Obtaining ekits or an emergency 3 day supply of meds

Hospice Nurse LPN, BSN, RN · Sep 1, 2011

We haven't had that issue w/ our pharmacy, yet. I'm sure it will happen soon, though. Seems like the government is saying, "lets pile on more regulations and red tape on hospice while cutting the reimbursement again". Thanks for the head up and good luck.

goldberryRN · Sep 1, 2011

We don't have ekits at all, and getting medication after hours is becoming a big problem.

Hospice Nurse LPN, BSN, RN · Sep 1, 2011

We don't have ekits at all, and getting medication after hours is becoming a big problem.

May I ask why y'all don't use e-kits?

goldberryRN · Sep 1, 2011

I don't know the answer yet but I'm new to hospice. I don't know if our hospice has never had them or it they had them and stopped. We're in a relatively poor, rural area with big meth problems, maybe that has something to do with it?

AtlantaRN, RN · Sep 1, 2011

eKITS kits are the only way i can successfully do my on call job imho.

it never fails, a patient has never been nauseated, you KNOW it will happen at 2am on sunday morning.

my philosophy is "better to have it and not need it, than need it and not have it." the cost is $37 for 30ml of roxanol 20mg/ml, 3 compazine 10mg po, 3 25mg compazine suppositories, 2 dulcolax 10mg suppositories, 3 tylenol 650mg suppositories, 6 haldol 1mg tablets, 6 ativan 1mg tablets. it is worth the cost if it keeps the patient out of distress and out of the emergency room. ekits can be tweaked for the specific illness, seizure kits have valium and a seizure med i can't recall and cardiac has nitroglycerin 0.4mg sl.

goldberryRN · Sep 1, 2011

your ekits sound wonderful. wish we had something like that. i'll have to find out why we don't.

AtlantaRN, RN · Sep 2, 2011

goldberryRN, sometimes branch directors will encourage nurses to only order what you need, when the symptom arises......to me, yes it may be cheaper for the bean counters, but in reality, if you are ordering the med WHEN the symptom arises, i feel that is a disservice to the patient. If a lung cancer patient isn't ordered morphine sulfate 20mg/ml UNTIL they are short of breath, then it takes HOURS to obtain. A family won't hesitate to call 911 and go to ER if we can't control symptoms, so in my position, I encourage ALL nurses to order an ekit for their patients on admission (unless there is extenuating circumstances, like a history of drug abuse in the family or patient).........

An ekit is like a "drug buffet," you don't open it until you need it, but it is there in the home. it comes in a box just a bit larger than a pack of cigarettes. It is a small quantity of several meds. Imho, it is a GODSEND.....

AtlantaRN, RN · Sep 2, 2011

goldberryRN, you may be able to order just 10ml of roxanol in individually drawn up syringes. that way you only have 200mg of morphine in the home instead of 500mg. On our ekit orders we write "#360ml dispensed in 30ml increments", that helps us in that we don't have to have another written and signed doctors order to refill when the patient gets low.

Hospice Nurse LPN, BSN, RN · Sep 2, 2011

Yes, the e-kits are a lifesaver! You are so right, Atlanta. If anything can go wrong it will be in the middle of the night.

rngolfer53 · Sep 4, 2011

We work with a local contracted pharmacy, and they state now they are no longer able to send ekits without a phone call from the physician. We have been really good at getting signed orders and faxing them to the pharmacy within the 3 day window, but NOW, they say "the DEA won't let us send without a call from the ordering physician" and a signed order within 24 hours....
How do you all handle getting your ekits or an emergency 3 day supply of meds? I miss my old job who used Hospice Pharmacia......

That happened over a year ago with our pharmacy. I moved to IPU shortly after, so I don't know the current practice.

All part of the wondrous govt crackdown on pain meds. Expect even tighter restrictions in the future.

WA state, for instance, has a new law that is driving physicians in droves out of pain management.

Count on the lawyers in capitols to make actually caring for Pts a royal PITA. :devil:

rngolfer53 · Sep 4, 2011

goldberryRN, sometimes branch directors will encourage nurses to only order what you need, when the symptom arises......to me, yes it may be cheaper for the bean counters, but in reality, if you are ordering the med WHEN the symptom arises, i feel that is a disservice to the patient. If a lung cancer patient isn't ordered morphine sulfate 20mg/ml UNTIL they are short of breath, then it takes HOURS to obtain. A family won't hesitate to call 911 and go to ER if we can't control symptoms, so in my position, I encourage ALL nurses to order an ekit for their patients on admission (unless there is extenuating circumstances, like a history of drug abuse in the family or patient).........
An ekit is like a "drug buffet," you don't open it until you need it, but it is there in the home. it comes in a box just a bit larger than a pack of cigarettes. It is a small quantity of several meds. Imho, it is a GODSEND.....

As you say, emergencies always happen when the pharmacies are closed, and there's usually a $50 or so "emergency" delivery charge for rousting a pharmacist and driver to get out meds that should have been in place.

When I was doing after hours call, having to wait for a drug delivery while the Pt suffers is intensely frustrating. It happened rarely, as we used e-kits routinely.