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by Poopsie Gigglebuns

We had a discussion at the hospital about a nurse that refused to hang meds b/c they were expired (expired that day). When asked how we would handle the situation - I said that I would double check with the pharmacist and if he/she gave me the ok, I would give meds and then document it in the chart. I was told that that should not be documented in the chart? confused...

[racing-mom4]

Re: Why wouldn't you chart this??

Interesting scenario. I agree, if the pharmacy says OK, then I would simply hang the med and not chart anything about the med being expired that day. As I have never documented the expiration date on any other med before.

[KaroSnowQueen]

Re: Why wouldn't you chart this??

Personally, if it were me, I would:

A.get another nurse to witness that the meds were expired,
B.write an incident report, send copies of the incident report to both the nursing and phar mgrs,
C. return the expired meds and make pharmacy give me good ones, THEN
D. return to the floor, give the good meds and chart I gave those.

None of this however, needs to go into the individual patient's chart, other than signing out the meds on the MAR when you finally get to give them.

[Jolie]

Re: Why wouldn't you chart this??

I support the nurse for refusing to hang expired meds. Some (such as Ampicillin) have a very narrow window of safety and effectiveness, so the fact that the meds were "only" outdated by one day does not guarantee their safety or effect. Why subject a patient to the possible risks and side effects of a med that may not be effective?

If pharmacy OK's the drug, then let them either re-label it with a new expiration date, or administer it themselves. Otherwise all that the patient and family will see and know is that Nancy Nurse hung an outdated med and Granny had a bad reaction to it.

If a medication can't be administered on time, it needs to be noted in the chart. I would make the following entry: "Ampicillin unavailable at this time. Pharmacy and physician notified. No new orders received." An incident report then needs to be written detailing the reasons for not administering the medication, as this is inappropriate to document in the chart.

BTW, why couldn't pharmact simply provide a new dose?

[bklynborn]

Re: Why wouldn't you chart this??

Would be interesting to know what the medication was....if it was an antibiotic then the pt missed a dose. Not a good thing.
Most medications in the hospital are timed and expire after the hour the dose is due.
The pharmacist if consulted will usually tell you to hang the med and then retime the next dose to provide adequate coverage.
Would like to hear more info on this.

[PsychNurseWannaBe]

Re: Why wouldn't you chart this??

So are the meds that expire...expire at the start of the day or at the end of the day. I ask because insulin is good for 28 days after opening...so they write the 28th day as the date of expiration. Is it still good for the 28th?

[bklynborn]

Re: Why wouldn't you chart this??

Use it on the 28th day and then discard

[MeghanRN]

Re: Why wouldn't you chart this??

Poopsie-

If a med expired that day, I'd still give it.

As for the question of why you shouldnt document that in the chart, its for legal reasons.

Say you documented ' meds expired but per pharmacist ok to give '

Then later on pt becomes septic and dies.

Family decides to sue (as they always do) for who knows what reason.

Now the lawyers get to see the chart. They see the line you have charted above. Ah HAH! They have all of the ammunition that they need.You gave an expired med. Pt didnt get the right concentration of meds b/c you hung an expired med. Now hes dead. Lawsuit won! Your license on the line.

As other posters said, you'd do an incident report. You would never ever document in the chart that you filled out an incident report, because they the lawyers could track it down and find our exactly what happened.

Does that help explain things a little more clearly?

[PsychNurseWannaBe]

Re: Why wouldn't you chart this??

You never chart that you filled out an incident report. Incident reports are for in house use only. Once you chart that you filled it out...it becomes a part of the chart and subject to discovery.

[PsychNurseWannaBe]

Re: Why wouldn't you chart this??

Originally Posted by bklynborn

Use it on the 28th day and then discard

So does this rule apply with other drugs such as what the original poster is talking about?