Omnicare Pharmacy-discuss

[ktwlpn]

In my experience we have a big problem getting meds delivered in a timely fashion.You all know that if we don't have a med available (even if it is something as simple as a multivit) the DOH wants us to document and make every reasonable effort to obtain the med. We have to inform the doc if a med is missed,fill out a pharmacy occurrence report yada yada yada....And we are prohibited from "borrowing" a med from another resident. What happens to us frequently is we'll fax labels well before the cut off time for same day delivery but then 2 days later get a written notice that the fax was illegible...HELLO? 2 days later? You are now probably out of some meds.Shouldn't someone be picking up the phone each and every time a fax is received that transmitted poorly and notify the sender? Then there are the times we get a notice stating "our records show this order was d/c'd on this date " and we look in the chart and no order was written on or around the date they cite. ow does that happen? Or-we don't receive a med that we have called them several times for-then we end up with NINE BOXES of the med....Then other times we can not get a refill because "our records show this med was ordered too soon" How does THAT happen? I remeber working in a facilty years ago in which pharmacy staff came in on a monthly basis and switched out the med carts-we were not responsible for routinely ordering refills.That system worked out well-I don't remeber ever having these problems.Omnicare is almost self serve-we have to peel and stick re-order labels on a sheet to fax...On top of our mega med pass....whoopee...

[debRN0417]

I am not sure about other states but in Virginia you cannot borrow medications;

Federal Regulation : F492- following state and local laws----and 12VAC5-371-300 Pharmaceutical Services: A. Provision shall be made for the procurement, storage, dispensing, and accounting of drugs and other pharmacy products... B. The Nursing facility shall comply with the Virginia Board of Pharmacy regulations related to pharmacy services in long term care facilities (see part XII 18VAC110-20-530).. 18VAC110-20-530: 3. Ensure that the drugs for each patient are kept and stored in the originally received containers and that the medication of one patient shall not be transferred to another patient...

Also if it is a narcotic there are regulations under the Controlled Substances act and pharmacy regarding the "borrowing of these medications" it could be considered drug diversion....

[SuesquatchRN, BSN, RN]

No one can legally borrow medications. Everyone does if they want their patients properly cared for. Except narcs, and we had a lock box for those.

As Achot Chavi said, the nurse on days on Thursday was expected to make sure everything was ordered, and on Firday make sure it was in.

[achot chavi]

So if you dont want to borrow (cause its illegal) and dont have the medication (cause it wasnt ordered) - I guess you have to call the doc to report this and possibly send the pt to the ER.

Good Luck

[debRN0417]

We've all done it...just saying we are not supposed to and if its found out...well enuf said....

[achot chavi]

Yesterday I got a call from a nurse- the day staff didnt order Tribemin and the patient would raise hell- the patient is blind and deaf (honestly not facetious) so I told them to give a similar round multivitamin instead so he wont notice and I had to report it to the doc who said "Why are you bothering me for"...

[morte, LPN, LVN]

The chain is in 47 or 48 states.I've seen stories on CNN about them and medicare fraud.We are a county run facility and we had to go with the lowest bidder.The DON is hoping to get rid of them when the current contract is up but with the state the economy is in we doubt she'll be successful. Just recently they changed the labels.I'm good with that-they have high lighted the pertinent info,the name of the med is larger.However when the first boxes came through they had put the labels on in-correctly.Instead of starting to apply them from the top and going around the side they started applying them from the side first which meant when you looked down into the drawer at the top of the box you saw nothing that told you anything about the box of meds.Talk about stooopid! The names of the med,the resident and the RX number were all on the side of the box and the boxes open on the top..Guess what our DON said when I took a box to the office? "Good-this will make some of your co-workers actually read the label" Talk about insulting....Anyway-coincidentally our pharmacy consultant came in later that day-I showed him the problem and it was fixed by the next day.

it has to be the lowest bidder that will PROVIDE THE CONTRACTED SERVICE....document that they are not doing that...

[CapeCodMermaid, RN]

Most pharmacies that have many nursing homes as clients are huge entities and they are getting bigger. Pharmerica always was fantastic until they merged with Kindred pharmacy. Add this to the fact that my facility isn't near anything (unless you count the Atlantic Ocean). We were always having to call and call and call again to get meds. I've solved some of the problem by ordering a gigantic E-Kit. It has almost every drug we'd ever use.

Borrowing is not allowed and if we sent a resident to the ER...close to 90 minutes away for missing ONE medication, we'd never hear the end of it. I know it's a huge problem, but let's face it. Most of these people take way too many medications as it is. Call the doc and let him know the med was not given.

[ktwlpn, LPN]

The DOH dinged us for not having meds during a survey a few years ago so we had to write a new P and P-if we circle a med on the MAR and document "not available" we have to call the doc,call the s/o right an order that is is ok to "hold" the med until it's available,notify the pharmacy and complete a 3 page incident report....See the pickle we are in? Sure-many of these residents have a pill,potion,lotion,nostrum,drop or spray for every complaint and orifice but the DOH says we have to provide them-we can't miss even a multi vit...So basically what most of us do is illegally borrow meds from another resident and then try to remember to replace them. We have gigantic e boxes stuffed full now-they would have to be the size of a coffin to hold all of our common meds.It's just all such a pain in the booty...

[achot chavi]

. I've solved some of the problem by ordering a gigantic E-Kit. It has almost every drug we'd ever use.

WHAT A GOOD IDEA!

Borrowing is not allowed and if we sent a resident to the ER...close to 90 minutes away for missing ONE medication, we'd never hear the end of it. I know it's a huge problem, but let's face it. Most of these people take way too many medications as it is. Call the doc and let him know the med was not given.

Makes me glad that borrowing IS allowed at my facility as long as we fill out a form explaining it and return it within 1 or 2 business days. With new admits esp those who come on friday afternoon...a problem in itself... we ask the family to bring with them 3 days of meds. sometimes they dont have so we have the doc order the med to begin on Sunday (Saturday is our day of rest) so we are covered.

Regarding polypharm syndrome- YOU ARE SO RIGHT!! but some meds are essential (like synthroid or sinemet or antibiotics..) By law the nurse and doctor have to go over the patients med list every MONTH (pain in the neck) and reevaluate continued need. Its just too easy for a doc to keep a long term med on the list so the nurses job is to challenge him and together see what can be D/C'd safely. Its a great system. It works because the nurse is on board to follow up and eval any changes in status and report. Certain meds need the ok from a specialist who has to eval once a year.

When I worked in NY, we instituted a drug holiday on Saturdays- only the bare essentials (like synthroid, digoxin, etc) and it was very successful. BP's were monitored and stable, BM's moved without the Colace, etc.

True story: once in the hospital, (i was private dutying a relative) on friday evening doc ordered a med that was unavailable, nurse called the doc who just hung up on her, I told her to call his supervisor to report the problem with the unavailable drug and she was scared- she ended up just signing for it even though she didn't have it. I told her it was wrong, she answered, "You dont understand hospital politics!!" Glad to be in LTC!

[CoffeeRTC, BSN, RN]

Kwlpn...we have the same issues and have the same type of p and p. We don't have a huge E Box tho. We had major issues with narcs and finally got a bigger supply in the E box for them. Everyone was on vicodin, but up until a few months ago..none in the E box. They weren't replacing the meds either. Now we get it changed 3 times a week.

The biggest issue is delivery time. Even STATs are 4 hrs or more. I think a big problem is communication with the nursing home too. If something isn't coming on the next run or they are out of stock, we should be notified ASAP with a phone call so that we can call the doc for a new order.

You get an admission at 7pm or so and fax the orders by that time (and I call them) I might not get the meds until noon the next day. Having a larger supply in our E box might help that one.

[achot chavi]

Michelle. why cant your ask new admits to bring with them 2 days of pills? Ask your SW.

[nrsstephanie]

Omnicare . . . . AKA Omnivore because they ate up all the little mom and pop pharmacies that truly knew what customer service meant!!! They have by far the WORST customer service of any company I have ever worked with!