Blog by Mark Wolfe, Customer Account Representative, GrandView Pharmacy

In the long-term care setting, there are many responsibilities toward caring for the residents within that facility, none more so than administering the residents their medications. This activity needs to be done accurately and timely, but it can also be complicated.

Most nursing school experts talk about the “Five Rights“ to administering medications. These five rights are:

  1. Right Patient
  2. Right Medication
  3. Right Dose
  4. Right Time
  5. Right Route

Nurse consultant Vivian Nwagwa lists 10 rights within her training (Nurse.Com, 2018/02/18). They include the five indicated above, but she adds the following:

  • Right education (of the patient or family)
  • Right to refuse (the medication)
  • Right Assessment (of the patient before administration of the medication)
  • Right evaluation (of patient after administration of medication)
  • Right documentation

Whether you ascribe to the old standby “Five Rights”, or if you add the additional five as Nwagwa suggests the administrative procedure of med pass can be complicated, especially in the long-term care setting. Practically no facility has an on-site physician, nor pharmacy requiring the nursing staff to attempt to achieve accuracy and correctness on their own.

But in order to act upon the residents’ behalf the facility first needs to obtain the medications from their pharmacy. GrandView Pharmacy has procedures in place to medicate the barriers that frequently make it difficult to receive medications timely. Understanding these hurdles or barriers allow the LTC facility to be more proactive in the medication management and working with your pharmacy provider. GrandView Pharmacy sees six common hurdles to receiving medications timely. These are:

  1. Controlled Substances:  In today’s environment, hundreds of thousands of people in the US take or are dependent on opioids. However, there has been much documented abuse of overuse of opioids or over-prescribing these substances. Thus, there are restrictions placed on obtaining these legally and correctly. But even while controlled substances are properly prescribed to the patients that need them, the system requires certain procedures to be followed before those control substances are delivered. Knowing this helps the LTC facility in flowing the proper procedures in order to receive these medications on time for their patients.
  2. Order Clarification:  Is the prescription complete? Has it been dated, signed by an authorized prescriber or agent? Is all the correct information on the prescription to allow a pharmacist to fill the request…patient name, name of medication, dosage, administration times and route?
  3. Product Availability:  Is the product available at the time the order request arrives? It could be that the pharmacy is out and that the re-stock order has not yet arrived. Or, it could also be that the product is unavailable regionally or nationally. An example would be that a tuberculin PPD was unavailable within the USA in the summer of 2019.
  4. Insurance Coverage, Fill To Soon:  Insurance will not allow a refill of an order as it is requested too soon. The policy only allows for a dispensing every 28 or 30 days. Because insurance company policies vary that may hinder in getting the product to your facility as desired.
  5. Insurance Coverage, Non-Covered Item:  A patient’s insurance may not cover the item that their physician has prescribed. Pharmacy must then attempt to obtain an authorization from the physician and agreement from the insurance company. At GrandView Pharmacy we work continuously to seek resolution on these instances.
  6. Human Error:  This is an area we continually strive to improve the process. But it is also the most frequent occurrence from the facility to the pharmacy as well. GrandView Pharmacy technicians work with our facilities to resolve these issues and if necessary ask that an account manager help re-educate healthcare staff via in-services or hands on training.


About the Author

Click here to learn more about Mark and the rest of the GrandView team.