I'll be working as an overnight hospital pharmacist and I am very nervous right now. 😱
I am sure they will train me first before I pick up my normal shift but I want to ask those who are currently working as an overnight hospital pharmacists a very practical question. How do you handle when you encounter an order/a question that you don't know how to do and you are the only pharmacist on duty during your shift. Do you call a neighbor hospital and hope they can help you or do you just serch on-line for your answers? 😕
Not a RPH, but I am a tech on nightshift.
Assuming this is not a stat order needed now, then you can always flag it and hold it until the morning pharmacists get there.
If it is a question regarding unclear writing, you can always ask your tech what they think they see as a second check on it and call the nurse who faxed the order and ask them for clarification.
The hardest stuff you will encounter on nights will usually fall towards Nicu situations and ICU situations.
I remember one night we had both a baby coding and a heart attack occur within minutes of each other. At this point you just have to make a priority. neonate > Heart Attack > normal items. I was in the IV room making the meds for the neonate and the pharmacist was doing the calculations/entering the orders for the meds for the neonate and the HA patient. During this time you just have to let the phone go, as you do not want to screw up a neonate order.
On the upside, as another poster stated, you will encounter most situations within a few months of the shift. Yes stuff will surprise you, but they will be few and far between.
Of course I also work at a Hospital with a Stage 3 NICU, so we consistently have neonates in bad shape. Woot woot for teenage mothers who think not getting prenatal care is fine because then you can hide that you're pregnant for longer.
Ask questions...to both the RPHs and any nightshift techs you work with. Trust me the nightshift techs know a lot more then most of the RPHs about how things go at night.
Some things to ask/do that you may not think of:
1) How do they handle crash cart replacement at night? At my hospital a nurse goes to central supply and gets a new cart. Then pharmacy puts a new drug box in the cart and places a lock on it. This seems simple, but if you put a new drug box in a used crash cart, you could get into trouble. The nurses will sell you out in a heartbeat. 'Oh pharmacy told me this was fine...."
2) How do they handle narcotic discrepancies? Paperwork that may need to be completed or maybe computer systems you must use. This way you are sure that whatever needed to be done is done properly. At the end of the day it is your responsibility to ensure the tech does everything that needs to be done. Clearly the tech will know what to do and should be doing it, unless you get stuck with a crap tech. At that point, it would be in your best interest to make sure management knows you got a slacker.
3) How to work any machinery for dispensing meds? Yes your tech will be dispensing stuff, but it is nice to know how to do it without asking the tech 15 questions on how to do it.
4) Ask about the procedures for Borrowing/Loaning items. Courier phone #, Hospital Acct. #, #'s for other hospitals you can borrow/loan to, etc. Typically there will be a binder or something with all this information in it, but it is nice to know where to find this. At the moment there are several drug shortages, so you will probably have a list of DO NOT LOAN items...make sure you do not loan them, as you will probably get flack for that...especially if you end up running out yourself.
5) Get to know your tech. It will just be you 2, unless your hospital has 2 techs/2 pharmacists. I am sure it would suck working a shift where you hate your only coworker. Your tech can help you or hinder you a lot. I can take care of 90% of the calls we receive at night (assuming the a**hat nurse will tell me what they want to know..because only a RPH can answer their question).
Most calls are:
Can you print me an MAR?
Did you receive order X?
Can you change the time for med Y? (I cannot change the time, but I can tell them to fill out the proper paperwork and fax it down)
Do you have med Z?
Can I run med Y with med Z? (Yes a tech can read/use micromedix...if it is an odd combination or if the results look odd I can ask the RPH)
Questions regarding meds not showing up on the profile or meds that should not be there. Here I can look at the orders and see if I can find the problem. Sometimes I can't and I pass it on to the RPH. Other times I can and I just let the RPH know that it needs to be fixed when they get a chance.
Clearly most of this is based off of your techs comfort level and experience working with orders and such.
Otherwise...Nightshift is fun.
Oh yea...find a dark, quiet room in your house to sleep. It will make your week on so much better if you get a good 8hrs of sleep each day.
