Commentary: Why Medications Take So Long to Get From the Pharmacy to Your Bedside

By Tina Lee
Staff Writer

Imagine that you are in pain after recovering from a major surgery, and the nurse tells you that you have to wait for the medication to relieve your pain since the fentanyl has not been prepared by the pharmacy. Although it is easy to express frustration, patients do need to understand that most delays in pharmacy operations are actually time spent to prevent medication errors. Traditionally thought of as an ancillary service, the inpatient pharmacy is gaining respect by the hospital administration as integral to creating and enforcing checks in the health care system to enhance patient safety.

After personally interning for nearly two years in an inpatient pharmacy, I have worked many hours in the basement of a hospital where staff pharmacists and technicians prepare medications to be sent to units for administration to patients. When the doctor has a question about a medication, the staff pharmacist spends a lot of time checking databases and reference books to provide drug information to doctors. Pharmacists answer questions about appropriate drug dosage, frequency, indication, compatibility, side effects, drug interactions or in-stock availability. The pharmacy systems manager and staff have the daunting task of overseeing a complex variety of medications, often needing to be pulled from dispensing if known to have short expiration dates. They are also responsible for removing drugs found to be unsafe or ineffective by the FDA and notifying practitioners in a timely fashion about temporary drug shortages.

In the past, medication orders were mainly faxed to the pharmacy, but order entry has become electronic to decrease errors in transcribing handwritten orders. In fact, my hospital pharmacy manager took the initiative to set up the computerized order entry (CPOE) system. CPOE is an electronic record of a patient’s medical history, clinician notes, lab values and medication order entry, a system accessible to authorized personnel from any computer in the hospital intranet. The pharmacist takes many calls from nurses and doctors about how to utilize the CPOE to enter medication orders into the system.

After the doctor enters the order, the pharmacist reviews all new orders. There is further delay if the pharmacist needs to contact the doctor to change the order after catching a prescribing error. According to the doses calculated by the pharmacists, technicians prepare the medications according to hospital compounding formulas or manufacturer specifications. Due to the overwhelming number of drugs flooding the market, technicians are likely to fill drugs that look alike and sound alike. The hospital regulating body (JAHCO) has even stepped in to decrease the risk of medication errors with Tall man lettering labeling, such as “prednisone” v. “prednisoLONE.” High-risk drugs dispensed from the pharmacy, for example certain blood thinners like heparin or insulin for high blood sugar, are labeled to indicate taking extra precautions needed for administering the drug. In between taking more calls coming into the pharmacy, the pharmacist must finally check all new medications ordered before delivery to the hospital floors.

After the nurse picks up the narcotic, he or she checks the medication, strength, name of the patient with the doctor’s original order in the computer prior to administering the drug. So, my message is that the pharmacy staff kindly appreciates your patience while all these procedures are taking place.

Once again, the checks in pharmacy operations are in place not to delay the receipt of necessary medications but to ensure the most effective and safest medication is provided to the patient.

Tina Lee is a third-year pharmacy student.