If it isn’t documented .. it didn’t happen

I have often told Pharmacists that -outside of the Rx filling process -we document too little and that there is a major difference between expressing concerns about something and COMPLAINING. The first is typically expressed to supervisors/management and kept within the company’s infrastructure. The latter is when your concerns are not addressed and you are forced to take your concerns outside of the company’s infrastructure.

A recent incident – at least to me – clearly demonstrates this. A Pharmacist’s that I know Mother-in-Law (MIL) was put into a Assisted Living Facility. This 84 y/o has some minor problems and was no longer able to live on her own. Her two major problems was scoliosis and sporadic episodes of hypertension which leads to headaches and falls. The typical pain level from untreated scoliosis was in the 5 range.

This Pharmacist asked me… I can’t get them to follow doctor orders.. initially when her SBP hit 160 she was to get a dose of Clonidine.. that wasn’t working so I asked that her PCP lower it to 140.. which he did.. They are still not giving her her Clonidine when her pressure is above 140. I have had in person and phone conversations with the nursing staff and the DON and walk away assured that doc’s orders would be followed.
They never ask her pain level and when she asked for her HCD/APAP, depending who is on duty.. she will get anything from NOTHING to just plain APAP.

When she asks for her HCD/APAP & Methocarbamol at the same time.. they say NO.. the Pharmacist has asked them.. WHY.. and can only get ..that is “our policy”.. when asked to produce such policy in writing.. it was like deer starring into headlights..

The Pharmacist told me that he was trying to be non-confrontational with the staff/DON.. but it is getting me no where… I’m in a “trickle down bitch situation”… the MIL bitches to the daughter (Pharmacist’s wife) and the wife bitches to the Pharmacist …. when the Pharmacist said…” I can fix it..” the wife’s typical reply was “you will piss them off”.. which the only reply was a NOD in the affirmative.

He asked me… where do I turn… I am getting no where… the MIL is in pain… not getting her meds for her hypertensive crisis and in general the staff is making up policies and procedures as they go along.

This ADL is part of rather large national corporation… I gave him my opinion… you expressing your concerns verbally seemingly is falling on deft ears and/or being forgotten as soon as you leave.. even though promises had been made to “make notes” on the MIL’s MAR.

First of all your conversations are not being properly documented… you need to switch to written expression of concerns.. I would start out by faxing the DON a letter .. expressing your concerns.. if nothing changes… there is always corporate headquarters…and then the bureaucrats that oversee their licensing.

He decided to fax the DON a letter outlining his concerns.. many of which had already been express verbally. His letter made no overt threats, but there were a number of statements made that implied he – a Pharmacist – was fully aware of what was legally required to be done.
Requests that the PCP be contacted and DC certain meds and implement other meds. That unless the PCP stated otherwise, that her prn meds could be requested at the same time .. or one given and let her reevaluate her needs one hour latter for the second med.
There would be no more requests for HCD/APAP and be given only APAP and that they would inquire about her pain level.. as required by the Joint Commission. All of the things (doc orders) that the staff had failed to comply with or had just become lazy about complying with would be a thing of the past.

Within 30 minutes of the letter being received by at the nursing station, the ADON was in the MIL’s apartment discussing what her needs were and how things were going to be different in regards to her getting her medications.

Two days later, the Pharmacist got a phone call from the DON… stating that she had faxed a letter to the PCP and all his suggestions had been approved and would be implemented and all other issues would be corrected.

This Pharmacist did what I suggest with everyone when they express concerns to management or others who you want corrective actions from… the final line of his letter stated ” Unless I heard from you to the contrary, I will presume that you will address … and correct… these issues with your staff…”

By putting this at the end of this letter … you have put the person you are sending your correspondence to – on notice – that basically… unless things are addressed and/or corrected and you chose to ignore me… you should not be alarmed when I take my concerns over your head .. or turn them into a complaint and take them to some bureaucrat that can look into this matter.

it is too early to determine if this situation has been corrected in just the short or long term, but this Pharmacist has laid the ground work if/when the staff reverts to their old methodologies, that he can take his concerns to corporate without any feelings of guilt of not giving the immediate staff the opportunity to save themselves the grief that will undoubtedly come down on them from someone at corporate.

Anytime that you have a one-on-one conversation with someone .. especially a supervisor/management that involves doing or not doing something and there is no “paper” involved… they could be setting you up… just remember anytime that something is important enough .. that the corporation feels that it needs to be protected…there is a piece of paper and a signature involved.

One Response

  1. My reply is that you should be rewarded for your concern for your MIL and every older person that cannot speak for themselves. I thank you from the bottom of my heart.

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