works.

[Fonenurse]

My husband is a pharmacist here in the UK. They have an emergency cupboard and technicians who stock the cupboards on the ward. They also keep stocks of 'TTOs' (tablets to take away) so the pharmacist dispenses and the nurses just give them out according to prescription out of hours...