"Borrowing" one patient's med for another.

[Katie5]

This does not sit too well with me. But it happens all the time. I'm wondering when it comes to documentation, what then do they write?You, "borrowed" from this patient? Or if not, then where did it fall out from.

[NurseLoveJoy88, ASN, RN]

I'm guilty !!!! I hate to practice like this, however when my resident has a fever or in pain I do borroe tylenol , its better than waiting for pharmacy to deliver.

[Plagueis]

But back in the day, I worked at a sub-acute Rehab. Most admissions came in the evening and coumadin orders were often written pretty late. Pharmacy would send the current night's dose and no more and there were nights that Pharmacy left early. We took to hiding any extra doses of coumadin we came across, like if a dose was changed after INR results or if we had a split tab left over. We got very creative where the coumadin was hidden. Pharmacy was scandalized and every so often we would come in in the evening and discover that they had found our "stash" and raided it. I remember for a while we hid the coumadin stash in a plastic bag taped on the back of a picture frame. But our patients did get the right dose of their coumadin in a timely manner because of our sneakiness.

Forgive me if I sound dumb, but why did you have to hide the coumadin that wasn't used after new INR results came in? I've had residents whose coumadin dose changed weekly (say, from 5 mg daily to 4 mg daily), but the older pills were still kept in the med cart, and, as far as I know, the facility has never gotten in trouble for that. No nurse has ever told me that it was policy to immediately get rid of a med that was discontinued, so is that some kind of rule?

[NurseKatie08, MSN]

I work in sub-acute rehab with an offsite pharmacy (not as far away as the Commuter's pharmacy, but far enough to be a nuisiance...turnaround time for "stat" med orders is 4 hours...which they hardly ever come that fast) Since I work evening shift, I am forever borrowing medications. We have sev'l emergency kits---a large PO med e-kit (has everything ranging from Lisinopril to Trazodone), an antibiotic kit (common PO abx as well as a couple injectable) a coumadin e-kit, respiratory e-kit, IV e-kit (iv start kits, fluids, flushes, etc.) narcotic e-kit (which doesn't have dilaudid...a nuisance because lots of our subacute pts are on it) injectable e-kit (has benadryl, lasix, heparin, glucagon, lovenox among other things.) and a refrigerator e kit (has a couple vials of insulin--i think regular, lantus, nph & 70/30, not always a ton of help since we get many many people on humalog or novolog sliding scales.) Despite all these resources, borrowing meds still happens, and there have still been times that we're not able to track down a med for a patient despite all the searching through e-kits and borrowing. What I wouldn't give for an on site pharmacy.

[rachelgeorgina]

I'm from Australia and we don't have (from what I've read) the same pharmacy system as in the US. Some wards keep patient's meds in the top bedside draw but more commonly the meds come out of a common cart or drug room. In one particular, stand alone psych facility with no pharmacy on site, I've seen meds borrowed between floors late at night when one floor needed something.

[loriangel14, RN]

This brought a smile to my face. Where I work now it's pretty hard to do and not generally necessary; if we get a new order we need right away we can often enter an "override" order in the med Pyxis or call the 24 hour Pharmacy to remotely reprogram the Pyxis so we can access the appropriate med drawer.

But back in the day, I worked at a sub-acute Rehab. Most admissions came in the evening and coumadin orders were often written pretty late. Pharmacy would send the current night's dose and no more and there were nights that Pharmacy left early. We took to hiding any extra doses of coumadin we came across, like if a dose was changed after INR results or if we had a split tab left over. We got very creative where the coumadin was hidden. Pharmacy was scandalized and every so often we would come in in the evening and discover that they had found our "stash" and raided it. I remember for a while we hid the coumadin stash in a plastic bag taped on the back of a picture frame. But our patients did get the right dose of their coumadin in a timely manner because of our sneakiness.

Your post made me laugh. We have a stash where I work as well but it contains Imovane. Heaven forbid we have a pt on the bell all night because we didn't have his sleeping pill. Our meds take a day to come(our pharmacy is at the bigger hospital in the next town) so we have to be creative.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

I have a big problem with this... We technically aren't allowed to do this, b/c it is playing the role of a pharmacist. However, we don't have a pharmacist on evenings, nights, weekends, or holidays at either hospital I work. Once place it generally isn't a problem if it is a routine med, since we have a large pyxis with a lot of available meds that can be accessed once the order is put in the computer... But the other place is a small pyxis and pharmacy has to put the new orders in. so a lot of the time we can't access what is ordered. We end up borrowing from other patients and putting a note in the pharmacy box so the appropriate patient can be charged for the med. I know this sets us up for liability and I hate it.

[tencat]

I was wondering about 'borrowing', how common it is, etc. I suppose legally it's a nightmare and shouldn't happen. However, what choice have you got if you can't get something from a pharmacy until tomorrow and you need it NOW, what else can you do????