Homeless shelter staff administering medication

  1. 1 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
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  3. Visit  KatzchenLSW profile page

    About KatzchenLSW

    From 'Ohio'; Joined Jul '06; Posts: 39; Likes: 80.

    21 Comments so far...

  4. Visit  Jolie profile page
    4
    I can understand the concern of the shelter administrators that allowing clients to keep medication in their own posession might not be a good idea. But why not simply keep all medications in their original containers under lock and key and have the staff unlock the cabinet when a client states that it is time for them to self-administer a medication?

    That way, you are only providing safe storage of medications, not administering them.
  5. Visit  KatzchenLSW profile page
    0
    Quote from Jolie
    I can understand the concern of the shelter administrators that allowing clients to keep medication in their own posession might not be a good idea. But why not simply keep all medications in their original containers under lock and key and have the staff unlock the cabinet when a client states that it is time for them to self-administer a medication?

    That way, you are only providing safe storage of medications, not administering them.

    That is how we previously handled medication. They now want us to prepare the bags of meds in advance to save time.
  6. Visit  santhony44 profile page
    1
    Have they really considered the implications of this?

    In a homeless shelter, I think there's a pretty good likelihood that you have folks on some fairly powerful prescribed medications, such as antidepressants, antipsychotics, antiepileptics, plus heart, blood pressure, and diabetes medications, among others. What if you make a mistake? (Not saying you are careless nor incompetent, just human). The wrong medication could cause a lot of harm, and the facility could be liable.

    Does the shelter have some sort of risk management, or legal representation? If so, that's who I would talk to. If not, then whoever regulates or inspects the facility and/or sets the standards.

    Good luck in getting this resolved. I think it's commendable that you are concerned, and it says a lot about you as a person. They'd be stupid to get rid of you.
    lindarn likes this.
  7. Visit  herring_RN profile page
    1
    I volunteer for a couple shelters.
    I've been called to help with a colostomy once and twice for problems with a trach.
    I think the lock and store the medication for the clients. And glucose monitoring equipment too.
    One shelter, the largest one, has a clinic on certain days for teaching and a doctor to handle routine care for asthma, DM, HTN, and such.
    MichaelFloridaRN likes this.
  8. Visit  jalease profile page
    1
    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.
    lindarn likes this.
  9. Visit  kythe profile page
    3
    Quote from santhony44
    Have they really considered the implications of this?

    In a homeless shelter, I think there's a pretty good likelihood that you have folks on some fairly powerful prescribed medications, such as antidepressants, antipsychotics, antiepileptics, plus heart, blood pressure, and diabetes medications, among others. What if you make a mistake? (Not saying you are careless nor incompetent, just human). The wrong medication could cause a lot of harm, and the facility could be liable.
    Several years ago, I stayed in a homeless shelter for a couple of weeks after I left an abusive husband. There were no medical staff on-hand, so medication was always administered by regular staff.

    One resident was written up for refusing to take her meds because the staff administering it was trying to give her the wrong dose. She was mentally competent and had taken this med for years, and she was fully aware of what she should have been taking. She later complained to the director of the center, who agreed with her complaint and said she would "talk" to this particular employee. However, the write-up against the resident still stood because it wasn't actually for refusing a med, it was for "insubordination" against staff and that is something they take seriously. This resident was informed that the "right" thing for her to have done was to have taken the medicine anyway and later filed her complaint to the director.

    This is obviously very wrong, but there is nothing residents in homeless shelters can do to defend themselves from being taken advantage of. In this shelter, you are evicted after 3 write-ups. There is a serious motivation on the part of residents to avoid write-ups because if you are evisted, where do you go? On the streets? To another shelter? This is why power-hungry authority figures in shelters get away with this type of behavior.

    "Rights" or no, if you are in a financial state where you do not even have a place to live, they know you can't afford to take them to court to sue for whatever injustices may happen. This allows shelter employees to get away with more than they would be able to with the general population.
  10. Visit  CHATSDALE profile page
    2
    mixing meds together is not a good idea, some meds are given or held according to b/p, level of edema etc
    this is not something a nurse should do and certainly not something a untrained volunteer should do
    MichaelFloridaRN and herring_RN like this.
  11. Visit  phoebebrat profile page
    2
    This is my opinion of original post.............YIKES, to put it bluntly. Always CYA, and run for the hills!
    MichaelFloridaRN and herring_RN like this.
  12. Visit  jackson145 profile page
    0
    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.
  13. Visit  Fiona59 profile page
    0
    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.
  14. Visit  oramar profile page
    0
    I doubt very much that you would be held resposible for an error because you do not have a license. The home could find itself in trouble I fear and of course if you made a mistake you would probably be very hard on yourself. I don't know what to tell you except to get out of there.
  15. Visit  Jolie profile page
    0
    Quote from jackson145
    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.


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