Why SMAT doesn't work
Hi Everyone,
I am new to the forum

I am not a nurse, nor do I play one on TV...but like many hospital pharmacists I am prone to tell really bad jokes

Anyway, I am here today to bash my favorite pharmacy policy and procedure ...SMAT's (standard medication administraton times)

Seriously, I don't think there is any need in the hospital for them, and I want to know what you think. The hospital where I work won't listen to me and I think I have a good idea. I encourage you all to evaluate and critique me to the max (btw, I am a semi-retired X=Director of Pharmacy).

Ok here is the blue print:

A. Trash can SMAT's except as a baseline for initial patient medication profile, clinical DUR, and dispensing (cart or pyxis or omnicell, etc., etc.).

B. Give nursing complete control over administration times, the pharmacy system can be set up with interval dosing that can change (more on this later). This puts control of the timing of patient care back where it belongs.

C. Nursing can set the times when a particular patient will recieve their meds according to the interval ordered.

OK, here we go...

Something like this: John D. Oe comes in with an uncomplicated UTI, and fever of 103, he gets his admit meds written (or POE'd, etc.).
Tylenol 325mg Q 4-6 hour PRN temperature of 101 or greater NTE 2G daily,
MVI w/minerals PO Daily,
MOM 30ml PO PRN Daily for constipation,
Docusate Sodium 100mg PO Daily,
OsCal 500mg PO Daily,
Atenolol 50mg PO Daily,
Lisinopril 10mg PO Daily,
Prilosec 40mg PO Daily,
Furosemide 40mg PO Daily,
Zolpidem 10 mg PO immediately before bedtime,
D5 1/2 NS w/20mEq KCl continuous IV at 80ml Hourly,
Cefepime 1gram IV Q 12 hours.

Ok, now he tells you he has taken his Atenolol at bedtime for the past 3 years, and his Furosemide at 6am daily when he wakes up. He also takes his lisinopril at bedtime, and prilosec exactly 30 minutes before breakfast (which is the correct way to take a PPI).

Also, you have 3 other patients on Q12 hr IV's, 2 patients on Q8hr IVs, etc., etc.

With SMAT's you are locked into the times with a window (early or late), but if nursing can move times can you imagine how well you could budget your time to take care of your patients?

Well I have more, lot's and lot's more. Ask me!!! Use the above profile as a base to create scenarios if you like...I hope to hear from you.