"Waiting on pharmacy?"

Specialties Geriatric

Published

I just graduated a few months ago and am a new lpn looking for work. Btw, just moved to Colorado. My question is what would you do and how would you document a med that isn't available for a resident/pt and pharmacy is closed? Hypothetically for ex: its 2300 on Saturday, pharmacy is closed and won't reopen until 0800 monday? (this may not be realistic but I just want to know how to handle if it was.)

I've read other posts about in LTC and borrowing but I want to know what the proper way to handle this would be. I've read that "med not available" can cite a facility. So i would prefer to chart "waiting on pharmacy"....but what if it would be almost a day and half to get that med?

I do not know which area I will be going in, ltc or more hospital setting. I did all my meds while in school in a hospital and paper charting, so the ltc area is a bit fuzzy to me. Any time saving tips would be useful too!

Thanks in advance!

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I work LTC and I have encountered this a few times. We have med aides, and normally they just borrow from another patient. This creates problems though, because then you have to borrow back since the original patient is now short. And of course you cannot borrow narcotics!

We do have an emergency drug box, with the major antibiotics and critical drugs. I dip into that usually once a shift (because of new antibiotic orders).

If a drug is truly not available, and nobody else is taking that drug and there is no way to borrow. I call back the doctor and explain the situation (which almost always irritates the doc!). Then I chart "Med XYZ dose# ordered. Medication not available. Pharmacy contacted. MD aware. No new orders"

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I agree that the pharmacy issue is a disaster. The delay in patient care is tremendous. There has to be an easier automated way of approval of medicaltion and its reasonable delivery.

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Specializes in Medical and general practice now LTC.

Moved to the Geriatric Nurses and LTC Nursing forum

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Specializes in LTC.

In most LTC's, they have contract with a pharmacy and while the pharmacy maybe be closed to the general public, they must be able to deliver to the LTC at all times. At my facility, we use 3 different local pharmacies plus the VA. The VA mails us their meds so if you need a med in a hurry, you would use the back-up pharmacy the family listed. We get are meds on the 4th every month for the whole month. However, there is a daily delivery at 7pm. Orders in by 5pm will be on that run. We have an after hours number to call and they will deliver it as well. I have even called pharmacists at home and told them what was needed. ( Its a very small town..) Like a previous poster mentioned, there is the EKIT to pull from also. We have a very strict rule about borrowing because alot of our residents (or their families) pay out of pocket for their meds. If you do not have a med, and you are not able to get it from the pharm in less than two hours or from the EKIT, then you can call the MD to either get a new med or order to hold current med until its available. Always Always update the MD who ordered the med and document document....

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Specializes in LTC, assisted living, med-surg, psych.

It is rarely, if ever, acceptable to delay the start of a medication beyond 24 hours. The "house" pharmacy will need to be called and they should satellite a weekend's worth of medication to the nursing facility through a local pharmacy, unless it's something nonessential like vitamins or other OTCs. Don't let them get away with saying "No"---they are contracted with a facility to provide certain services, and that includes expedited delivery of critical meds such as antibiotics and pain meds (if they are not in your E-kit).

Also, you should document all efforts to obtain the med on the back of the MAR or in the progress notes, along with the times you called and the name of the person(s) you spoke to in the process. This could save your license in the event that a family, resident, or physician ever tries to blame the facility staff for a poor outcome (that may or may not have resulted from delays in starting a medication). You should also enlist the assistance of your RCM or DON if you're not getting what you need---it's amazing how quickly a lot of folks will change their tune when they're confronted by someone with an important-sounding title.

What makes me cringe when I'm reviewing a MAR (I'm the DNS for an assisted living facility) is to see days' or weeks' worth of circled initials and "med not available" scrawled on the back of the page. Somebody should have followed up with the pharmacy within 24 hours, and if the matter was still unresolved beyond that, I should've gotten a phone call. I've talked to pharmacists from the comfort of my bed at eleven-thirty PM to try to get a med in for a resident......sometimes that's what it takes.

Oh, and for future reference, you may want to consider writing "med on order from pharmacy" on the back of the MAR along with your note about calling Susie from XYZ Pharmacy at 2335 on 11/24/10 and her promise to send the med out with the morning delivery. Nothing agitates a state surveyor more than rows of circled initials with "unavailable" charted on the back!

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When you first take an order from an MD at that time you can ask the MD if you can give the initial dose of a med. when you know the med. can be there to give. Then you can include that in the order for example, Tylenol 500 mg. po QD give initial dose on 1-1-11. Then you are covered.

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Specializes in Gerontology, Med surg, Home Health.

It's all semantics. Waiting on pharmacy or med not available mean the same thing...the resident missed a dose. Honestly, these people take SO many meds that usually missing one dose isn't crucial. Call the doc, tell him what's up, and go from there. And too bad if they get irate. You do what you have to do to cover yourself. We had a doc once who, if we found a med error, would actually write an order covering the error (as long as it wasn't serious and there was no patient harm.). I always found this to be the strangest thing, but he and the DNS were petrified to get tagged over a med error.

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Specializes in Professional Development Specialist.

In our facility we have to get an order from the doc to hold the med until it is available from pharmacy.

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Specializes in LTC, ER, ICU, Psych, Med-surg...etc....

One med not available in my opinion does not make a citation, however repeated availability issues indicate a problem somewhere. As other posters have said: Follow your facility policy...call pharmacy, ask them to deliver ASAP, call MD, document it. What else can you do? You don't have access to the medication, so it is not your fault. It only becomes a nursing problem if the medications are not reordered timely. If the facility gets cited over a med not available (if you have reordered and called), then the administration should be putting pressure on their pharmacy provider to make sure that the residents and nurses have the medications that are needed. If you as the nurse have done what you're supposed to do, then you have no worries...the pharmacy should be the worrier. Also make sure to check if you facility has STAT or emergency boxes available that contain frequietly prescribed medications that you can have access to for a one dose need. Also the timing of the medication is important. If its a "daily medication" then you can administer it anytime during the "day". If it is more than one time, the MD needs to decide what to do regarding administration when it becomes available. I have often seen orders that say "Hold (whatever drug is) until becomes available from pharmacy".

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