"I need my Lipitor!"

[1fastRN]

Rant time!

Patient is an admitted hold in the ED. In the ED, we obviously just treat emergent things which often don't include dispensing the patients regular meds. If they're still an active ED patient I'll often just tell the MD "hey pt X wants to take his regular meds, lipitor and plavix. Is it ok if we order it?" No problem there, most MDs don't care provided the pt isn't NPO."

But we sometimes hold patients in our ED for quite a while. It's up to the admitting doctor to order their home meds. Now it's 3am, and the patient is livid he didn't get his regular meds last night. I'm sure the admitting doctor would love to be woken up so I can ask for an order for lipitor... I get it, patient's have a routine that they're used to. But you'll live without the lipitor for a few hours, trust me. Pain meds and other meds may be important and worth a 3am call.

What the heck do you guys usually say to these patients to address their concerns? If they were just recently admitted I'll usually just ask the ED MD for an order to make the patient happy, but when it's hours later and the ED MD is no longer involved it can be challenging. Do you usually just tell them it can wait until morning so you don't have to make that dreaded call?

[Anna Flaxis, BSN, RN]

We don't hold them long enough to have an issue most of the time (thank goodness). Usually what I tell them is that in the Emergency Department, we only stock drugs related to emergency situations, and that they will have to wait until they get to the floor to get their regular, non-critical meds like Lipitor. I offer sympathy for their plight, but tell them my hands are tied. I might even add that I've faxed their medication orders over to the floor to give the nurses there a heads up, but that there are processes that they need to go through, so don't expect the meds to appear the moment they arrive on the floor. In the meantime, I offer another warm blanket and food. Warm blankets and food fix everything.

[1fastRN]

We don't stock them but pharmacy can bring them to us. Unfortunately the hospital is packed so we are holding patients like crazy... like 60 at a time.

And amen on the food and blankets thing. A snack can turn a patient completely around!

[Anna Flaxis, BSN, RN]

Yeah, the pharmacy can bring them to us, too, or if the pharmacy is closed, the house supervisor can. But typically they're not in our ED long enough for me to offer that option, like I said, unless it's a critical med, something they really shouldn't skip or be late on.

[Gabby-RN]

We hold admitted patients in the ED for long periods of time (12-18 hours!) very often. Just yesterday we were holding 48 admitted patients at 7am. The admitting doctors do the initial assessment in the ED soon after picking the patient up and put all of their orders in. We have to med request the meds we don't have from the pharmacy.

[1fastRN]

We hold admitted patients in the ED for long periods of time (12-18 hours!) very often. Just yesterday we were holding 48 admitted patients at 7am. The admitting doctors do the initial assessment in the ED soon after picking the patient up and put all of their orders in. We have to med request the meds we don't have from the pharmacy.

Ah, see that's the problem.... the admitting doctor can take quite a while to see the patient, so there's a lag in getting full orders.

12-18 hours is nothing, we've lately had some people sitting for DAYS! We've had the same issues, the other morning I left with 60 admitted patients and about 15 active ER patients. Our lives would be so much easier if it wasn't for the holds... and the patients would be happier!

[Gabby-RN]

Days?!? That is horrible. Hopefully not the norm. Patients would be so much happier if we could move them along quicker. The ED is not equipped to care for admitted patients for extended periods of time.

[Mn nurse 22]

I work in LTC and we send most of our patients to a small rural ER. I usually will send inhalers, eye drops and a dose of a medication like Sinemet along with a copy of MAR for dosing times. When I call and give report to ER nurse I let them know when meds are due but also understand if they don't get them, just trying to make things easy and save on resources, why should they open a $200 inhaler for 2 doses?

[ChristineN, BSN, RN]

I work in LTC and we send most of our patients to a small rural ER. I usually will send inhalers eye drops and a dose of a medication like Sinemet along with a copy of MAR for dosing times. When I call and give report to ER nurse I let them know when meds are due but also understand if they don't get them, just trying to make things easy and save on resources, why should they open a $200 inhaler for 2 doses?[/quote']

Wow that actually sounds super helpful! As an ER nurse I would love it if all Pt's came in with meds from home/ltc.

[1fastRN]

I work in LTC and we send most of our patients to a small rural ER. I usually will send inhalers, eye drops and a dose of a medication like Sinemet along with a copy of MAR for dosing times. When I call and give report to ER nurse I let them know when meds are due but also understand if they don't get them, just trying to make things easy and save on resources, why should they open a $200 inhaler for 2 doses?

Please send them in with a new 20 gauge, a rainbow of labs, and a urine sample. Thank you!

Haha, that's pretty cool of you though... cheers!

[ADeks]

We've been having the same problem. Though the admitting MD is supposed to put orders in within a certain amount of time. If there is anything more pressing like their BP is high and they usually take nightly BP meds, I'll try and get the ED doc to write up a dose. All else fails call the admitting doc!

Initially, I tell patients that when the MD puts the orders in we or the floor will either catch them up that night or they will skip a dose and restart in the AM. They usually understand.

[toomuchbaloney]

Ask their family to bring the home meds if they are going to be held.

If there is no family explain that the Lipitor is not critical and move on.

Be kind, be compassionate, be firm.