Thursday, April 19, 2012

The Joint Commission is at it again. Get a load of this new idea and  read the quote found in a “Pharmacy Communication” that was sent to all Nurses at our Facility.

“Effective Wednesday, April 18, pharmacy will dispense exact doses by splitting tablets and repacking them for each dose. It is required by TJC and recommended by ISMP that a patient specific unit dose should be prepared by the pharmacy and available for nurse for administration, negating any manipulation. “

As I read it, the Joint Commission is accusing we Nurses of  “manipulating” medication delivery. And of course, that means something like that would never be done in the Pharmacy. Actually, it probably means that Pharmacy Techs, will now become the Pill-Cutters. How’s that for a job title. “Dude,  tell me about your new job?” “Well, Bill, it’s like crazy, like I chop frickin’ pills all day!


They are dismissing our pill-cutters
Man, that’s hard to believe,
Now Pharmacists, will get the task
So, why do I grieve?
Because it’s just too damn stupid
The reasons they list,
A Joint Commission directive
I guess somebody’s pissed,
And they wanted to take-away
Something else, we Nurses do,
Chopping up pills
Was too risky for you,
The patient-consumer
Might get an improper dose,
And the Pharmacy chops pills
Statistically more close,
Than any Nurse could achieve
Even thirty years on the job,
Screw it, let them do it
Take it on, Pharmacy Bob!


_ _ _ _ _ _ _ _

My Editorial on the above topic:

I realize I represent a tiny voice in the shadows of mighty decisions, but hear me out on this concept of Pharmacy Pill cutting. I am aware that this idea comes from other big agency thinkers, but I believe it violates sensible Nursing practice We have both been Nurses a long time, yet I haven't forgotten the teachings of "The 5 Rights of Medication Administration", nor have you.

the right patient
the right drug
the right dose
the right route
the right time

One of my concerns is this: many pills look similar, but may have distinctive markings. Now, someone in Pharmacy is going to chop a pill in half, and I won't be there to see what pill they chose. And when that chopped pill comes to me, in its own little package, I may not be able to identify that pill, because I did not see it in its original shape, appearance, and perhaps some unique markings have now been obliterated. In fact, that was one of the purposes of Unit-Dosing, one pill, clearly marked, I open it, and I chop it.

Now, I am expected to administer a medication, that quite likely, I can not identify. How does this make for a more safe situation? We are taking away the "Right Drug" step of the process.

And if a patient has an adverse reaction (because, just maybe, the wrong pill was grabbed in Pharmacy), the Nurse will be blamed, because they administered it! This policy, although adding a "new and improved" layer of safety, is actually eliminating the step where the Nurse, can truly check the validity of what they are administering. This is not progress.

I think it would have been appropriate to address this issue, prior to having it "suddenly announced", and expecting us to incorporate it into our practice. 

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