I’ve been very lucky in my hospital career. For the most part, I always had good bosses. Usually, they left me alone to run the pharmacy department. This was because they knew I could do the job. They knew I would do what was right. They knew that I was consistent in my decisions. And they knew I would do whatever was in the patient’s best interest.
My bosses were all Directors of Pharmacy. I was second in command— the number two man. My bosses planned for the future of the pharmacy department. They determined in which direction the Pharmacy was going. I was concerned with the day-to-day operation.
Throughout my many years, I worked with a variety of Vice-Presidents. The Vice-Presidents had other departments (in addition to the Pharmacy) that they were responsible for. My Vice-Presidents were not pharmacists.
My boss and I did a good job in keeping the Vice-President abreast of what was happening in the pharmacy department. For the most part, the Vice-President left us alone because 1) he knew that my boss and I were doing a fine job running the Pharmacy, 2) he didn’t have a pharmacy degree and therefore wasn’t familiar with a lot of items from a pharmacy perspective, and 3) he had other issues and departments to deal with.
One of the most important lessons that I learned was that I never wanted my Vice-President to be involved in the daily operation of the pharmacy. I wanted to make the decisions rather than have him make decisions. Thus I tried to handle any conflicts with staff or hospital workers before any issues escalated to Vice-President.
At first, the threat of involving the Vice-President wreaked havoc on my decision-making process. Others would attempt to scare me by saying, “ If we don’t get what we want, we’ll tell your Vice-President.” These people thought that making these idle threats, it would scare me. Or that it would unnerve me. And I’d concede and give into their demands.
But others soon learned that I couldn’t be intimidated. This was because:
1) I was firm in my decision-making viewpoints. I made judgments based on the issues, not on the fear of notifying my Vice-President.
2) My Vice-President disliked being used as a pawn in other people’s arguments. He was tired of being told to “jump” when others requested. Thus, he tried to distance himself so that he would not be inserted into arguments.
3) There were several stories where threatening to notify my Vice-President backfired (not for me, but for the other party). Thus, others were not so quick to involve my Vice-President.
Hiring A New Vice-President
The Pharmacy had a new Vice-President. It was his second job as a hospital Vice-President. However, this was the first time that he had the pharmacy as one of the departments that he was responsible for.
But he was a very good Vice-President. His primary goal was to help the pharmacy accomplish its goals. Unfortunately, my boss (the Director of Pharmacy) didn’t think so. My boss resigned shortly after the new Vice-President came on board. And I had to move into the position that I hated more than anything. I left my role as the number two manager— the Assistant Director of Pharmacy. I became the acting Director of Pharmacy.
Establishing A New Image
Now perhaps the new Vice-President was trying to establish a new image for the pharmacy. Or perhaps, he thought he could link me with my boss, who resigned. Then I’d become collateral damage, and he’d get rid of me too. That way, the Vice-President could start with a new pharmacy management team.
His perspective was that the pharmacy was a service department. Thus he expected us to serve not only the patients but the nurses as well.
There were times that the pharmacy was out of medications. Sometimes medications had to be borrowed from another hospital. Or the pharmacy was waiting to get the medications from our wholesaler. But sometimes, medications were back ordered and just not available. Thus, there were times that the medications were out of stock in the pharmacy.
My Vice-President told me that there were to be no more stock medications excuses. He did not want to hear that any medication was out of stock. That was an unacceptable reason why something shouldn’t be readily available.
He called the Director of Nursing. He told her to tell the nurses that if they encountered any medications that were out of stock, to let him know. Then he would call me, and he wouldn’t be too happy. He’d demand to know why the pharmacy was out of stock with medications.
The Vice-President handed us an impossible task. The pharmacy couldn’t be out of stock of any medication.
Fighting With The Head Nurse
One of my pharmacy technicians came back from the Intensive Care Nursery. (ICN). The pharmacy technician told me that the ICN head nurse was calling my Vice-President. It seemed that there was no Dextrose 50% on the unit. The nurses claimed the medication was out of stock. The head nurse was aware of the Vice-President’s new out-of-stock rule. She was going to call and let him know.
I don’t know why the head nurse (or anyone) would do this! Was she trying to make the pharmacy look bad? Did she have some kind of vendetta against us? Did she enjoy watching my boss yell at me? Did she get her thrills by playing the role of a tattle-tailer?
Perhaps this was a power play! Did the nurse think that she was achieving some level of power by notifying the Vice-President? I decided to do damage control. I went to the ICN to see the head nurse.
Before I went to see the head nurse, I stopped in the ICN nurses’ medication room. This is where the unit stores all its patients’ medications and IV solutions. On one of the shelves, I found fifteen one-liter (1000ml) IV bags of Dextrose 50%. The pharmacy normally breaks down the 1000ml IV bags into ten 100ml IV bags for neonatal babies. This was the medication that was supposed to be out of stock!!
What I suspect happened was that a nurse used the last 100ml IV bag of Dextrose 50%. And no one called the pharmacy to let us know that more IV bags had to be broken down. Instead, the message became that the medication was out of stock.
I grabbed an empty box that was by the door of the medication room. I filled the box with all fifteen of the Dextrose 50% IV bags and marched into the head nurse’s office. She had just hung up the phone. I assumed that she had just been talking to my Vice-President.
“You told my Vice-President that you’re out of stock of Dextrose 50%, right?!” I screamed. She nodded.
“Look what I just found in your med room!” I said as I started throwing IV bags of Dextrose 50% on her desk. The head nurse opened her mouth to say something, but nothing came out. She was quite surprised.
“You’re not out of it. You need it broken down. Is that what you told my Vice-President? Of course not! You told him you were out of it!” I shouted at her as I continued throwing IV bags on her desk.
I yelled at her, “Call him back. Tell him you were wrong!”
She finally responded, “ I can’t do that. He’ll think I’m stupid.”
I was tempted to reply, but I bit my tongue. I gathered the IV bags back into the box and left her office.
Bewildering My Vice-President
I returned to the pharmacy. My Vice-President was there waiting for me (I knew he would be). I decided to turn on the theatrics. Before he could say anything, I began throwing Dextrose 50% IV bags on a table.
I exclaimed, “I just came back from ICN. And guess what?! They don’t have any Dextrose 50% up there!” I threw another IV bag on the table.
“Imagine, there’s no Dextrose 50% up there!” My Vice-President was dumbfounded. I threw another IV bag on the table.
“Yeah, they don’t have any up there on their unit.” One of the IV bags missed the table and fell on the floor.
“Where did you get these IV bags?” The Vice-President said as I continued throwing IV bags on the table.
“From the ICN medication room!!” I shouted. I threw the next IV bag up in the air. It missed the table and fell on the floor.
“But the head nurse said she would call you and say that they’re out of Dextrose 50% IV bags.” I kept throwing IV bags in the air.
“Maybe I’ll call my wholesaler or borrow some from another hospital,” I said. I reached down and picked up a couple of Dextrose 50% IV bags, which had landed on the floor.
“Wait, look what I found! It’s a few Dextrose 50% IV bags. I’ll have my staff break them down and bring them up to ICN!” I gathered up the remaining Dextrose 50% IV bags, threw them in the box, and walked toward the IV room.
I stopped and turned to look at my Vice-President. Up to now, my Vice-President has said very little. But he knew. He knew he had been played.
I said, “ Tell me something. When you got the call from the head nurse, did she say that the Dextrose 50% was out of stock? Or did she say that it needed to be broken down?”
“She said that it was out of stock,” he said.
I did a double take. I continued, “ She told you that it was out of stock? Rather than saying that they had it and needed the Dextrose 50% broken down?”
“Yes,” he replied.
“Boy, what a stupid thing to do,” I said as I turned and continued to the Pharmacy IV room.
My Vice-President just stood there shaking his head. He realized that he had been played for a fool. He had been manipulated by the nurses. In the future, my Vice-President will be more cautious in his actions. He would not be so quick to act when others complained.
Providing An IV Solution
I wasn’t home when the nurse originally called at 8 pm. It was the 1980s; people didn’t have cell phones. So she called me at home and left a message on my answering machine. I heard the message when I got home at 9:30 pm.
There was also a voice message on my answering machine from my boss. Since I wasn’t home, they called her. She said she was glad she answered because they were next going to call the Vice-President next. And she didn’t want that!
My boss just wanted me to know that there was a problem with an IV bag for an Intensive Care Nursery (ICN) patient. But she handled it. My boss asked one of the pharmacists to prepare another IV bag and deliver it to the nursing unit.
It seemed that a patient (child) in ICN was supposed to receive an IV antibiotic twice a day. The patient’s nurse was at a meeting, went to dinner, and came back from supper at 6:30 pm. She couldn’t find the IV antibiotic bag for the patient.
The nurse called the Pharmacy. The pharmacist who answered remembered preparing the IV bag and having it delivered. The nurse became irate; she stated she needed the IV for the patient. The pharmacist said that due to the expense of the antibiotic, they would only prepare it if they received authorization from my boss or me to make a new one.
The nurse asked for our home phone numbers. She stated that she’d even call the Vice-President if she didn’t get satisfaction. The pharmacist was not intimidated by the nurse’s threats to call the Vice-President, my boss, or me. The pharmacist provided the necessary phone numbers.
As previously stated, I wasn’t home, but my boss was. She got the call at 7:00 pm. She handled everything without involving the Vice-President. Another IV antibiotic was made and sent to the nursing unit. Everyone was happy. And the situation would have been forgotten, except….
Figuring Out What Happened
I was off the next day. When I returned to work two days later, I should have let it go. My boss told me to forget about it. After all, she handled it. The IV bag was sent. No one complained. It was over; move on.
But my boss knew me. She knew I wouldn’t be happy until I found out what had happened. She knew I had to pursue it.
I first spoke with the pharmacist who was scheduled in the IV room two days ago. She [the pharmacist] remembered preparing the IV antibiotic and giving it to a technician to deliver. I talked to the technician who delivered it. He said he placed it in the ICN refrigerator before he went to dinner (at 5pm). Thus, it should have been there for the 7pm dose.
I still felt something was off. Something was wrong. I decided to go to the computer and bring up the patient’s medication profile. I noticed that the patient was no longer in ICN. In fact, he was no longer in the hospital.
That’s strange. I thought. Most ICN patients are usually sent to another nursing unit first before being sent home. I decided to go to the ICN unit and speak with the nurse. However, the nurse who requested the IV bag wasn’t there, so I spoke to the unit clerk/secretary. I asked her if I could see the patient’s chart. She told me that since the patient was discharged, the chart was sent to medical records. This was standard protocol. I went to medical records.
The person at medical records told me to fill out a form in order to check out the patient’s chart. I explained that I really didn’t need to check out the chart— I just wanted to flip through it. She said I need to fill out the form to flip through the chart. So I filled out the form and checked out the chart.
While I was flipping through the chart, I noticed a white form at the end of the “Doctors’ Orders” section. All the doctor’s orders were written on white, official doctors’ note forms. These “notes” were 8 ½ by 11 inch, yellow-lined forms, each page bearing the hospital’s name and logo. Each page had an area for the patient’s name, date of birth and age, room number, hospital number, and attending physician.
The white form I found at the end of the Doctors’ Orders section was different. For one thing, it was about half the size of the official doctors’ notes. This form was preprinted. It had sections to put in the patient’s name as well as other necessary information. It also had a specific place for the physician to sign.
The form was a death certificate. It was completely filled out and signed by the physician. Apparently the ICN patient died two days ago. The time of death: 5:25 pm.
Now I was completely confused. I tried to recreate the timeline. The nurse goes to a meeting at 4:30 pm. Her meeting ended at 5:30 pm, and she went straight to dinner. The ICN patient dies at 5:25 pm. The nurse came back from supper at 6:30 pm. She didn’t know the patient had died. The nurse couldn’t find the IV bag. So the nurse then called the Pharmacy to request another IV bag.
The Pharmacy refused, so the nurse called me around 7 pm. The nurse got my voicemail and left a message. She then called my boss around 7:10 pm. My boss spoke to the pharmacist (7:15 pm) and asked to make another IV bag. My boss then called me (7:20 pm) and left a message that she had handled everything. The Pharmacy sent the IV bag to the unit at 7:30 pm. Problem solved! All was good.
But if the patient had died at 5:25 pm, then why did everything else happen? There should have been no need to obtain an IV bag since the patient died at 5:25 pm. I needed to speak with the nurse. The nurse was the key that precipitated the whole incident. She was the catalyst that caused everything to mushroom. Her actions started the ball rolling, eventually leading to a new IV bag being prepared for a patient who died.
When I returned to the pharmacy department, I met with my boss. I told my boss the entire story. I told her how I found a death certificate for the patient— listing the time of death as 5:25 pm. I reminded her that the nurse called me around 7:00 pm and her shortly after that. I told my boss how she (my boss) called the pharmacist around 7:10pm to prepare another IV bag.
I told my boss that the nurse had gone to a 4:30 meeting. Then she (the nurse) went straight to supper without returning to the unit. I explained that it was obvious that the nurse didn’t know that the patient had died when she returned from dinner at 6:30 pm.
We made an IV antibiotic bag for a dead patient! We were intimidated by a nurse who was yelling and screaming. We caved into a nurse who threatened to call our Vice-President.
I told my boss that I would speak with the nurse when she came in after 2:00 pm. My boss smiled. She told me to forget it. She told me that it wasn’t worth it. She stated that the whole incident happened two days ago! It was already forgotten! What did I hope to accomplish by resurrecting it again? Was it really worth all the aggravation? She didn’t think so.
My boss suggested an alternate plan. She told me to write down the incident. She said to make copies of the death certificate and the IV order. She stated that I should then file everything away.
And then, one day, I’ll have a great story to tell.
She was right. I’m glad to finally use this story in one of my articles.
Daniel Shifrin, R.P., M.S. is a recently retired pharmacist who enjoys sharing his insights about hospital pharmacy. He is proud to own one of the largest collections of Pharmacy Stamp First Day Covers.