Perhaps the most commonly asked question I get from nurses either verbally or implied is why their medication takes so damn long to get to the floor. In the interest of full disclosure, I feel it is my duty to fill you in, Ms. RN, on why your medication doesn’t instantly appear in your hands as soon as you read the order. Let us look at the following example. We will assume all other meds ordered on this new admit are mundane PRNs and it’s these two items you are after:
Protonix gtt at 8 mg/hr
Zosine 4.5 gm IV q6h
Dr. Doctor #0000
I get the order scanned to me five hours after it was written. I ignore the fact that Zosyn is spelled wrong and notice it is not on the mandatory antibiotic form. The pharmacy does not stock Protonix IV and does not have an automatic therapeutic interchange for IV Proton Pump Inhibitors (those are for upset tummies). I page Dr. Doctor to change Protonix to Nexium and to fill out the antibiotic form. I then call the floor to obtain a height and weight for the patient which was omitted on the admit sheet. The HUC tells me she will tell the nurse and hangs up in my ear.
Three hours later, after hearing no response from Dr. Doctor or receiving height and weight, you call down asking me where your meds are. I explain what’s wrong with the Zosyn and Protonix and inquire about the height and weight again. You sigh loudly, claim the HUC never let you know, and tell me that height and weight isn’t important and to just put the meds in anyway. I explain that height and weight is required in the pharmacokinetic calculation of creatinine clearance that will determine the estimated kidney function of the patient and will ultimately allow me to ascertain the appropriate dose of all renally cleared medications including Zosyn. You tell me that is dumb and a waste of your time but put me on hold to get the height and weight. Five minutes later you tell me the height and weight and hang up in my ear.
After not hearing from Dr. Doctor for three hours I get a call from him a few minutes after hanging up with you. He tells me he’ll fill out the antibiotic form and to just make the Protonix whatever it has to be to make it right. I assume this means Nexium gtt at 8mg/hr and write the telephone order.
I’m interrupted by a phone call from one of your colleagues who requests the timing of a patient’s simvastatin be adjusted by 1 hour. I ask her to please fill out a MAR correction form, which she tells me is dumb and a waste of her time. Five minutes later after explaining the policy and why a one hour time change for simvastatin is clinically irrelevant, she hangs up in my ear.
I complete writing out the telephone order and see that the antibiotic form was scanned. I start to calculate the patient’s creatinine clearance and am interrupted by another one of your colleagues who demands to know why her Pyxis machine is “all messed up.” Tempted to ask for more details, I think better of it and transfer her to a technician.
I enter the Nexium drip into the computer, but my printer is out of labels and the IV technician is on a smoke break.
Before I can fix the issue, the phone rings and it’s another one of your colleagues requesting a new MAR because she spilled coffee on the last one.
I get the printer working, but now must print another label for the Nexium. After that, I finally complete the creatinine clearance calculation and notice the Zosyn dose should be decreased to 3.375 gm iv q6 hours. I begin to fill out the Pharmacy Dosing per Policy form to adjust the dose, but am interrupted once again by the phone.
This time it is you asking me why it’s taking so long to get your medications.
I complete the form, and enter new Zosyn dose. By this time, the tech has gone into the very expensive and sterile IV room, taken the proper sterile procedures per USP 797 policy, and completed the Nexium drip. After ungowning, she brings it to me for verification. I check it off along with the pre-snapped Zosyn and have the tech send the Zosyn, Nexium, telephone order, and pharmacy dosing forms up through the tube system.
Fifteen minutes later you call me asking what my problem is and why it’s taking so long. I inform you everything has all ready be tubed up. You tell me I’m lying and hang up in my ear.
Ten minutes later you call back and say you found the forms and the Zosyn but not the Nexium drip. Considering they were all in the same tube and you probably had to lift the Nexium drip to get to the Zosyn and forms, I ask you to double check. You tell me that’s not your job and you hate me. You then ask for new more IV maintenance fluids for another patient. I ask you to demand it through the computer system, but you claim you’ve never heard of that and neither has the HUC. I agree to remake the Nexium and demand the IV fluids for you.
As I am about to do so, Dr. Doctor calls and asks a legitimate and involved drug information question. Not knowing the answer off the top of my head, I tell him I will look it up and get back with him shortly.
As I’m researching the answer, a nurse from another floor calls and asks me to replenish the toilet paper in the bathroom.
I go back to researching and upon finding the answer, page Dr. Doctor, who is readily available when needing something from me and calls back immediately. After the conversation, I go back to demanding your IV fluids and reprinting your Nexium drip.
You call me asking me where your meds are again.
Just as we are about to tube them up, you call me again saying that you found the Nexium drip from before but you still haven’t gotten your fluids yet and demand to know why.
Now imagine this wasn’t you but the person who scanned their orders twenty minutes before you and you’ll start to have an idea why your medications take so damn long to get to the floor.