Medication handover during inpatient transfers

[Xarelto-10]

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Greetings!

I was wondering how your hospital handles medication handovers during inpatient transfers between units.
I am looking to see if any of you will be willing to share protocols that makes the inefficiency, redundancy, and suboptimal patient care that results from the lack there of such policy in place.

Thank you in advance for your help.

 

[FinallyOnTrack]

When a patient transfers from different units (ie: ICU to the Floor or vice-versa) the patients meds are returned back to the pharmacy then reordered / restocked at the new location when our next batch processes.. Majority of the meds are available in our med selects though..

Not sure if I can share the protocol - but I’ll see what I can do for you..


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[Xarelto-10]

When a patient transfers from different units (ie: ICU to the Floor or vice-versa) the patients meds are returned back to the pharmacy then reordered / restocked at the new location when our next batch processes.. Majority of the meds are available in our med selects though..

Not sure if I can share the protocol - but I’ll see what I can do for you..


Sent from my iPhone using Tapatalk

The amount of meds that are being returned are way in excess such that the techs can’t even keep up with crediting and returning the meds to the carousel. It is such a mess.
I appreciate any insight you can share and I hope more people will share their experiences too.

Thank you !

 

[BidingMyTime]

What FinallyOnTrack says. If you are depending on nursing staff to transfer the drugs, then errors will be made. Since all the orders have to be reordered anyway due to JCHO protocol, then all the drugs should be redispensed from pharmacy. The protocol should be for the technician to run up and get all the IV's or other non pyxis/omnicel meds, bring them back to the pharmacy, and then have the pharmacist reissue them if appropriate.

 

[gwarm01]

What FinallyOnTrack says. If you are depending on nursing staff to transfer the drugs, then errors will be made. Since all the orders have to be reordered anyway due to JCHO protocol, then all the drugs should be redispensed from pharmacy. The protocol should be for the technician to run up and get all the IV's or other non pyxis/omnicel meds, bring them back to the pharmacy, and then have the pharmacist reissue them if appropriate.

Is that really a Joint Commission requirement? I don't think I've ever worked somewhere that did that. Maybe the wording is a little loose and open to interpretation. Typically I have seen docs do a med rec and continue/DC meds, but never a full re-order with a new RX number and new labeling.

 

[sakigt]

In theory they would go with the patient to the new floor. In practice they get left behind and we get missing med phone calls until the batch catches them back up. We have a report that prints meds that isn't in the accudose but the report isn't accurate for whatever reason.

 

[Xarelto-10]

What FinallyOnTrack says. If you are depending on nursing staff to transfer the drugs, then errors will be made. Since all the orders have to be reordered anyway due to JCHO protocol, then all the drugs should be redispensed from pharmacy. The protocol should be for the technician to run up and get all the IV's or other non pyxis/omnicel meds, bring them back to the pharmacy, and then have the pharmacist reissue them if appropriate.

It makes sense to have a tech bring back meds that are not needed by the pt once they are transferred/discharged.

I guess my concern is the number of phone calls pharmacy receives for missing Med requests as a result of all this as well as the amount of meds coming from the units once pt is transferred or discharged.

 

[Xarelto-10]

In theory they would go with the patient to the new floor. In practice they get left behind and we get missing med phone calls until the batch catches them back up. We have a report that prints meds that isn't in the accudose but the report isn't accurate for whatever reason.

Inventory is usually off. That too adds to the inefficiency because RPH thinks the med is on floor stock when processing an order but RN calls frustrated bc Pyxis/Omnicell is out of stock.

 

[Xarelto-10]

When a patient transfers from different units (ie: ICU to the Floor or vice-versa) the patients meds are returned back to the pharmacy then reordered / restocked at the new location when our next batch processes.. Majority of the meds are available in our med selects though..

Not sure if I can share the protocol - but I’ll see what I can do for you..


Sent from my iPhone using Tapatalk

Thank you for your response. I guess where I work the automation isn’t optimized such that most meds have to be dispensed from central. Even IV fluids.
When I asked the person in charge why that was the case I was told there has been concern that nurses weren’t charging the bags and the problem off mismatching inventory.

I’d be very interested to hear whatever pointers/ insights I can get from others experiences of increasing distribution efficiency.

 

[sakigt]

Inventory is usually off. That too adds to the inefficiency because RPH thinks the med is on floor stock when processing an order but RN calls frustrated bc Pyxis/Omnicell is out of stock.

Do you guys do just in time inventory like Toyota? Most of our machines set Par at like 5 for slow movers so theres always plenty of stock to go around for transfers.

One place I worked would add new meds/take away meds not ordered in real time several times a day as people shifted around. Crazy.

 

[PharmDBro2017]

Our policy is the patients nurse is required to bring their meds or tube them to the correct location when the patient is transferred.


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[BidingMyTime]

Is that really a Joint Commission requirement? I don't think I've ever worked somewhere that did that. Maybe the wording is a little loose and open to interpretation.

Possibly. My boss says its a JCHO requirement, but I've never been on the JCHO committee, and can't say I've actually seen where it says that. Haha, maybe my boss made it up, just to get the doctors/nurses to do what he wants, that would be a good way to do it so they would take it seriously. However, there are too many nurses on the JCHO comittee for him to actually get away with that.

I guess my concern is the number of phone calls pharmacy receives for missing Med requests as a result of all this as well as the amount of meds coming from the units once pt is transferred or discharged.

The bane of a hospital pharmacist's existence. Too many missing meds even when the pt isn't transferred.