1. During floor/unit transfers, many expensive patient medications, (inhalers, IV medications, creams, ointments) do not accompany the patient. Consequently, when transfer orders are completed, the new RN does not have the necessary medication on the new floor/unit and requests a new dose from pharmacy. The medications listed above can easily cost upwards of $1000 per item. If the item is not found, the cost of medication is a loss to the pharmacy budget and consequently the city. Thousands of dollars are wasted in floor/unit transfers on a daily basis.

   Solution: Just as the chart accompanies the patient, the medications would be placed in a bag with an itemized list and initialed by the outgoing RN. The incoming RN would review the list, match the itemized list with the medications and initial that they received the medications. These lists could be randomly audited against pharmacy charges to make sure RNs were not requesting unnecessary medications.

2. Due to poor communication, timing and possibly laziness, many medications, especially in the IV form, are repeatedly requested. When a IV medication goes "missing," a technician fields the call and asks the pharmacist. The pharmacist then researches if the medication was entered into the profile, the medication was charged and if the timing is correct. If all those steps were met, the pharmacist then talks to the IV pharmacist and IV technician to determine the status and whereabouts of the medication. 80% of the time, the pharmacist will return to the phone to explain the medication is in the patient's cassette or in the fridge, only to have the RN say, "Whoops, I found the medication." In the mean time, five licensed individuals were occupied finding ONE medication, a tremendous waste of resources as both pharmacist and nurse are paralyzed with inaction on other tasks until the medication is found or has to be re-made at a loss to the pharmacy and city.

   Solution: A licensed individual is responsible for receiving the medications. They sign for the medication and acknowledge receipt and possession of the medication. At this point, it is the floor's responsibility to keep track of the medication. If the medication is "mis-placed," the cost of the medication comes out of the nursing budget.  Monthly awards can be given to floors who successfully keep track of the greatest number of medications.

For SFGH