PHARMACY PROBLEMS?

Losingfaith · Mar 10, 2011

I work @ a very large hospital. @ least where I work, we have A LOT of missing night meds that required notes be sent, then a phone call and maybe another phone call. It's getting better, but I notice things are worse when we have a lot of admissions/a busy ER.

LegzRN · Mar 10, 2011

We had an epi shortage (among other drugs) at my old hospital. Nothing like having to mix your own epi during a code.

3dayRN · Mar 10, 2011

Missing meds. When I'm ready for my 2100 med pass and I notice meds are missing I call and am told someone will be up to fill pyxis. I end up being late with passing some meds so in comment box I put med was late because not available from pharmacy. Then pharmacist goes to supervisor and complains because nurses write in mar that med was late because med not available. If I did not write this then months down the road when I have my evaluation and I get lower percentage because of my late med pass I can show the reason. Also when I call about a missing med I am always asked did you look for it? Seriously, ummmm no I just wanted to call you for nothing. :confused:

Flo., BSN, RN · Mar 10, 2011

For the most part our pharmDs are great! The problem that I am most faced with regards order clarification. The pharmacy will call the nurse to ask her to call the doc to get an order clarified. I never understand this, they can take orders. Take out the middle man and call yourself. Thanks for trying to see our side.

Sun0408, ASN, RN · Mar 10, 2011

Yes we have a lot of missing meds and that is very frustrating to pass meds then have to go back and wake a pt to give a medication after many msg sent and phones calls..

The biggest thing that gets me, not sure if you can help but why have meds set at 1900, 2000, 2100 and then 2300.. Can't you up the time or back the time up by a few minutes to give as many at one time as possible.. Not really talking about ABX or meds that can't be given with others :) Pts really get frustrated at night having to be woken up every hour to give medications that could have been given with the last set... Oh and it is frustrating to us nurses too..

Many of our MD's could care less about the times as long as the pt gets the medication X number of times; again as long as it is not a time sensitive medication..

merlee · Mar 10, 2011

I have to agree about the timing of meds. Unless there are specific reasons to give something at a particular time, we should try to limit the number of times to 3 or 4/day.

Very very few pt. take meds 7 times a day at home. It's just not reasonable. Try harder to minimize this.

BabyLady, BSN, RN · Mar 10, 2011

Hi..I am a pharmacist and I would like to know,as a nurse, what problems you encounter with pharmacy/pharmacists. I would especially like to know if you have a lot of missing meds if you are a hospital nurse.

My biggest pet peeve with Pharmacy is drug substitutions, which I understand is within their scope of practice, without at least calling the nurse and letting them know the change is being made and it can lead to a drug error.

Example: ..and I'll admit here I forget some of the details...but I had an order for Lasix that this baby had been on for days..the hospital was out of Lasix...we were not informed...another medication was substituted and I verified the ml against the order and drew it up...THANK GOD I am very consistent about the 5 rights...because the pharmacy had substituted another medication (someone help me here..I cannot remember the name but distinctly remember the drug book said it was 10x stronger than Lasix)..which did not match the order. The containers were similar...small, amber.

So I set my syringe down...verified again that the physician's order did not match what pharmacy had...I had to look up the drug that pharmacy had substituted because I had never administered the drug...and that was when I realized that I had drew up a whopping dose of the new medication, and only a fractional amount was to be given.

Now, when I originally called Pharmacy...you know what they told me? "Oh yeah, it's just another form of Lasix"...it was only after I wanted to verify the strength of the drug and that I was giving a very, very small dose, that they said, "You are right, it is much stronger, so you would administer the smaller amount...what we have in the computer is correct."

Communication would have gone a long way...but then again, it is why we have the 5 rights in place and the wrong dose was not administered...but I picked up the vial in all confidence it was Lasix..only to discover, it was not.

Oh...and one more pet peeve...Stat means Stat. If we say we need something now, a Pharm Tech had better be sprinting to the unit. I once had to wait an hour for antibiotics on an infant that had a perforated bowel...time is of the essence and that hour was an eternity for that baby...we do not use that term lightly...and if I was the pharmacist...hell would come down on the nurse that did!

BabyLady, BSN, RN · Mar 10, 2011

For the most part our pharmDs are great! The problem that I am most faced with regards order clarification. The pharmacy will call the nurse to ask her to call the doc to get an order clarified. I never understand this, they can take orders. Take out the middle man and call yourself. Thanks for trying to see our side.

I actually can see why they do this...about 90% of the time, when a pharmacist calls me to clarify the order, it boils down to the way the physician wrote it and I usually know what the physician intended to order because they have already discussed it with me.

Our Neonatologists, allow us to write verbal orders for clarification on obvious things like route (ie. if a baby is NPO and a route was not entered, the only option is for IV administration as I have never had a case where the dose was entered incorrectly)...or if they TOLD me the frequency but did not write it down, they are ok with us writing this.

We do not write for dose...ever...if they don't write it down, we have to call them.

Sometimes it's because of handwriting issues...which we can fix.

Obviously, all of this would depend on the relationship you have with your physicians and residents...ours never throw us under the bus, however, we did have one resident that if we needed to wake her butt up, it got woke up because she was notorious for "forgetting" things that she did not write down personally, so for us, she lost that convenience priviledge.

Esme12, ASN, BSN, RN · Mar 10, 2011

As a supervisor who runs for missing meds......missing meds.

BluegrassRN · Mar 10, 2011

I work nights, so missing meds isn't as much of an issue. I do hear the day shift complain about that sometimes.

The "problems" I see with our pharmacy is inconsistency with certain practices. As previously mentioned, some pharmacists call the physician directly to clarify orders, and some call the nurse to ask her to call the doc to clarify. Luckily, our night pharmacists are pretty self motivated. They will call us to tell us they need an order clarification. They ask if we are planning on calling the doc for anything else, and if we are, we clarify it for them. If we aren't, or it's an issue where the pharmacist actually needs to discuss (not just clarify) the med, they will contact the doc directly. I have noticed, though, that if one of our regular night pharmacists are gone and a day shifter fills in, they expect the nurse to clarify all orders, even when it would be better for them to do so.

Another problem is that the day shift pharmacy techs get busy during the day and don't always pay attention to the pyxis numbers. Occasionally we'll have to request the pharmacist stock certain items or we have to go to another floor to get it. Not a big deal in an item that you wouldn't expect to have to stock; we don't give methadone that often, and if a patient comes in during the evening or night on large doses of it, we might very well need to be restocked before morning. I'm talking about items like flushes, normal saline, or 2mg morphine vials. Twice in the last two months we've run out of D50. That makes me cranky. We shouldn't ever run to the pyxis for that, only to find it empty.

Overall, our pharmacy rocks. They are fast, friendly, a great resource, and very VISIBLE during the shift. If a patient has a lot of questions about their meds, the pharmacist will make a huge attempt to come down and talk to them about it. They meet with every admitted patient to review their home meds upon admission. They never make me feel stupid for asking a question. They really are a wonderful resource, and I can't imagine what we would do without them. I find it hard to believe that, merely 8 years ago, my facility didn't even have a pharmacist on site after 10pm. Now, during the day, they have one assigned to each unit, and one for the entire hospital during the noc.

sevensonnets · Mar 10, 2011

As somebody already said, STAT means STAT, so the nurse should never have to call 10 times to beg for a med. Another huge issue at my hospital is TPN and ABX that just don't show up at the right time and when you call pharmacy they always say Well we sent it up. Then when another unit on the other end of the building 3 floors up calls and says they have your TPN pharmacy won't send the tech to get it. No, the tech is "busy" so the ICU nurse has to leave 2 ventilated patients to go get it. The tech who made the mistake should have to retrieve it and bring it to the correct unit. That's the responsible thing to do.