Expectations above and beyond…

I realize that when dealing with a actively dying patient and their family can be a trying time for all involved, but when the LTC staff does little to nothing to help deal with the unreasonable requests of the patient’s family.. even to go as far as to encourage their unreasonable requests, things can get rather intense. It was the last hour of my shift and the end of the day. In LTC… your phones cut off at a certain time and you work until everything that has been faxed in before cut off has been done and out the door. The shift is a 9 hour one.. with the “clean up time” can be anywhere from 15 minutes to three hours. This night everything seem to have extenuating circumstances attach to it… We get a verbal order for controls for a actively dying patients.. of course.. we have to have a faxed written for the C-II and at least a verbal from the prescriber… we can no longer take order for controls from the nursing home staff..unless we have a document on file .. appointing the staff member as a “agent” for the prescriber. Of course, everything is “super stat” at this point… the prescriber writes for Lorazepam injectable.. this product has been hard to get for ~ four weeks and we ran out two weeks ago and anticipated availability is another 1-2 months – MAYBE !… I ended up talking to the night supervisor.. tried to explain the supply situation that the manufacturer was unable to supply.. pipeline dried up 2-4 weeks ago… I explained that the only options we had was Lorazepam Intensol (SL) or Diazepam rectal.. no benzo injectable was available. This night supervisor knows that we get backup from one of the chains … and then began DEMANDING that I call everyone in the three county area to find some… this is a product that the normal chain store does not even stock.. I told her that in such situations before – where manufacturer unable to provide – that we did not expend time tracking down something that was probably not available and if it was .. the pharmacy would probably want to keep it for their own patients. There was “threats” via the nurse that the family knew/related to some VP at the pharmacy corporate.. Finally the prescriber ordered the Lorazepam intensol SL and the order read – from the nurse… PHARMACY REFUSED TO SUPPLY INJECTABLE. We all need to care for patients… but .. expecting for us to pull rabbits out of our hats… and do nothing to help calm down the situation.. just seems to be counter productive. Maybe instead of being part of a team… it would seem to be more like two teams .. us vs them… unfortunately.. there are some apparently keeping score..but there are no winners

One Response

  1. It blows my mind that fellow healthcare professionals – people who have college degrees – cannot comprehend what “national shortage” means. Also, if they need it stat, how are you able to provide quickly while you are spending an hour on the phone in what you’ll know will be a fruitless search? I don’t sit on the phone and argue with a nurse what the correct drug administration techniques are, and I don’t tell a doctor how to diagnose – why does everyone else think they know how to do our jobs better than we do?

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