Pharmacist said "I don't care" regarding Vancomycin dose time.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

I've been working a nursing contract for almost 3 months at a hospital over an hour from my home. This weekend I had a MRSA pt restarted on Vanco q 24, he didn't get the first dose until 1700. The next day, the Vanco was timed for 1000.

Now, this patient had multiple problems, including renal insufficiency. I called and asked to speak to one of the pharmacists. I asked her, wouldn't she like to reschedule when that Vanco was scheduled, because if she looked at the CareT computer med charting from yesterday she'd see that I gave the Vanco at 1700. As you all know, Vanco is nephro and oto toxic and must be given on time, as ordered, to avoid too high of levels.

She responded that she had been told that q day dosing should be at 10 AM for the convenience of nursing. 'Hello! What kind of pharmacist are you?' I thought. I responded by mentioning that this was Vancomycin we were talking about here, and shouldn't we have the next dose 24 hours after the previous one? She impatiently responded "I don't care when it's scheduled, whatever you want will be fine". She repeated the line "I don't care" more than once in our conversation, although she did agree to rescheduled the Vanco to 1700.

Frankly, this seems to me to be an utter dereliction of duty on the part of the pharmacist. This wasn't a pharmacy tech I was speaking to but a pharmacist. Pharmacists are supposed to be the first guardians at the gate of med administration. At my usual hospital the pharmacists are very meticulous about timing medications based on when they were started. I'm talking about medications were the dosing interval is imperative, such as Vanco.

This hospital where I'm doing this contract is extremely busy and I've seen many things fall through the cracks, but this incident seemed like blatant disregard for professional standards. What do you think?

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Well, IMHO, you just have to forget her and do what you know is right. Does she have authority over when it is scheduled?

I would think the nurses could reschedule something like that the way it should be, without the pharmacist's permission, can't you?

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I've been working a nursing contract for almost 3 months at a hospital over an hour from my home. This weekend I had a MRSA pt restarted on Vanco q 24, he didn't get the first dose until 1700. The next day, the Vanco was timed for 1000.

Now, this patient had multiple problems, including renal insufficiency. I called and asked to speak to one of the pharmacists. I asked her, wouldn't she like to reschedule when that Vanco was scheduled, because if she looked at the CareT computer med charting from yesterday she'd see that I gave the Vanco at 1700. As you all know, Vanco is nephro and oto toxic and must be given on time, as ordered, to avoid too high of levels.

She responded that she had been told that q day dosing should be at 10 AM for the convenience of nursing. 'Hello! What kind of pharmacist are you?' I thought. I responded by mentioning that this was Vancomycin we were talking about here, and shouldn't we have the next dose 24 hours after the previous one? She impatiently responded "I don't care when it's scheduled, whatever you want will be fine". She repeated the line "I don't care" more than once in our conversation, although she did agree to rescheduled the Vanco to 1700.

Frankly, this seems to me to be an utter dereliction of duty on the part of the pharmacist. This wasn't a pharmacy tech I was speaking to but a pharmacist. Pharmacists are supposed to be the first guardians at the gate of med administration. At my usual hospital the pharmacists are very meticulous about timing medications based on when they were started. I'm talking about medications were the dosing interval is imperative, such as Vanco.

This hospital where I'm doing this contract is extremely busy and I've seen many things fall through the cracks, but this incident seemed like blatant disregard for professional standards. What do you think?

I think you misinterpreted the Pharmacist.

I think what she was saying that 'she didn't care' because she doesn't care when it's scheduled...she just needs to know when to prepare and send it.

If you went on extensively during the conversation about the change of the time it was given, etc....I can understand where someone would get impatient and say something like that...what she was trying to say, "and poorly" is she doesn't care who-did-what...just tell her when you need to give it and she would fix it.

It would be different if she refused to change the time.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

My point is that this pharmacist did not care whether we left the time at 1000 or changed it to 1700. She said either way was okay with her.

Sorry, but that is unacceptable. Pharmacy has a responsiblity to make sure that patients don't receive toxic doses of Vanco, and they should be the ones making sure the dosing schedule is at the proper time. Nursing is a back up on this, but the primary responsiblity is with the pharmacist, and they definately should care that it is done. They are highly educated individuals with a code of ethics that demands this.

If a different nurse had been on yesterday the patient would have gotten their Vanco too early. It's pharmacy responsiblity to check when the first dose was given and then schedule accordingly.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.
Well, IMHO, you just have to forget her and do what you know is right. Does she have authority over when it is scheduled?

I would think the nurses could reschedule something like that the way it should be, without the pharmacist's permission, can't you?

At this hospital there is an electronic medical administration system that is highly pharmacy dependant, with a hand held scanning device that prompts you to give meds when scheduled. It's a ridiculous system spurred by Joint Commision regulations and demands.

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My point is that this pharmacist did not care whether we left the time at 1000 or changed it to 1700. She said either way was okay with her.

Sorry, but that is unacceptable. Pharmacy has a responsiblity to make sure that patients don't receive toxic doses of Vanco, and they should be the ones making sure the dosing schedule is at the proper time. Nursing is a back up on this, but the primary responsiblity is with the pharmacist, and they definately should care that it is done. They are highly educated individuals with a code of ethics that demands this.

If a different nurse had been on yesterday the patient would have gotten their Vanco too early. It's pharmacy responsiblity to check when the first dose was given and then schedule accordingly.

Ok...educate me here.

I can't imagine the pharmacist being responsbile for WHEN medication is being given.

Are you sure it's not a timeline informing them of when a med is supposed to be prepared and ready? Could that be why she wouldn't change the time, because on any given day, if it's prepared at 1000 it's prepared early and it would be up to the RN/LPN to check when the actual medication is being given?

Obviously this wouldn't work with meds that have to be given within a certain time or it has to be wasted.

I just want to make sure that I understand the situation and we are both on the same page.

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Specializes in ER, ICU, Infusion, peds, informatics.
ok...educate me here.

i can't imagine the pharmacist being responsbile for when medication is being given.

are you sure it's not a timeline informing them of when a med is supposed to be prepared and ready? could that be why she wouldn't change the time, because on any given day, if it's prepared at 1000 it's prepared early and it would be up to the rn/lpn to check when the actual medication is being given?

obviously this wouldn't work with meds that have to be given within a certain time or it has to be wasted.

i just want to make sure that i understand the situation and we are both on the same page.

i think what she is trying to say is that with vanc, the pharmacist should care about what time the vanc is/was given.

the administration time of vanc isn't arbitrary.

in fact (esp in a patient with renal failure), the pharmacist should have noticed that the vanc was given at 1700 the previous day, and either adjusted the med record in the computer, or called the nurse and let the nurse know that the vanc shouldn't be given at 1000 as the "standard" time, but given 24 hrs later, instead.

(ideally, the pharmacist would do both -- adjust the time in the computer, after collaborating with the nurse regarding the reason.)

that is supposed to be the pharmacist's job -- they really are there as a knowledge base, more than someone that fills rx's all day, signs off on the tech's work, and practically blindly hits the "override" button each time the computer system flags them with a "drug interaction."

pharmacists are a wonderful resource; unfortunately, they are often as understaffed as nursing.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

For the uninitiated here, let me explain.

When the MD decides to order a med, such as Vancomycin, he/she writes an order. This order is then processed by the unit secretary. The pharmacy then receives a copy of the order. In the case of Vancomycin, often the physician will leave the dosing to the pharmacist who will look at the patient's weight and also creatine clearance which assesses kidney function.

The pharmacist then processes the order and the pharmacy techs prepare the medication, which is then delivered to the unit for administration.

The time that this process takes is highly variable. The nurse then gives the medication and then charts when it was given, either on an electronic or hard copy medical administration record (MAR). The pharmacists receive these MAR at the end of 24 hours.

The pharmacists then have the responsiblity to review the MAR to see when the first dose of the Vanco was given, and then to schedule it accordingly. Also, pharmacists are responsible to order routine Vanco troughs and review them, then adjust the doses. Pharmacists also keep track of the patient's kidney function lab values.

So, for a pharmacist to act like she is indifferent when a nurse brings to her attention that the Vanco schedule is incorrect show me that there is something seriously wrong here. There is also a system error with the pharmacy at this hospital where this pharmacy responsiblity is not being fulfilled.

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Specializes in Telemetry.
Well, IMHO, you just have to forget her and do what you know is right. Does she have authority over when it is scheduled?

I would think the nurses could reschedule something like that the way it should be, without the pharmacist's permission, can't you?

That's exactly what i was thinking. Cross off the 1000 and replace with 1700. We do it all of the time where i work. There was no need to call the pharmacist.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.
That's exactly what i was thinking. Cross off the 1000 and replace with 1700. We do it all of the time where i work. There was no need to call the pharmacist.

As I mentioned above, this hospital has an electronic medication administration system.

Also, I want to point out that it was merely a stroke of good luck for the patient that I was the nurse both days. If the patient was new to me, I would not have a clue when the Vanco was given the previous day, nor the time to investigate that.

The primary responsiblity for the timing of meds is the pharmacist. The night nurse doing the chart checks at night would be a secondary safeguard.

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Specializes in Cardiac Telemetry, ED.

Also, I want to point out that it was merely a stroke of good luck for the patient that I was the nurse both days. If the patient was new to me, I would not have a clue when the Vanco was given the previous day, nor the time to investigate that.

That was my first thought. Scary!

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Specializes in Med Surg, LTC, Home Health.
Ok...educate me here. I can't imagine the pharmacist being responsbile for WHEN medication is being given.

Well in fact they are. When we fax an order to the pharmacy, they actually put it into the computer where it will then show up on our MAR (on a computer screen). We could then not give the med at 1000 and give it at 1700 on that second day, but it will be perceived as a med error to the computer system and produce the corresponding red flags. The major point is if the same nurse is not back the next day, then the med will be given at the wrong time, and the new nurse will know nothing about the error. Thus the time of administration falls in the hands of the pharmacist!

That's exactly what i was thinking. Cross off the 1000 and replace with 1700. We do it all of the time where i work. There was no need to call the pharmacist.

With a MAR on the computer, you cant simply mark out the time, which is not a correct method in the first place. It isnt legal to mark through times and write in your own on a computer generated MAR. The correct way would be to D/C the drug for the prescribed time and reorder it for the new one. If the MAR is wrong, then you must rewrite the order into a new blank and mark the old one out. Nurses do this wrong all the time. :twocents:

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