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?
The issues with continuing a 1700 administration are that you are going to be in off hours when trying to calculate the trough and waiting til the next day for the pharmacy to do the levels. A 10 am administration means that they have most of the day to figure out the pharmokinetics.
I've been so spoiled working in a place with fabulous pharmacy coverage at night. It's one of the few departments that actually seems to accomplish things at night. Peaks and troughs are no problem any time of day. But I remember back at my old job, 10am would be better for doing P and Ts.
I called the nurse manager of the unit where I'm working and explained the issue, seeking clarification on the hospital policy on this. I explained what my original concern was, and also shared the feedback I got from David here. I told her that I had considered this a 'near miss' incident, but that I after the imput from him I wasn't certain if that was the case.
She was going to bring it up at a medication policy meeting she was going to today. She did affirm that there have been issues with some pharmacists who are lacking in areas of collaberative cooperation with nursing.
So, I'm glad I started this thread and thank you all for your feedback.
She did affirm that there have been issues with some pharmacists who are lacking in areas of collaberative cooperation with nursing.
From the impression i got from the quotes of the pharmacist, i really dont think she was coming from the same point of view as core0. Her responses implied changing the time was for "the convenience of nursing" and that "whatever you want will be fine", and in the end, changed the time. Quite different and much closer to lacking collaborative cooperation in my opinion!
From the impression i got from the quotes of the pharmacist, i really dont think she was coming from the same point of view as core0. Her responses implied changing the time was for "the convenience of nursing" and that "whatever you want will be fine", and in the end, changed the time. Quite different and much closer to lacking collaborative cooperation in my opinion!
Since I was the one who actually spoke to her, I can say that her attitude was more one of 'I'm busy, I don't really care, I was told to just time everything at 1000, but if you insist I'll change the time to humor you'. She gave no explanation as to the rationale as to why she didn't care at all.
I'll just say here that at my regular hospital, pharmacy is far more interactive and informative when I call them with questions or concerns.
Since I was the one who actually spoke to her, I can say that her attitude was more one of 'I'm busy, I don't really care, I was told to just time everything at 1000, but if you insist I'll change the time to humor you'. She gave no explanation as to the rationale as to why she didn't care at all.
I'll just say here that at my regular hospital, pharmacy is far more interactive and informative when I call them with questions or concerns.
One of my pet peeves is that we have our specialty transplant pharmacists who are absolutely essential and incredibly knowledgeable and then we have a small minority of other pharmacists who are neither. You get used to the superstars and its really hard to deal with those who are less than stellar. I've found that taking time to educate someone is never going to hurt you, but unfortunately this is far from the norm. Unfortunately you can't make people care.
Yes, but a "good nurse" does not always have time to do these things. In a perfect world yes, but I know I don't always have time to look over every MAR before giving meds.
wooh, BSN, RN
1 Article; 4,383 Posts
I've been so spoiled working in a place with fabulous pharmacy coverage at night. It's one of the few departments that actually seems to accomplish things at night. Peaks and troughs are no problem any time of day. But I remember back at my old job, 10am would be better for doing P and Ts.