Missing medications in hospitals

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vash1012

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At my hospital, we have what seems like a higher than normal amount of missing medications. It is an hourly thing to tube medications upstairs only to get a call 8 hours after the medication was due saying they "stiiiiiilllll" don't have the med. Has anyone else worked in a hospital like this and been able to make improvements?
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EVERY hospital is like this. I almost wonder if some of the nurses just hide things to p1ss us off.

:bang: :boom:
 
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Circling every nurse are mini singularities. These microscopic black holes have a strong affinity for a variety of meds. But the highest affinity is thowards IV bags that belong in the refrigerater, any compounded med in a bottle (vancomycin po, magic mouthwash, etc.), eye and ear drop bottles, and all medications after a room change.
 
Every hospital is like this, regardless of how good the med distribution process is. If you have sporadic (re: never on time), these calls will happen far more frequently. The nurses are trained by us to think the meds will never be there on time.

Standardizing administration times and improving the distribution efficiency helps, but it'll never be perfect. You'll find the calls switch from little things that are easily lost to the superexpensive hand delivered large items. You can't win.
 
I've hand carried IV bags directly to nurses. Literally handed it to them...1/2 hour later, they swear they never saw me over the phone.
 
Half the time we get these phone calls, they never check the cabinets or refrigerator in the med room.

Occasionally, it is our fault in the case of a misdelivery where we dropped off the med on 4 North when it was supposed to go to 4 South. Even in the case, after we bring it to the right place, they still claim to not be able to find the meds.

Although, sometimes when they're being really annoying, I l**** around with them by putting the meds in a hard to reach spot or hidden away somewhere dark in the med room.
 
Sparda29 said:
Half the time we get these phone calls, they never check the cabinets or refrigerator in the med room.

Occasionally, it is our fault in the case of a misdelivery where we dropped off the med on 4 North when it was supposed to go to 4 South. Even in the case, after we bring it to the right place, they still claim to not be able to find the meds.

Although, sometimes when they're being really annoying, I l**** around with them by putting the meds in a hard to reach spot or hidden away somewhere dark in the med room.
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Do you WANT them to call and hassle you about where their meds are? You know they aren't going to make a serious effort to find them. They're probably just going to call pharmacy like they usually do if their meds aren't exactly where they expect them to be :laugh:
 
WVUPharm2007 said:
I've hand carried IV bags directly to nurses. Literally handed it to them...1/2 hour later, they swear they never saw me over the phone.
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I was thinking the same thing.

"I need Miss Vanco's IV"
"Remember, I brought it to you a half hour ago?"
"No, I just checked and it is not in the fridge."
"No, I handed it to you in the hall. You said you needed it. I think you put it on your cart."
-silence-
"Is there anything else?"
-click-

:laugh:
 
R2pharmD2 said:
Do you WANT them to call and hassle you about where their meds are? You know they aren't going to make a serious effort to find them. They're probably just going to call pharmacy like they usually do if their meds aren't exactly where they expect them to be :laugh:
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Flat out bad patient care, he is a toolbag, plain and simple.
 
R2pharmD2 said:
Do you WANT them to call and hassle you about where their meds are? You know they aren't going to make a serious effort to find them. They're probably just going to call pharmacy like they usually do if their meds aren't exactly where they expect them to be :laugh:
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PumpkinSmasher said:
Flat out bad patient care, he is a toolbag, plain and simple.
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I don't know how you guys take him seriously. :laugh:
 
Our missing meds died down a bit when we starting doing hourly runs where a tech delivers the meds to the med room. We also have three batch fills that are delivered a day. Our director has had multple meetings with nursing on how to reduce the amount of missing meds. With (a lot) of training and remaining consistent, we seemed to have fixed the problem (relatively speaking). We still have some nurses that don't follow procedure properly but, for the most part, I think we are doing a damn good job. We also put certain things in pyxis to reduce the amount of calls.
 
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owlegrad said:
I don't know how you guys take him seriously. :laugh:
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The problem is I have met people exactly like him in real life (not just pharmacists but other health care people also). Therefore, it is hard to be able to tell if he is serious or just being an ass.
 
R2pharmD2 said:
Maybe he is joking, but based on previous comments I'm not so sure :laugh:
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I never take anything he says as 100% true. He has admitted in the past to troll-ish habits and I think he likes to embellish just a touch. Honestly, I enjoy his posts. Who hasn't dreamed of hiding a med way in the back of a fridge and making a nurse search for it? :laugh:

If his posts are 100% true, well I still think they have entertainment value. :shrug:
 
owlegrad said:
I never take anything he says as 100% true. He has admitted in the past to troll-ish habits and I think he likes to embellish just a touch. Honestly, I enjoy his posts. Who hasn't dreamed of hiding a med way in the back of a fridge and making a nurse search for it? :laugh:

If his posts are 100% true, well I still think they have entertainment value. :shrug:
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They probably have even MORE entertainment value if they're true :laugh:
 
I have the same problem at the hospital that I currently work at and its more commonly due to:

  • Nurses not checking the patient bin/fridge
  • Nurses not being aware of which meds are stocked in their pyxis
  • Nurses not being aware of brand name/generic name or forgetful of auto-subs
  • Patients being transferred w/o their meds
  • Medication orders which require a renewal
  • Slow Pharmacists (yes, there have been horrid days where the queue would be at around 50+ orders)
Few things that DID help our pharmacy was doing hourly deliveries, purchasing newer pyxis machines which can hold larger amount/variety of meds, and keeping the queue count under 15 orders.
 
Once I had 2 daptos go missing in one day. I called the tube system operator, pulled up its log, went to every floor it could have possibly gone to, asked the nurse manager, etc etc etc.

Was in the return in the next day. :laugh: :shootsself: I generally go to great lengths not to remake something. Once the nurses see you up rummaging through the med room often enough they know youre not just making stuff up. Especially when you find it where its supposed to be and call them out on it (Ahem, Heres the Albumin I told you you had now its 7:15 and Im missing the Superbowl kthanks)

We hand deliver expensive/pain in the butt meds. If its a unit dose med or something with a reasonable expiration date I dont let it bother me.
 
For those of you who started doing hourly rounds, where you delivering the medications via tube system before? Did the change to hourly rounds require adding more tech help or reorganizing work flow? Did you find this process took more or less time than you expected?

Thanks for the replies everyone
 
Overall it takes less time. We used to tube everything and it would magically disappear or get put on the wrong pod. One tech delivers at the top of the hour and it usually takes about 15-20 minutes (30 with "heavier" runs). Another tech helps with pulling labels/meds, unit dosing, compounding, and getting things ready to be loaded in pyxis for the next round. Both techs do that in between runs. There are two techs in the IV room. One is in charge of doing all the chemo but both techs do the batch fills and whatever comes off the printer. We also set up the TPN machine for second shift. The out front tech fill the fluid towers every 3 hours on a regular run. Then there is a pyxis tech. We fill all the pyxis twice a day (at the minimum). We have the ED and specialty building in addition to the regular hospital floors, so that is a full-time job for one person. They pull all the meds for each pocket that needs a refill, the rph checks it, and the tech starts at the top working their way down. Takes 2-3 hours (if you're efficient) to get one fill done. I haven't worked during the week in a long, long time so I don't know their workflow. But, yes, we had to hire a couple additional techs. It works out though because there are less missing meds, faxes for "pyxis out", and less phone calls disrupting the rphs with their verification/consulting. We have CPOE as well so that helps a TON.
 
Its gotten to the point at our hospital where it is so bad..you ask did you look in the patient bin? and even if the answer is yes, we go up to the floor and check because 99.99999% of the time, it is there.

waste. of. my. time.
 
Currently on my on-call week and had a head nurse call about a drug BEFORE she looked for it. Admitted that to me on the phone. Rule: look first THEN call pharmacist.
 
Rxbound said:
Currently on my on-call week and had a head nurse call about a drug BEFORE she looked for it. Admitted that to me on the phone. Rule: look first THEN call pharmacist.
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Reminds me of the Guiness commercials from a few years ago: "BRILLIANT!!"
 
It's truly a mystery for the ages. It happens very rarely where I work now, but it seems to be the same department over and over.
 
Dont you guys have QI projects that work on stuff like this?

It was determined (and I didnt work with the project, just heard some chatter about it) that a lot of the helpers would take meds from the tube system and put it in their pocket or leave it on a random counter somewhere. Once nursing got on board with putting anything from the tube system in a designated spot things got much better.
 
Is it possible to have a chart and keep track of units/floors that are missing medication. If a unit has more medication missing, maybe the nursing manager can take a look into it. Maybe take it a step further and add a cost to the medication?
 
Aznfarmerboi said:
Is it possible to have a chart and keep track of units/floors that are missing medication. If a unit has more medication missing, maybe the nursing manager can take a look into it. Maybe take it a step further and add a cost to the medication?
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Ha ha ha.

Oh, how the world of hospital politics work...nurses, many...pharmacists, few.

There is a reason we ALWAYS get the short end of the stick.
 
what we need is RFID, so all the drug's location can be traced. Let's see how nurses try to talk their way out of that one.
 
R2pharmD2 said:
Do you WANT them to call and hassle you about where their meds are? You know they aren't going to make a serious effort to find them. They're probably just going to call pharmacy like they usually do if their meds aren't exactly where they expect them to be :laugh:
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In that scenario, yes.

RN - I can't find the meds for the new patient.
Me - Did you check everywhere?
RN - Yeah.
Me - You didn't see any brown bags lying around in the room?
RN - Yeah
Me - I'll be right up there. *Hang up* *:smuggrin::smuggrin::smuggrin:*

I'll march on up to the floor. Find the nurse I was talking to on the phone. Take them right to the med room, and point out exactly where the medication is.

Me - So you checked the whole room right?
RN - Yup.
Me - What's that brown bag sitting next to the brown cardboard boxes? And it's labelled with the room# too.
RN - Ohh. I couldn't see the brown bag since its next to something else that is brown.
 
Sparda29 said:
In that scenario, yes.

RN - I can't find the meds for the new patient.
Me - Did you check everywhere?
RN - Yeah.
Me - You didn't see any brown bags lying around in the room?
RN - Yeah
Me - I'll be right up there. *Hang up* *:smuggrin::smuggrin::smuggrin:*

I'll march on up to the floor. Find the nurse I was talking to on the phone. Take them right to the med room, and point out exactly where the medication is.

Me - So you checked the whole room right?
RN - Yup.
Me - What's that brown bag sitting next to the brown cardboard boxes? And it's labelled with the room# too.
RN - Ohh. I couldn't see the brown bag since its next to something else that is brown.
Click to expand...

Sounds about right... And not just in the pharmacy. Believe me, completely unrelated industries are just as bad or worse...
 
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