pharmacy hours

mcl4 · Dec 16, 2001

Originally posted by erdiane
In the latest cost-cutting move, our hospital has now closed the pharmacy from 2100-0600. What they are doing is having the night nursing supervisor go into the pharmacy and pick up any new/emergent meds that are needed, and taking them to the floors. (The ER had to wait over 2 hrs on friday for diprivan for a hip reduction...)

question is: How do other hospitals work this? Are most open 24 hours (like we used to be)? I am also wondering if having the nursing supervisor get meds from pharmacy constitutes "dispensing meds" which would probably be out of the realm of her scope of nursing practice.... We are not a little podunk hospital...We have approx. 400 beds. Psych, chem dependancy, ortho, med-surg, telemetry, ER.

Any thoughts? (other than letting all management people go)

Is it possible the reason the hours were cut was due to a shortage of pharmacist. In this area of the country, there is a severe pharmacist shortage. This shortage is even worst then nursing.

oramar · Dec 16, 2001

It is going on everywhere and managment always insist there is no danger but that is a lie. It is a set up for medication errors. I witness an increase in errors at both hospitals I worked where they reduced pharmacy hours. The bigger the hospital the greater the danger. I include slow delivery in medication errors.

Uptoherern, RN · Dec 17, 2001

as far as i know, there is no pharmacist shortage here...matter of fact, two pharmacists have resigned since last week.

galenight, BSN, RN · Dec 17, 2001

What a luxury it would be to have pharmacy in house until 2100!!! Where I work, there is only one pharmacist who works 0700 to 1500, and not a minute past. Up until recently the house supervisor (the ER RN) had the keys to pharmacy, but thanks to JACHO those were taken away from us several months ago. The rule now is that the pharmacist will only come in if it is life or death. I'm thinking that if the need is that urgent, the patient will die before he gets there. I can't blame the guy.. he can't be there 24-7. The problem comes though, when we need less common medications.. vital.. but not on our night cart. Or if someone needs a lot of what we do have then we are out.. case in point.. newly dx addisons.. treatment protocol calls for solucortef 100 mg q 6 hours. we had 5 100 mg bottles in night cart and of course it was the weekend.. obviously that wouldn't last long... the pharmacist did come in for that. Anyway.. it is frustrating.. I can totally sympathize. One kinda good thing about not having to constantly go to the Pharmacy is that I have more time with patients and less liability... i always worried that if something came up missing the first people they would target is those of us who were house supervisors. Well, good luck to you!

**canoehead, BSN, RN** · Dec 17, 2001

We have 8h pharmacy coverage 5 days a week and the sup gets the meds on weekends. We can only get meds for immediate patient needs, and that can be up to 3d on the weekends. Our new pharmacist has allowed us the refilling function on the Pyxis to minimize repeat trips to pharmacy, and will let us pick up enough meds for several days, but the previous pharmacist made us go down for each dose, which made us pretty much unavailable for anything else. So ya we dispense, but we don't tell anyone, and as a staff nurse I would check supervisor med pulls extra carefully knowing that they are doing someone else's job, and in a rush.

Teshiee · Dec 17, 2001

That is dangerous. I guess unfortunately someone will end up suffering because of this.

Dayannight · Dec 20, 2001

We have no pharmacist after 7 pm - The hospital night supervisor spends a lot of time running to pharmacy to fill missing med orders for the floors, as well as ER. This has been going on for years now. There is a shortage of pharmacists here in northern CA.

hapeewendy · Dec 20, 2001

wow I feel like the hospital I work at is completely disfunctional!!

we have a pharmacist for our floor (acute medicine) from 9am - 5pm then it is up to the floor nurses - only five RN's on nights for 38 patients to obtain our own meds either from the night cupboard *which isnt even on our ward!*

or from emerg......

this causes great stress when we get several admissions in the night - which of course we do because emerg wants to send everyone up at the same time etc

also we are responsible for the most part to mix

our own IV meds - the only ones I've seen that come pre packaged are flagyl and cipro

and heparin of course....

you would think by the sound of my post that I work in some small rural area - I dont - I work at a well known hospital in a very big city.

to have a pharmacist for 24 hours would be a blessing!!!!!!!!!!

Jen911 · Dec 20, 2001

We have pharmacists in the hospital until midnight, and after that we have to page the nursing supervisor to get meds, or if she's unavailable, we have to get the meds from another floor... takes a while to get to another floor, find a nurse to access their accudose machine, put the patient in, and dispense the drug.... not all floors have the same drugs, and each unit has a list of which drugs are kept on which units...

BTW, I work ER, we don't *plan* on sending all patients to floors at the same time, usually we get all our room assignments at the same time, and all our patients have been holding till we got those room numbers... It just happens that way, and where I work, we usually don't even know we've sent more than one patient to the same floor unless we run into another one of our guerneys while we're up there! In fact, that just happened last night... I overheard a nurse complaining on the floor that we had just brought them 3 patients...this was a nurse that I've always gotten along with, so I mentioned that I didn't even know we had brought the other 2, but don't worry, we also had 3 more ambulances coming in, plus our waiting room was full. Sometimes I wish the ER was able to hang out the "full" sign...LOL

Okay, sorry, I'll step off my soapbox now, hit a nerve....

RNed · Dec 20, 2001

As a 400 bed hospital I would hope that more coverage was available for the patients. Suggestions:

Contact the State Nursing Board

Contact the State Pharmacy Board

asking for clarification of rules, etc. Although, I do not suspect action on either part, it serves as notification and documentation of concerns.

If you have a nursing union, contact them and attempt to set some type of documentation system recording, frequency, problems, risk, etc.

Do the same if pharmacists are within a union. Establish a liason between nursing union representation and Pharmacy union representation.

Here is what you are looking for. If the hospital knows you are collecting information, they desperately want to know what, why and how. This is a trigger for the hospital to become involved. Executives can not stand to know someone is collecting information about them and they be outside that loop with little or no control on how that information is used, dispersed or analysed. They unwittingly become part of the project and unwittingly provide information you previously did not possess. In the final analysis, if you identify and establish a valid problem, risk or concern, you must find the manager that needs a goal for the year end bonus. If you find out what the Hospital's Strategic Plan is for the year, you may find that one manager that is needing to meet a Strategic goal.

Write to JCAHO your concerns, again this may not trigger immediate action, however, it may trigger a closer review of Pharmacy services in their next certification process. Understand these people talk. It would not surprise me that a call was made regarding the possiblity of an indebt review of pharmacy services occurring on the next JCAHO visit. This could be the impetus to do something now rather than later.

And finally, I suspect a Pharmacist is on call. Uitlize that system to its fullest. When the hospital identifies call expenses excedes a FTE expense, they will be motivated to change.

Just some suggestions, as requested.

hapeewendy · Dec 20, 2001

woah sorry my post hit a nerve

I wasnt attempting to imply that the emerg nurses were the ones sending everyone up at the same time

at our hospital it is admitting that is in charge of sending patients up, and they tend to do it just before change of shifts to free up space in the busy ER.

I have been in emerg and I know that the nurses there are busy, what I was saying was that as a floor/unit nurse it is hard to hunt down meds for

say 3 new admissions when some of the meds are in the night cart , some are not , some have to be obtained from ICU/CCU etc....

one of my best friends in the hospital is an emerg nurse and often times she complains that she gets swamped with patients because all her beds have been "free'd up" by admitting..

so sorry if you misunderstood

I figured that all the hospitals worked thru an admitting/pt services type operation, I didnt know that nurses in some hospitals were in charge of sending up the patients and to which floors etc...