Homeless shelter staff administering medication

[KatzchenLSW]

Hi! I'm hoping that you all can help me answer a question (or at least point me in the right direction since I'm finding very little on my own)

I work in a homeless shelter and one of our new responsibilities is to take the clients prescribed medication, get what they need to take out of the bottles and place it in a bag and then give then their bag when they request their medication.

As the daughter and wife of a nurse, I am really hesitant to go along with this, after all, I'm not a nurse or even a HHA or STNA. I'm truly afraid that I will make a mistake and injure a client. I'm also concerned that I might not be allowed to administer medication in this way under Ohio law.

The higher ups say it is ok because we have them sign a list of the meds that they take and are supposed to verify that the meds we give them are correct.

The only thing I could find in the Ohio Revised Code about unlicensed personnel administering medication referred to adult care facilities and MR/DD homes, there was nothing about homeless shelters.

Adult Care Facilities

MR/DD

Can anyone clarify the laws in Ohio for me or point me in the right direction of who to ask?

I'm afraid that if I refuse to give the clients their meds this way and can't back it up with a law that I'm going to lose my job

[Jolie, BSN]

There is a legal loophole for this situation. Group homes have untrained staff administering meds. I have a friend who is a judge and he said there are certain situations where there aren't legal implications for this. He said it was considered along the same lines as a family member helping an elderly grandparent to take their meds or someone with a live in "helper".

He said it is possible to sue for mistakes made but highly unlikely that anything would come of it. After all, the alternative is for the involved resident to struggle along alone doing the best they can.

I understand what you are saying, and I don't think that anyone expects the same standards of practice for medication administration in a homeless shelter that they would for a hospital or clinic, but to take medications out of properly labeled containers (pharmacy vials or OTC packages) and place meds unlabeled into a baggie is just screaming for trouble.

I can see a resident walking away with baggie in hand, setting it down and inadvertently walking away, and a child walking up and taking the "candy" out of the baggie and ingesting it, or two residents having lunch together accidentally taking each other's medications.

If I can imagine it, it will happen.

Medications need to be dispensed in a tightly controlled setting. No one should walk away from the dispensing area with a fist-full of unlabelled drugs in a non-childproof container.

[Jolie, BSN]

A pharmacy that serves several of our local shelters, blister packs all the meds, so all the staff have to do is punch out the pill for hs or whatever.

Most patients in the community don't monitor their BPs prior to taking meds. Coumadin is usually a set dose. The list goes on and on.

The narcotics are kept locked for the fact they have street and recreational value in that community.

Whenever dosage problems have arisen, the doctors who provide care to this community will go and alter the blister packs themselves.

A large part of this population knows their meds, doses, and schedules very well and will tell you what is what.

That's why the blister pack is the way to go.

What is done for clients who stay only occasionally, or on a short term basis and who come in with a pharmacy vial of drugs. Your suggestion sounds good for long-term, regular residents, but not practical for those who are in and out on a short-term basis who bring meds in with them.

[KatzchenLSW]

To comment on a couple of the thoughts here...

Is the shelter you are working (and your self) considering the possible implications that could arise from medication administration? Once the medication is taken out or there orignal containers, it is quite possible to mix up pills especially with those that look alike. There are certain medications that must stay in a sealed container in order to maintain its stability. Also are you not concern of the possibility of giving the incorrect medication and causing harm? Also theft of certain narcotics or pain meds.

The meds are still in their child proof, labeled bottles until the morning before they are handed out, so I'm not worried about the storage issue or mixing up similar meds.

A pharmacy that serves several of our local shelters, blister packs all the meds, so all the staff have to do is punch out the pill for hs or whatever.

The narcotics are kept locked for the fact they have street and recreational value in that community.

Whenever dosage problems have arisen, the doctors who provide care to this community will go and alter the blister packs themselves.

A large part of this population knows their meds, doses, and schedules very well and will tell you what is what.

That's why the blister pack is the way to go.

Blister packs aren't really an option since we just lock up and administer the medications that clients bring in, we can't control how the doctor/ pharmacy prepares the prescriptions.

I understand what you are saying, and I don't think that anyone expects the same standards of practice for medication administration in a homeless shelter that they would for a hospital or clinic, but to take medications out of properly labeled containers (pharmacy vials or OTC packages) and place meds unlabeled into a baggie is just screaming for trouble.

I can see a resident walking away with baggie in hand, setting it down and inadvertently walking away, and a child walking up and taking the "candy" out of the baggie and ingesting it, or two residents having lunch together accidentally taking each other's medications.

If I can imagine it, it will happen.

Medications need to be dispensed in a tightly controlled setting. No one should walk away from the dispensing area with a fist-full of unlabelled drugs in a non-childproof container.

The meds have to be taken in fron of the staff and cannot leave the office. We don't have unlabled baggies of medication on the loose :)

What is done for clients who stay only occasionally, or on a short term basis and who come in with a pharmacy vial of drugs. Your suggestion sounds good for long-term, regular residents, but not practical for those who are in and out on a short-term basis who bring meds in with them.

All of our clients are short term, as we are a 30 day emergency shelter.

Thanks for all of the comments so far, I'm still trying to figure out if it is legal for me to bag and hand out the meds in this manner.

[november17, ASN, RN]

There is a legal loophole for this situation. Group homes have untrained staff administering meds.

In Michigan group homes, staff are trained to give medications by the county they work in. They are just as accountable to "the state" as a hospital is.

[pebbles, BSN, RN]

If you're making up baggies or packaging up the meds for them to take, I think that might count legally as "dispensing" medication - which even RN's cannot do, a pharmacy should be doing it.

I think you're right to be concerned, and maybe checking with the pharmacy that supplies the meds for the shelter would be a good avenue for finding solutions. They might be able to do the packaging, etc, make it easier on the clients without you having to do it yourselves.

[Fiona59]

That's my point about the blister packs. Many members of this population will take their meds if they are pre-packed. They don't have to figure it out when they are high or drunk. They are pretty responsible. I've seen guys pull blister packs out of their shopping carts for the Drs. to check. So they are a pretty transient bunch but they tend to stick to the same pharmacies due to their payment methods.

Its the narcs that are the problem. Scripts are stolen, sold, the drugs are lost, borrowed, stolen, name it there will be an excuse.

[rph3664]

Those of you who work in correctional facilities can confirm or deny this, but about 10 years ago, I worked at two separate pharmacies that services jails in two different counties. Both jails had a doctor on staff, regular business hours, and a nurse on staff for expanded hours but not overnight. I don't remember what the nurses' hours were. Anyway, they had jail trustys (inmates who had earned the privilege due to good behavior) handing out meds! No controlled substances were dispensed in either jail; any inmate who needed them, even very low-risk meds like phenobarbital or Lomotil, was placed in the hospital.

I have no idea if they still do this, there or elsewhere.

[BrnEyedGirl, BSN, MSN, RN, APRN]

Just an observation,...I've seen alot of debate on non lisc personel handing out meds,..in settings like group homes, shelters etc. Many people seem very adimate that only a lisc nurse should hand out prescribed meds. What I don't understand is why? Assuming these people are not ill enough to be in a hospital setting,....why can't anyone who can read give someone a pill? We think nothing of sending Mom home with three scripts for her 2 yr old to take as directed. Who would be "passing meds" if this person where living in a pvt residence rather than a shelter? Do you think the man who has been taking Toprol everyday for the last 4 yrs actually checks his BP before every dose? If the bottle says take one tablet by mouth every 8 hrs, how hard is it to do?

[Jolie, BSN]

Just an observation,...I've seen alot of debate on non lisc personel handing out meds,..in settings like group homes, shelters etc. Many people seem very adimate that only a lisc nurse should hand out prescribed meds. What I don't understand is why? Assuming these people are not ill enough to be in a hospital setting,....why can't anyone who can read give someone a pill? We think nothing of sending Mom home with three scripts for her 2 yr old to take as directed. Who would be "passing meds" if this person where living in a pvt residence rather than a shelter? Do you think the man who has been taking Toprol everyday for the last 4 yrs actually checks his BP before every dose? If the bottle says take one tablet by mouth every 8 hrs, how hard is it to do?

I don't mean to downplay the ability of the general public to competently manage their own medications. But if a facility is taking away their ability to manage their own medications by requiring them to be turned in to the staff (which I don't have a problem with), then the facility must be held to basic safety standards in identifying patients and accurately dispensing their meds. I just don't see how a plastic baggie meets those standards.

[BrnEyedGirl, BSN, MSN, RN, APRN]

I don't mean to downplay the ability of the general public to competently manage their own medications. But if a facility is taking away their ability to manage their own medications by requiring them to be turned in to the staff (which I don't have a problem with), then the facility must be held to basic safety standards in identifying patients and accurately dispensing their meds. I just don't see how a plastic baggie meets those standards.

I just don't believe that "basic saftey standards" are the same for a shelter as they are for a hospital. My meds at home are sitting in an unlocked cabinet in my kitchen. I can see medications being kept in a safe place,.just like large amounts of cash or other valuables. I guess it depends on why they are keeping the meds locked up. If the shelter is in no way meant to provide medical care and the person staying there is aware of that,..surely they can look at their own med bottle and take their meds just like they would at home.