Alternative title to the post: how to wait an hour or more to get medication in the hospital.
Let's say that you (the patient) are requesting some tylenol for a headache. Assuming that tylenol is not already ordered by your physician, the nurse needs to make a phone call to your doctor to get that order. She then needs to write it in the order sheet of your chart. Then she faxes that order to the pharmacy. Since tylenol is hardly considered a stat order, the pharmacy takes their sweet time entering it into the "system" so the nurse can get the medication for you.
In the meanwhile, the pharmacy can't enter the medication into the system until the nurse has entered your height, weight and allergies into the computer. Only once that is done, can pharmacy enter the blessed tylenol.
Then the pharmacist/assistant does their thing and enters the tylenol into their computer system, which is then entered into the medication dispensing system on the nursing unit.
By this time, it's probably close to an hour since you've asked for that tylenol. Oh, your aching head!
The nurse can finally withdraw the medication from the medicine dispensing unit (commonly called Pyxis) and give you the pill(s).
Oh, but wait! Now she needs to log into the medication administration system at your bedside. She scans your bracelet, and now must make sure that the medication is entered correctly in THAT computer system. She needs to verify it and sign electronically that it is correct.
You get your pill(s) now, right? Nope.
Next, she scans the barcode on the pill(s), making sure that the pill(s) match the order. She also asks you to state your name and date of birth to confirm that you are who you are.
Check!
Yeah! Now you can have your tylenol for your headache, an hour or more after you requested it.
Welcome to hospital bureaucracy.
Welcome to my world.
20 comments:
Is it really necessary for that much protocol for OTC meds? After I had my son and was transferred to the Mommy/Baby room, I requested Ibuprofen. It took 4 hours for me to get some. However, had I requested Percocet, (pain wasn't that high, just mild cramping) the nurse said I could have had it in about 10 minutes.
Then, you get charged more for it than you would to buy a whole bottle. I decided not to take my DHA prenatal while in there because it would cost more. If I had brought mine to the hospital, it would have to be taken down to the pharmacy to be dispensed. Tempting to just take the meds and tell them later...tempting.
Yah... or you send your husband over to the gift/snack shop for a two dollar sincle dose of Tylenol and you get rid of your headache.. and get a candy bar or a soda if you've properly trained your husband... Whole process takes ten minutes.
This is why I don't think I could work in the US healthcare system any more, after 35 years in Israel. I'd have an ulcer or a stroke within weeks from all this bumf.
Nurses don't like the red tape any more than the patient. HOWEVER. Having said that, people think of tylenol and ibuprofen as innocuous medications ...when in fact they are the number one cause of liver damage/failure in the USA when not taken as directed - responsible for 56 THOUSAND+ emergency room visits and 456 deaths annually. If you have a headache, try a cold pack first. Besides, the ice machine is easier to get to than the tylenol and does less damage (if you use THAT correctly and don't give yourself frostbite!) :)
Regular strength Tylenol is on the list of meds we can override from our pyxis for this very reason... Our pharmacy is terrible and slow.
We cannot override OTC things like Tylenol or Ibuprofen. However, we can easily override Morphine, Stadol, Demerol, Dilaudid........
I think the reasoning is that if it's for severe pain, we can override and later get the order entered. But mild pain? You're better off taking your own OTC meds (but you didn't hear that from me).
Laura - you do bring up an excellent point about liver damage from tylenol. However, most of the patients on L&D/postpartum are normal, with no existing liver problems.
Ahh this is one of the daily struggles! Patients and family don't understand, but we have to do all this to protect ourselves, which is silly in itself but so true. Then no one understands why I can't "just give to them" because it's "just Tylenol." And no, you technically can't take your own.
That being said, I love the patient who refuses a single dose of Tylenol because they read in the newspaper about how bad it is for your liver. Well, so is all that alcohol, but I don't see you stopping that...
Oh dear me.
After spending 21 days as a patient due to a complication, I can totally relate to this post. For me it was trying to get a stool softener! I was on a morpine PCA for 17 days so yeah, I needed something. I resorted to good old warm prune juice. Yummm.
yeah, i might just bring my own tylenol to the hospital then. and i always take it as directed. just out of curiosity, what would happen if i told my doctor/nurse that i took 1 regular strength tylenol without their permission?
I don't need anyones permission to take legal over the counter medication. I will, however, inform my medical care persons that I did so.
It seems like there are always advantages and disadvantages to new technology. This being a prime example of the negative side.
I have type 1 diabetes and while I was in the hospital for pre-term contractions I was not even allowed to check my own blood sugar! It was SO annoying to have to call in a nurse and then have all the bar code scanning, etc. At least I got them to let me use my own finger pricker. It just seemed so ridiculous, and actually there were a few times I just checked it myself without them knowing because it wasn't one of their "scheduled" times to do it, but I felt it needed to be checked. Also, someone wrote an order for me to receive 10 units of insulin every night at 10pm. I have no idea who prescribed that for me, the first night that a nurse came in and told me I needed to give myself 10 units through my pump I just said "well only if you want me to die overnight". I do not use very much insulin and would certainly never need to give myself that amount all at once. There was apparently no way to take this order off so I had to deal with it each time I had a new night nurse. It really bothered me that an order like that was written for me, yet no one discussed it with me or asked me about how much insulin I use, how I take it, when I take it, etc. Luckily I do use an insulin pump and had full control over how much insulin I receive and when.
Actually, you don't need to have liver damage or be "unhealthy" for tylenol to do it's dirty work. Usually it's the healthy people that damage their liver......I can't tell you how many people phone me and then proceed to tell me that they have exceeded their tyl and ibuprofen limit because the normal suggested dose didn't work. I would advise that if the normal dose doesn't work....ask for something stronger. :)
As a pharmacist, there are many reasons why things are done in the hospital the way they are. On L&D and post-partum things like this can be annoying & aggravating, particularly because the stays are so short & the orders can change rapidly, but it takes time to get them to us and for us to process them.
However, please consider our roles in other parts of the hospital. I appreciate your Tylenol is important right now to you, however, I may have 3 patients in the ICU who's orders have been changed & I need to mix a new IV, or I may have your own baby in the PICU whose pressors have changed & I need to get those orders in the computer fast so your baby's nurse can do what she needs to do.
Your nurse may have 4-8 patients, depending on the state, the unit, etc. But, there are times in the hospital there is only one pharmacist working at a time. I must prioritize & helping a nurse to save a life does sometimes mean you wait for a few hours for your Tylenol. I know thats hard to tolerate when you have a headache, but thats the reality.
Someone asked what would happen if you brought, or your husband brought in your own Tylenol. On a strictly professional & legal level, that would not be tolerated. In a realistic sense - go for it. I did when I delivered.
This is a situation when unless you walk in our shoes, you might not know the whole story. I don't expect anyone other than a pharmacist to understand the complexity of drug distribution within a hospital, but truly - we do the very best we can.
And administrators wonder why patient satisfaction scores are low?!? ;)
To the Anonymous Pharmacist....Thank you for what you do. I am one of those who understand why someone would need to wait for tylenol because a more urgent medication is ordered. I work in the ER where the time it takes me to get a med could mean life or death and our pharmacists are almost Gods with the speed in which they work so Thank you!
One great thing about being an ER nurse, although I think it may make it impossible for me to ever do floor nursing, is that we have set protocols on SO many different things that I can have a patient come in and prior to a physician laying eyes on the patient, I can start a line, give fluids, breathing treatments, give tylenol/motrin or even narcs by protocol. I'm not sure how well I would do in an environment where I have to wait for an hour for an order for tylenol. Yikes.
I have been ER for me entire RN career so this is all I've ever known. I had no idea that the floors were so stringent. Best of luck to you and bring some tylenol.
Ridiculous! I brought my own Motrin to the hospital after the birth of my 5th child and snuck it when the nurse wasn't looking. I have absolutely no health issues with taking Motrin and took it on a full stomach about 1/2 hour before I was going to nurse my newborn. So, quick, so easy - I'm so naughty!
There are two issues that I see with patients taking their own meds. One, since you are under my care, I *need* to know what you are taking so that when something is ordered for you, there are not issues with what you have already taken (exceeding dosages, cross-reactions etc) And two, if someone brings in a bottle of pills, how do we know it really is what you say it is without a pharmacist's review? You could throw a handful of narcotics in a Tylenol bottle and expect us to take your word...
just stumbled across your blog. i love it! and this particular post made me LMAO... wish i could hand it out to my patients when i write them for meds :)
As a former patient for 8 weeks on hospital bedrest, I find this post very familiar....
I knew my hospital ID number by heart within a week from repeating it so often, along with my name and DOB.
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