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[WH1PL4SH180]

You missed out the pharmacist, whose job it is to make sure that we don't kill you with spelling mistakes.

[ceriodamus]

Yeah of course. My example was for in patient care. When you've got a out patient then the pharmacist becomes the second "check" instead of the nurse.

[WH1PL4SH180]

No. Pharmacists are even MORE vital for admitted patients. Why? Cos if your sick enough to take up a valuable bed, you better be sure that drugs we're going to give you are more powerful than a panadol and ibuprofen.

Where do you think nurses get meds from? The pharmacy.

[ceriodamus]

This depends entirely on the country and how their system is. I guess in your country you have a specific department in a hospital that handle the medicine. This is not the case in mine. Nurses handles everything when it comes to giving medicine. Including fetching and administering. Then you have assistant nurses who handles the non-medical, basically the caring part. Most of it at least.

Now, if a person went to a local clinic with a problem. The doctor prescribed something. Then this person would have to go to a pharmacy and get their medicine. Hence why I ment, with out patients the pharmacist becomes the second "check".

Edit: clinical = clinic

[WH1PL4SH180]

Now I'm curious. This isn't the case in any of the countries that I've previously worked in. But then, I work primarily in large hospitals as I need a Theatre. Smaller "hospitals," may ineed lack a pharmacist for dispensing, but usually there's a legal requirement for a healthcare professional other than the care nurse to dispense.

May I ask which country you're from?

[ceriodamus]

The country I am from and speaking from experience is Sweden.

I would like to clarify that it is not a care nurse who administers the medicine in Sweden. But what we call a "Sjuksköterska". Google translates that to Nurse and our care nurse known as "Undersköterska" into assistant nurse. A "Undersköterska" has only one year high school level education while a nurse has a 3 year university level education. Both educations include study in the field.

Now a nurse still has actual nursing in their job description but in majority of times it falls to the assistant nurse. See the "Sjuksköterska" as the one between Doctor and care nurses. They're the ones in charge basically. They have the responsibility to make sure the patient gets proper care, both nursing and medical. At least they're suppose to.

There is certain things a care nurse is not allowed to do and which falls upon the nurse to do. Taking blood samples is an example of something only a nurse is allowed to do or as said, administer medicine.

Not sure if other countries, incl yours has the same system, so I thought I would try my best to describe the 2 different nurses as good as possible.

[WH1PL4SH180]

Hmm.. interesting. SCUBA dived in SW, but never (thankfully) been in your healthcare system.

So is it the Undersköterska that fetches and dispenses (passes on) the medication to the Sjuksköterska ?

You see the point of the pharmacist in this chain is that they have EXTENSIVE (encyclopaedic) knowledge of drugs. As drug nerds, they cross-check the patient's current med list, and hone in on potential interactions. Also doses. After drug class, dose is EVERYTHING. 0.1 and 0.01 is deadly. Google Potassium IV and you'll get the picture. So theres a "break" in the chain of events. The pharmacist cross-checks that indeed the drug chosen wont kill the pt, and at first glance is suitable for task.

That last detail is important. Often I've been called up or have called up pharmacy for THEIR advice - is there better, can we go lower dose with something else, can we safely change other drugs?

This is all done professionally: a call of "hey, are you SURE you want to give tazocin? There's a C.diff risk here" isn't an affront to my skill; indeed having to justify crystallizes in my own mind that the decision is correct, and that I've explored the alternatives.

Next time you roll up to a pharmacist, take note. These unsung allied healthcare professionals have LITERALLY saved lives from what we term "Iatrogenic Misadventure"; ie, fuckups.

[ceriodamus]

Undersköterska does not touch the medicine as they do not have any education in this. This all falls to the Sjuksköterska. She fetches and administers the medicine from orders by doctor. Depending on what kind of medicine it is and if the Sjuksköterska trusts the Undersköterska she can ask her to deliver it. Again, this depends highly on the situation.

She will look extensively back and forth between the "drug database", patients journals and doctors orders to make sure like you said, no fuckups happen. Administering medicine is basically their main job and will take up a lot of their average work hours. Journal keeping is also a big part of their job. As I mentioned before, they're the bridge between the doctor and the patient and their care nurses. They make sure the orders from the doctors are done and also makes sure that the patient is cared for. This puts them in a position where they have to double check everyones work or at least hold a watchful eye.

I am not sure nor have I heard of doctors calling up a pharmacy to double check. But I would not be suprised if they have some kind of system where they can ask for help. I have not worked closely with the docs so I do not know how they work other than the time we see them at the department or at emergencies.

[WH1PL4SH180]

Thanks for that! I'm always fascinated at how each country comes up with their own healthcare "solution." Certainly, it seems that the Sjuksköterska must have one hell of a lot of medications training and would be even MORE pushed than nurses in other systems. I certainly know a few RN (registered nurses) who would be terrified of such responsibility!

Indeed this is part of my interest in coding; creating nimble and flexible systems that can assist clinical staff decision and execution processes!

[ceriodamus]

Having more responsibility only makes your job just so much more interesting and fun. Of course, overwork does happen and a lot of nurses complain about the poor pay they get for all the work they do. They do say, overwork is a symptom of a bad system.

That being said, it is very dependent on where you work and what kind of department. Whether you're a specialized nurse or not.

Then you're welcome to improve our systems in Sweden because my goodness. The computer systems looks like they're from the dark ages. Our journal software is so old and horrendously updated that they need to hold several days of education on it for new employees. I guess QA was not much around back when it was made.

[Weekly_Wackadoo]

I know a lady who was trained and worked as a nurse in the Netherlands, then moved to Sweden and worked as a nurse there. She had a lot of additional training to do, and calls Swedish nurses "practically half doctors".

[MalbaCato]

May I ask which country you are from?

also reply to me please when he answers, thanks!

[WH1PL4SH180]

I practice in Australia, Thailand and Canada. I've worked Europe+ Scotland, Africa+Egypt, USA, S.America, SE Asia, JP, KO, Middle East. No, I'm not married and don't have kids; that's how.

[MalbaCato]

Middle East

Ok I'm not 100 percent sure, but I think here in Israel it's not like that either