Nov 182012

“That’s not a medication we have up here so someone has to go down to the pharmacy a couple floors down to get it.” – L&D Nurse’s explanation as to why prescribed medicine asked for repeatedly was still not there 3 hours later.

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 November 18, 2012  L&D Nurse  Add comments

  39 Responses to ““That’s Not A Medication We Have Up Here, So Someone Has To Go Down To The Pharmacy…””

  1. And the elevator’s out of order and a pack of wolves on the stairs… nurse’s excuse needs more work.

  2. At our ultra modern hospital we don’t believe in using elevators or stairs and our transporter is out of order. So we’ve got our super delivery team transporting your medicine through the ducts.

  3. Because that sounds SO much better than “We totally forgot” and “We don’t care.”

  4. Seriously? My little dinky county hospital here has a capsule system like the kind you see at a drive up at a bank – so you can send meds and personal effects up or down in seconds. Are you saying you’re more backward than our 10-bed-maternity ward hospital?
    Impressive. I thought we won as lamest, bass-ackward hospital in the country. Looks as though I was wrong.

  5. Also, everyone working in the hospital has broken legs. I get that there is paperwork and things involved, but at what point do you as a care provider say “Okay, this is ridiculous, I’ll get it myself”?
    Do you know what would happen to me at my job if I made someone wait around forever for an item if a coworker wasn’t there to get it? You would bet if I wanted to keep getting paid I would have to get up and get it myself, and I don’t work with people’s health.

  6. Having worked on an L&D unit in a very busy hospital, I can vouch for this one. Here’s the thing- we could not go down to the pharmacy to pick something up, it had to be put in the patient’s online prpfile so we could access it in the individually locked drawers of the medication pyxis, or the pharmacy had to send it to us through the pneumatic tube system. Sometimes the tubes were down, sometimes the pharmacy was busy with many, many, medication requests at once. People would get so angry that I couldn’t give them something as simple as a Tylenol, but it was system problem, not a “nursie-poo” problem.
    NOT to say that this nurse wasn’t BSing the OP, but please know that sometimes something that seems really isn’t.

    • I was about to say this. I worked in a hospital pharmacy once, and we had to handle all of the medication orders. Even something as simple as Tylenol had to be approved by the pharmacist and then brought up to the floor by a pharm tech. It’s a ridiculous, but it’s really not the nurse’s fault. Unless, of course, she was lying to the patient and/or forgot to put in the order.

    • The bigger issue for me was, if this were true, why didn’t someone explain it earlier? At the time of one of the previous requests? And 3 hours of repeated requests? Seems a bit on the long side.

      • What really ticked me off about it (OP) was somewhat along these lines. I’m patience, I understand things can take time. I didn’t lose my patience with her until hour 4. But what was so very annoying was we offered at the 2nd querry (after the first hour had passed) to have my husband go fill the script at the hospital pharmacy and bring it up. I know others who have done that *in this hospital*, so I know hospital policy does allow for them to add on/accept medication the patient has retrieved themself from their pharmacy. Now they said that would make things more difficult and they’d really like to avoid us bringing in the medicine even if it was from their pharmacy so I agreed to wait. But, heavens!, there is a big difference between being willing to wait a reasonable amount of time to make their job easier and waiting another 3 hours (because it actually took a total of 4 to get this medication) just to make their job easier!

    • look that makes sense, but we are talking about a prescribed medication for an inpatient, if a drugstore can fill a script in 10 minutes a hospital sure can, hell the midwives at my hospital walk around with packets of paracetamol in their belt pouch. it sounds to me more like the nurse was just being lazy and covering her arse (not very well mind you) a one hour wait is understandable 3 hours is not, a patient could have died in that time depending on what the drug was for

    • Shouldn’t some pain medications be stocked on the L&D unit, though, so pain relief is right at hand and not at the mercy of whether the pharmacy is busy?

      Most doctors will leave standing orders for Advil in the postpartum period, so it makes sense to just have that available. But according to the pink link (which is further down, so hadn’t been posted yet when you posted) the nurse didn’t even give her medication for pain relief for twelve hours after the birth.

  7. All right nurses gather round! We’re gonna draw straws to see who goes and gets the meds. Okay, the one with the shortest straw loses. Everyone get it? Good, okay.

    *hell, if this was me I’d just go and get it myself. Let’s hope it’s not a necessary med.

  8. It’s amazing how Pit is available within seconds, demerol within minutes, lidocaine takes slightly longer, and analgesics can take hours.

  9. So? Go get it, would’ve been my answer as a patient or a provider. When I last worked at a large hospital, I would often say to patients, “I’ll be right back.” Twenty minutes later, I would find their charts or meds or whatever it was they were missing with a little search and knowing where to find things. Patients were happy, I was happy.

    Administration wasn’t happy. I was fired shortly after.

  10. This is from my 2nd birth. I’d actually been transfered from L&D to the post partum unit. Now I totally get the hassel that can be working with a hospital pharmacy, but the way this resolved made it clear this wasn’t ‘helpless nurse, bad pharmacist’. First it was about 7am and I was the only new admittance to the floor that morning so it wasn’t exactly hoppin’. I had a really nasty cough (let me tell you how much *fun* contractions are while trying to cough up a lung) and had a script already in the system for codine cough syrup. My first words after being introduced to my post partum nurse were to tell her I had a script in my charts for cough medicine and could I please get that asap and I needed to speak to the doctor about pain control. 3 hours and 3 requests later I get this jewel (and still no doctor or pain medicine either). When we were coming up on hour 4 she tried the same excuse and I told her: “look, my husband is out getting lunch, if I don’t have my cough medicine from you by the time he’s finished eating he will get the script from Walgreens and I’ll take it regardless of what you want” (we had already offered at hour #1 to go get the script ourselves if that would be easier and had been told they “really want to avoid” people taking anything they don’t get from them). She left in a huff…and brought in my cough syrup less than ten minutes later. The doctor and the pain medicine for post partum pain took 12 hours.

    • Good grief! I am so sorry you had to fight to get what was already written for you!

    • I can almost understand taking three hours to get cough medication to the postpartum ward, but is it really so unusual that a postpartum mom might want pain control?! They never keep Advil or Motrin on the postpartum ward? No one ever required pain management?

      This is more than a “pharmacy is busy” problem (which I understand) but really sounds like a “I couldn’t be bothered to page a doctor” kind of problem. Did the doctor ever explain why you were left in pain for twelve hours?

    • That goes beyond a pharmacy-is-busy problem and into a don’t-want-to-do-my-job problem. I can understand cough syrup not being on the postpartum ward, but they never stock Advil either? Are you the first postpartum mom to experience pain?

      Did the doctor explain why it took twelve hours to get to you and help you with pain management?

      • I’m a chronic pain sufferer due to a genetic disorder. It was *supposed* to be in my chart six ways to Sunday that L&D/postpartum would prescribe what was needed for the acute post-partum pain, which on me was sever, and then i’d follow up with my usual pain management doctor to restart long term care for chronic pain (since my medicines had been discontinued for the pregnancy). So we weren’t just talking advil. When they finally did get around to giving me something it was an NSAID whose name escapes me at the moment that they typically give to their c-section moms. While I never was given a reason why it took 12 hours to see a doctor the ‘issue’ with the pain medicine went something like this: you had a natural child birth, we can give you advil, oh, pain sufferer? In your charts? Well, I see they took you off opoids for your long term pain, we’re not going to go against them, oh, acute pain? We’re supposed to prescribe? Um, well, why don’t you try to get in to see them, maybe they can prescribe you something, we just don’t feel comfortable dealing with your pain level, I mean, you *did* have an uncomplicated delivery. Oh, it’s Friday afternoon by now and they are gone for the weekend? Um, well, the doctor will be by at rounds…
        Finally the doctor, 12 hours after delivery after a day when I can’t so much as roll over or move a leg without assistance due to pain, comes in frowning and leafing through my chart, goes over the same ruetine as the nurse and I have been through over the whole day, I explain, again, that it’s supposed to be in my charts that pain management has signed off on whatever they feel is necessary to control short term pain, and she says they can give me this post-op NSAID they give c-section patients, but only for 24 hours (it took 2 weeks for me to be able to walk functionally). It was a disaster of a stay.

        • I’m so sorry you had such a horrible hospital experience. :( It seems that every time a patient deviates from the assembly line and has even slightly different needs than what they’re used to it’s the end of the world. To be denied pain management and a doctor consultation is just wrong. No mother should spend the first 12 hours of her new baby’s life doubled over in pain instead of snuggling with her baby.

          • Thank you. There really was just nothing good about the staff at that hospital, it was a truly maddening 3 days. I would have left the first day if i’d been physically capable of doing so, but alas I was not. I did, however, recently have my 3rd baby (aug 31st) at the other hospital in town. We had planned a home birth but ended up with some last minute concerns which drove us to head to the hospital. I was weary, but we ended up with a truly lovely birth and an OB who I hope to have some Thoughtful Thursday quotes featured eventually. She and the rest of the staff were truly wonderful and the birth went great. Such an amazing difference! This first hospital gets an A for facilities but a big old F for staff, the second one gets a D for facilities but an A+ on staff! (Now if only they could swap facilities!)

    • My mom sees a pain management doctor who does really well at working with her other doctors. On her last hospital stay, the hospital decided that she needed the regular morphine rather than the extended release but keeping the dosage the same. Then they wondered why she was having so many extra side effects, and decided to stop her pain meds cold turkey. She’s been on them for more than 5 years. We ended up having to call her pain management doctors office and get them to send someone over.

      I really wish doctors would realize there is often more than one thing going on. You were more than a pregnant mom, just as my mom was dealing with more than pneumonia, or my husband’s fever was part of his rheumatoid arthritis, not post-operative.

  11. Alright, I’ve never worked in a hospital but I’ve been a patient in plenty of them and I do understand that when it comes to medications, there are very strict rules. I can appreciate that because there are a lot of patients and things can get mixed up very easily. I don’t claim to know what the solution is but I do know that it’s absolutely unacceptable for a patient to have to wait hours on end for a medication that was already written for them!

  12. I’m so sorry to hear that ALL the elevators in the hospital are down for maintenance and every hospital employee has two broken legs.

  13. After my c-section a nurse brought in some pain meds for me to take. I told her that I’ve had bad reactions to that med in the past and every time I’ve taken it, I end up vomitting. She still tried to make me take it and when I asked for an alternative she said “I already brought this one in here, I’d have to go give it back and get you a new one!” I told her to go ahead and do that, then she stormed out in a huff like it was the biggest inconvenience in the world.

    You’d think exchanging the meds would be a lot easier than having to clean up my puke, or I dunno, maybe asking me before she ever got the meds in the first place!

    • Exactly your last sentence there! (I have the same issue with being told to take tylenol repeatedly which I’ve told them repeatedly gives me migraines)
      Why is it they ask you 14 times upon admittance if you are allergic to anything but when it comes to handing out meds it’s too complicated to ask about past side effects?

      • My favorite is when they say, “Oh, but that’s not an allergy.” No, it’s not an allergy, but it’s a serious enough side effect that I was told my heart could stop if I take this medication ever again, and that’s beside the racing heart, numbness, and the fact that after a while I begin to lose touch with reality. But you want to prescribe this to me instead of the perfectly safe alternative I’ve taken a dozen times because my life-threatening side-effects aren’t actually an allergy.

        I don’t understand that mentality. At all.

        • Were they giving you a different dose or formulation? A common one with the sulfa-drug side effects is that it can depend on the sulfa (unlike sulfa drug allergies)

          • It’s not an antibiotic. It’s a decongestant, so it’s not even in the “lifesaving” category for me. :-) And with an alternative that worked just fine, I didn’t see why they were being so stubborn. I now refuse to take decongestants at all because it’s not worth the fight.

        • Goldilocks: When I told the hospital pre-op folks about how bad my ‘reaction/side effects’ are to Demerol, *they* are the ones that told me, “From here on out, list it as an allergy–that way, you shouldn’t be getting it again.” (Uncontrollable vomiting, hallucinations, panic attacks). SO, no, not ‘fatal’ but pretty dangerous for a post-op neck surgery (all that vomiting wouldn’t be good) and something to avoid…so I’ve always followed what they suggested (that was 2009). Never had a problem with anyone since saying “Well, those are just expected side effects.” Their usual response is “Yes, that seems to happen a lot–we have much better alternatives since it causes problems for you.” I do see the point if there are NO alternatives, but in the case of pain, thankfully there are other options.

      • Because true medication allergies can kill you that is why. The things you are describing are all side effects and they are dependent upon dose and formulation. So yes they are more concerned about potentially deadly allergic reactions, rather then annoying side effects that you may or may not get.

        • **grin** You realize you just did exactly what my doctor did to me. :-D

          • I didn’t see your post until after I posted, migraines and vomiting don’t kill. She was wondering why the freak over allergies and not so much over most side effects and intolerances. The rule of medicine is there are always exceptions, my mother was on two meds that don’t mix, and should never be given together. She was on them for 40 years with never a problem, that doesn’t mean it was a good idea, and it should not be done to other patients just because it worked for her.

            You had a rare reaction, and yeah if it wasn’t life threatening and you were okay with the extra cost I could see changing meds, but for some meds there isn’t an alternative or the alternative has unacceptable risks.

          • I figured our posts got crossed. :-) It was just one of those serendipity moments. :-)

            I understand that if the side effect is non-life-threatening that sometimes you’d prefer to have the patient on the med and dealing with the side effects rather than not on a medication at all.

            EG, it would be stupid for me to let my UTI turn into a kidney infection just because I didn’t want to risk that I might get an upset stomach from the antibiotics. But in cases where there’s a proven alternative, I don’t see a point to monkeying with the dosage or the delivery method in hopes of finding a way for the person to take, say, Tylenol or Sudafed.

            And for a doctor to tell me, “Tachycardia and loss of sensation isn’t really a problem because it’s not an allergy,” well…am I going to be somehow less dead because it wasn’t an allergy? But the kicker was that even after agreeing to prescribe something else, the doctor still tried to give it to me under a different name. (Thanks to my pharmacy, I didn’t actually take it.) With that guy, it was as if he really had to win by making me take it anyhow. I never saw him again.

            About Jespren’s situation: my understanding about migraines is they leave some people wanting to die. :-( If the purpose of a painkiller is to alleviate pain, then the nurse should have realized replacing one kind of pain with another isn’t effective.

          • Yes, that was my point. No (most) side effects aren’t lethal (neither are most allergies). But sometimes side effects can make *other* problems worse or even counteract the point of the medication. I know a lot of people with sever reactions to demeral re the kind described above. If you are prescribing for post-opt pain then giving someone something that makes them deleriously wander the halls when they are supposed to be on bed rest or strain their bodies with repeated and violent vomiting that’s counter productive, possibly even more counter productive than a mild allergy which can be taken care of with a benydril. For me being told to take a tylenol for a migraine is useless. Sure, myabe it helps the initial migraine (big maybe there), but 30 minutes after I take it I’ll just get laid low with a drug-induced one! I get that what they are afraid of is deathly allergies, but it’s not like the human brain (or any system derived there from) can only handle one concern to the exclusion of others.

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