[curiousauntie]

At my hospice, if a patient needs meds NOW (can't wait for the delivery from Hospice Pharmacia the next day or it is a weekend that they cannot get a delivery) we will get the script and have it filled...if the family cannot get to the pharmacy we will take it, wait for it and take it to the home. I frequently get scripts for new admits that need morphine NOW and have it filled and take with me to do the admission. What we cannot do is carry any med that is not for that patient. This caused one of our nurses to be terminated last year.

She had been at a death pronouncement and had an unopened Fed Ex bag with an unopened bottle of morphine in it that the family wanted her to send back. It had actually been delivered while she was pronouncing the patient, but the driver left before anyone was able to tell the driver that they wanted to refuse the package. They had been arguing with her about opening it and destroying it, so instead of causing more pain to the family then the death already had, she just put it in her car. She then went to a nursing home to admit a patient, who was actively dying and in respiratory distress. She asked the nurse at the LTC how long it would take to have morphine delivered from their back up pharmacy, and was told it would be at least 4 hours. The patient resp rate was over 40, very wet and he was also clearly in pain. She went to her car and got the morphine and gave him the ordered dose. He began to calm down, his resp rate decreased to a more manageable level and after a dose of Levsin, his secretions started to dry up. All of this was in front of the family, one of who was a nurse practitioner. They were very happy with the lessening of the symptoms.

At that time the patients doctor came in and she went to get him to write a script that she would take to a pharmacy to get filled for the patient. During the 5 minutes she was out of the room, the facility DON came in the room and saw the morphine on the bed side table. Our nurse had inadvertently placed it there instead of in her bag or pocket. The DON made a big stink, in front of the family, calling our office to demand that something be done about our nurse.

Now, I understand (as did the nurse) that we are not to carry meds in our cars, that we are not to give meds prescribed for one patient to another, and that we should never place meds on a bedside table in any type of facility (as this is a safety issue for all of the demented wanders). BUT...

I also know that there are times when the bending or breaking of a rule is in the best interest of the patient. If this patient had been in a private home, not a nursing home, the fact that she went to her car and got the medication that made the patient comfortable would NEVER have come up. The family went out of their way to try to save the nurses job, they had witnessed the facility DON yelling at my director to "do something" about "that nurse" and felt horrible that the nurse was probably going to be fired.

Until that time, I, along with every other nurse in my office, usually had a little cache of "emergency" meds hidden in our cars. (mine was under the spare tire) That day, we all got rid of them. Our director called us in and said that she was leaving the office an hour early, and maybe we should all check our cars, and if we happened to find anything there that should not be there, use each other as witnesses and destroy it as there was to be an inspection of our cars the next day. That is just what we did, laughing and crying as we said good-by to our good friend and co-worker.

By the way, the patient died about an hour after the Morphine and Levsin, comfortable and with his very grateful family at his side.

[CANRN]

Originally Posted by curiousauntie

At my hospice, if a patient needs meds NOW (can't wait for the delivery from Hospice Pharmacia the next day or it is a weekend that they cannot get a delivery) we will get the script and have it filled...if the family cannot get to the pharmacy we will take it, wait for it and take it to the home. I frequently get scripts for new admits that need morphine NOW and have it filled and take with me to do the admission. What we cannot do is carry any med that is not for that patient. This caused one of our nurses to be terminated last year.

She had been at a death pronouncement and had an unopened Fed Ex bag with an unopened bottle of morphine in it that the family wanted her to send back. It had actually been delivered while she was pronouncing the patient, but the driver left before anyone was able to tell the driver that they wanted to refuse the package. They had been arguing with her about opening it and destroying it, so instead of causing more pain to the family then the death already had, she just put it in her car. She then went to a nursing home to admit a patient, who was actively dying and in respiratory distress. She asked the nurse at the LTC how long it would take to have morphine delivered from their back up pharmacy, and was told it would be at least 4 hours. The patient resp rate was over 40, very wet and he was also clearly in pain. She went to her car and got the morphine and gave him the ordered dose. He began to calm down, his resp rate decreased to a more manageable level and after a dose of Levsin, his secretions started to dry up. All of this was in front of the family, one of who was a nurse practitioner. They were very happy with the lessening of the symptoms.

At that time the patients doctor came in and she went to get him to write a script that she would take to a pharmacy to get filled for the patient. During the 5 minutes she was out of the room, the facility DON came in the room and saw the morphine on the bed side table. Our nurse had inadvertently placed it there instead of in her bag or pocket. The DON made a big stink, in front of the family, calling our office to demand that something be done about our nurse.

Now, I understand (as did the nurse) that we are not to carry meds in our cars, that we are not to give meds prescribed for one patient to another, and that we should never place meds on a bedside table in any type of facility (as this is a safety issue for all of the demented wanders). BUT...

I also know that there are times when the bending or breaking of a rule is in the best interest of the patient. If this patient had been in a private home, not a nursing home, the fact that she went to her car and got the medication that made the patient comfortable would NEVER have come up. The family went out of their way to try to save the nurses job, they had witnessed the facility DON yelling at my director to "do something" about "that nurse" and felt horrible that the nurse was probably going to be fired.

Until that time, I, along with every other nurse in my office, usually had a little cache of "emergency" meds hidden in our cars. (mine was under the spare tire) That day, we all got rid of them. Our director called us in and said that she was leaving the office an hour early, and maybe we should all check our cars, and if we happened to find anything there that should not be there, use each other as witnesses and destroy it as there was to be an inspection of our cars the next day. That is just what we did, laughing and crying as we said good-by to our good friend and co-worker.

By the way, the patient died about an hour after the Morphine and Levsin, comfortable and with his very grateful family at his side.

Ya know, some nurses just don't get it! Instead of seeing how that fast intervention benefited the patient, she climbed on her high horse and destroyed someone's life. HER behavior (the DON's) was more inappropriate than the nurse that had the best interest of her patient and family in mind. Afterall, the family witnessed her behavior!

Was it right what the hospice nurse did? That is another debate! Personally, I side with the hospice nurse. I sure hope she found another hospice position and is able to provide comfort and compassion to other families and patients!

Cindy

[finn11707]

we return some of patient/family thank you contributions to hospice patients in the form of courier delivery service for people who can't pick up. After hours--after 9pm--the only option is for the in hospital discharge pharmacy, which is open all night, to dispense to a family member who has to come in--all coordinated by the oncall hospice nurse. We cannot hand carry meds per our agency's policy.

In the agency I worked at prior, we dealt with one pharmacy who delivered everything to hospice patients---except after 11pm. Then the hospice nurse met the oncall pharmacist at the pharmacy to pick up and deliver to the patient. Yes there is always a greater risk of drug diversion--real or alleged if the nurse hand carries meds--and perhaps a safety risk too.

[coralynwoodson]

I must say honestly, I have transported medications only when absolutely necessary. I remember transporting morphine to a patient who was elderly and his wife could not drive and had no one to assist them because they family members were out partying and going on. The patient needed the pain medication and the family members were not dependable and as a licensed nurse, I felt that I was responsible for making sure the patient was not in pain for a long time and that I had made every effort affordable to me to alleviate this pain. It's a tough decision, but someone has to do it.

Coralyn Woodson, R.N.