Red tape

August 29, 2012

Running a long-term care facility can be very complex. There are so many regulations governing these facilities that a person is designated to help keep the place on track. Regular reports have to be filled out by the director of nursing and the administrator, plans of care for each patient, usually done by resident care managers. Ordering medication is usually done by the nurses or medication aids. To keep costs down, medications ordered by the physician that is available over the counter (otc) are ordered from supply companies instead of individually from the pharmacy. Usually a person was designated to go over the supplies. Some places I worked would post a paper that the nurses would write down items they were low on in the OTC category.

One place I worked had the sign-up sheet, but it frustrated me that nurses only placed an item on the sheet after opening the last bottle. There were two medication carts that required a bottle in each. If the other cart were almost out of the same item, often the new supply would arrive after it was out of the item as well. I started to look over the cupboard of OTC meds and write in meds that had 1-2 left. That many could easily be gone when the replacement stock came (or not, depending) One day, the Director of Nursing (DON) was gone for a few days and supplies were getting low, so I took it on myself to fill out the fax form and fax it in. I confessed my sin as soon as the DON returned and she grinned and said you may as well do all the ordering, so then I was checking on Attends supplies as well as wound care supplies.

I worked night shift there, so had a little bit of extra time and looked to fill it. I would do the ‘return for credit’ forms for discontinued pharmacy medications. If an ordered medication had not come in, I got on the phone and called the pharmacy to trouble-shoot, since the other nurses only kept faxing order after order instead of looking for the problem. I was on first name basis with all the night pharmacists. I also made most of the calls to the VA, making appointments, reordering medications etc, since it was a pain to cut through all the red tape and I seem to have a knack with red tape and nobody else seemed to want to bother. It was irritating how little initiative was taken. We once got a special patient in that required special formula for a J-tube. Formulas for the usual stomach tubes aren’t right for the jejunum, halfway through the small intestine. I found and ordered a box of the right stuff and went off on my weekend. I came back to find the box of formula out in the middle of the hallway, unopened. I was livid since I’d told the nurses it would come while I was gone. The patient was receiving stomach formula, which isn’t terrible, but not the best.

Noticing that frequently prescription meds weren’t ordered until the last one was used, risking a gap in time without them, I started to pull the reorder tabs. I’d go through each cart and when meds were down to the last week of supply, I’d pull the tab and place it on the reorder form. Sometimes I’d have another form for those two weeks ahead and file it to fax a week later. This worked good until one particularly large order didn’t arrive. I was off on my weekend and when I came back, things were in a quandary. They were out of several medications and the nurses kept faxing reorders. The pharmacy would fax back that they’d already sent the order and the next shift, a nurse would fax another reorder. NOBODY thought to pick up a phone and talk to the pharmacy.

I sifted through all the cupboards and other possible cubby holes looking for a lost order, but couldn’t find anything, so picked up the phone after evening shift left. I told the rep on the phone that I had faxed the order for all of the missing meds myself and had looked everywhere for them. I also firmly insisted that it was large order and it would be a disaster if we couldn’t solve this. The rep said she’d check around and call me back. Fifteen minutes later, she called and told me that they had located the order. What had happened was that courier delivering the meds that night was brand new and didn’t know to stop at our facility or look for something for us. The box was found in the far back of the delivery vehicle where it had been overlooked for several nights. It was sent promptly by special courier.

I guess one could say I’m good at trouble shooting.