Unavailable meds

[Pat_Pat RN]

We have a new "policy".

Our computer MAR has an option for "Med/Item Unavailable". We have been told to NEVER

use this option. Even if we don't have the medication.

So our new "policy" says:

1. If available, pull from the EDK.

2. Notify Pharmacy

3. Call MD and get an order to hold med.

4. If you can't get an order to hold, call DON.

5. Do not put Med Unavailable.

Does this seem ok?

[CapeCodMermaid, RN]

Seems silly doesn't it? The hospitals are always sending us patients whose MARs state Med Not available. What good does it do to call the DON? Does she have an ekit in her car? We try to get the med out of the ekit or we call the doctor and get the dose held.

[ktwlpn, LPN]

We were cited for marking "med not available" in the past. Seems nurses would just continue the trend without attempting to insure the med was delivered. Our policy (plan of correction) is similar to yours. If we don't not have the med in the ekit we must get an order to hold it until it's available from the pharmacy. It does not matter if the med is colace or lasix.Part of our problem was it really didn't matter to the staff, in one of our citations years ago a resident missed several consecutive daily doses of Lasix and none of the nurses involved took any action.

[Pat_Pat RN]

How does this policy solve that problem of nurses taking no action? And just because the doctor puts the med on hold, is that really what is best for the patient?

It just seems like a sneaky way to get around the fact that the patient is not getting the proper care. But the facility doesn't want to fix the problem.

[VivaLasViejas, ASN, RN]

One of the facilities I visited during my brief stint as a surveyor had a problem with their pharmacy shipping new orders in a timely fashion. Sometimes 2-3 days went by during which the resident was not getting the medication. What saved them was Q shift documentation about what was done about it, e.g. "Spoke with M____ from XYZ Pharmacy @ 1740; she stated Lasix would be sent on the next shipment tonight 8/23/14", or "Received order from Dr. A to hold Colace until it arrives from XYZ Pharmacy". Each nurse was expected to follow up until the meds showed up.

At one point in the investigation I called the pharmacy manager to find out what he saw as the problem. He was not particularly helpful. We suggested they change pharmacies.