Medication administration confusion??? - page 5

Hello everyone! I am a nurse who is newer to dialysis. I have only been working there for a short period of time, but I am concerned about their medication administration to patients. There is a... Read More

  1. by   Julius Seizure
    Quote from dudette10
    I think we are getting stuck on the definition of the word "interpret" so let's skip that part and go directly to a role discussion.

    It seems that what you're saying is that, as a matter of course, nurses are fully able to bypass in-patient pharmacy all together and administer any medications a provider orders that he/she also agrees is clinically appropriate.

    It leads to the question, then, why have in-patient pharmacists at all?

    Do you believe they have no important role in the patient medication process, and that a nurse's education and clinical expertise suffices to ensure patient safety?
    But the original scenario isn't bypassing pharmacy...

    1) The physician ordered a med.

    2) Pharmacy checked the order, put it on the patient's MAR.

    3) Then the charge nurse got the med out of whatever drug vending machine they use and put it into a syringe.

    4) Then the patient's nurse gave the med.

    Pharmacy is right there in step #2.
  2. by   Julius Seizure
    Quote from BSNbeauty
    I would not feel comfortable. This violates the 5 rights. How do you know it's the right medication, and dose if you didn't witness her draw it up?
    How do you know the medicine in the vial was even the correct medication at all, by that logic?
  3. by   vintagemother
    Quote from brownbook
    Seems wrong to me. Is there any logical reason it is done this way? Something to do with LPN's?

    Can the LPN's even give the medications (I assume) I V push?

    All very confusing to me.
    I'm pretty sure LV/PNs can't give IV push meds...at least in my state. I'm a former LVN.
  4. by   Alex Egan
    Ok. So I'm gonna com in and ad a little here.

    1. Actually there is no pharmacy involved in the process at all in the dialysis units I worked in. The physician writes for the protocol, labs are taken, the medications are adjusted weekly per the protocol. The order is updated in the charting/computer the label is printed and the drug is given from stock. (Think mini fridge, not pixis)

    2. Don't loose site of the fact that this is a dialysis clinic, so it is a wildly different practice area than many of you are envisioning.

    3. The ability to push IV meds for LPNs is dependent by state, just because you don't do it doesn't mean it's done.

    4. Unless you get your gas spectrometer out you are fully trusting the pharmacy label to tell you what drug is in whatever you're giving, I don't think extending that trust to another nurse so long as the correct information is provided is wrong, it logics out just fine for me. Is it ideal...no, but the real world often isn't.

    5. Because of the setting the odds of a Catastrophic med error is shockingly low. That's why the system is ok here and probably not on your units. Don't forget the setting.
    Last edit by Alex Egan on Apr 16
  5. by   1TiredOldNurse
    This is from Frederick Karsten R. Ph. Director of the Drug and Narcotics Agency State of Georgia. 480-28-.08 Practitioner's Assistants.
    Nothing in these rules shall prohibit any person from assisting any duly licensed practitioner in the measuring of quantities of medication and the typing of labels therefore, but excluding the dispensing, compounding, or mixing of drugs, provided that such practitioner shall be physically present and personally supervising the actions of such person in doing such measuring and typing, and provided, further, that no prescription shall be given to the person requesting the same unless the contents and the label thereof shall have been verified by a licensed practitioner. No practitioner shall be assisted by more than one such person at any one time.
    Authority O.C.G.A. Secs. 26-4-4, 26-4-27, 26-4-28, 26-4-37, 26-4-60, 26-4-85, 26-4-130.
    For purpose of these Rules and Regulations, the following definitions apply:
    (a) Drugs. Drugs shall mean drugs as defined in O.C.G.A. Section 26-4-5.
    (b) Practitioner or Dispensing Practitioner. Practitioner or dispensing practitioner means a person licensed as a dentist, physician, podiatrist or veterinarian under Chapters 11, 34,
    35 or 50, respectively of Title 43 of the Official Code of Georgia Annotated. So if I'm reading this correctly, at least in Georgia, the RN cannot draw up meds for someone else to give unless a practitioner is watching . I personally do not give meds that I myself didn't draw up, or witness being drawn up, that is what I was taught in nursing school, and I stand by that. I have seen two different concentrations of the same med delivered to a clinic where I worked ( there was a back order on the concentration we normally used), and the bottles looked the same. Check with your BON. Don't take the administration's word for it. I once applied for a job at a small rural hospital (in Central Illinois) that did NOT have a physician,PA,or even a NP in the building after 8 pm. Administration actually told me that because they were a rural hospital, the rules were different for them......Sure they were....not according to the State of Illinois,and the BON!
    '
  6. by   Alex Egan
    So my understanding of the term dispensing is packaging a medication for direct use by the patent, not another nurse. Even assuming I am wrong I believe this refers to the use of pharmacy techs, thus why there can
    Be only one at a time and the complete lack of the terms RN or Nurse.

    Disclaimer my knowledge of Georgia law is not great as I don't or practice there. My statements are based on PA law as I understand it.
    Last edit by Alex Egan on Apr 17
  7. by   brownbook
    Quote from Alex Egan
    CMS guidelines specifically forbid the drawing up of any medication at chair side.

    Thats most likely the reason they want to do it this way, is to comply with the current CMS guidelines around infection control. Medications in dialysis must be prepared in the "clean area" of the clinic. To work in the clean area you must be wearing a different clean gown (different than the one you where on the floor) and wash or sanitize you hands when entering and leaving. So. I enter the clean area, change gowns, wash hands prepare med, remove gown, wash hands, apply "dirty" gown walk over administer med. repeat 36 times a shift. When your doing it as OP discribed you can hand the meds across the clean dirty line and still be in compliance.
    There were so many replies to the post, I just glanced over yours. Glad I went back and re-read it. It seems to at least make sense. I hope the original poster saw it.
  8. by   JKL33
    Quote from 1TiredOldNurse
    This is from Frederick Karsten R. Ph. Director of the Drug and Narcotics Agency State of Georgia. 480-28-.08 Practitioner's Assistants.
    Nothing in these rules shall prohibit any person from assisting any duly licensed practitioner in the measuring of quantities of medication and the typing of labels therefore, but excluding the dispensing, compounding, or mixing of drugs, provided that such practitioner shall be physically present and personally supervising the actions of such person in doing such measuring and typing, and provided, further, that no prescription shall be given to the person requesting the same unless the contents and the label thereof shall have been verified by a licensed practitioner. No practitioner shall be assisted by more than one such person at any one time.
    Authority O.C.G.A. Secs. 26-4-4, 26-4-27, 26-4-28, 26-4-37, 26-4-60, 26-4-85, 26-4-130.
    For purpose of these Rules and Regulations, the following definitions apply:
    (a) Drugs. Drugs shall mean drugs as defined in O.C.G.A. Section 26-4-5.
    (b) Practitioner or Dispensing Practitioner. Practitioner or dispensing practitioner means a person licensed as a dentist, physician, podiatrist or veterinarian under Chapters 11, 34,
    35 or 50, respectively of Title 43 of the Official Code of Georgia Annotated. So if I'm reading this correctly, at least in Georgia, the RN cannot draw up meds for someone else to give unless a practitioner is watching . I personally do not give meds that I myself didn't draw up, or witness being drawn up, that is what I was taught in nursing school, and I stand by that. I have seen two different concentrations of the same med delivered to a clinic where I worked ( there was a back order on the concentration we normally used), and the bottles looked the same. Check with your BON. Don't take the administration's word for it. I once applied for a job at a small rural hospital (in Central Illinois) that did NOT have a physician,PA,or even a NP in the building after 8 pm. Administration actually told me that because they were a rural hospital, the rules were different for them......Sure they were....not according to the State of Illinois,and the BON!
    '
    No one in the OP scenario is acting as a "practitioner's assistant" but rather as a practitioner in their own right, performing duties they themselves are duly licensed to do.
  9. by   ruby_jane
    Quote from Mike DBD
    The individual who give the med takes all responsibility, the charge nurse name is no where documented.
    Um....nope! Is this one particular shift or is it policy?
  10. by   Twinmom06
    Quote from Alex Egan
    Ok so the reason this works is because of the setting, and the label system.

    On the dialysis unit I worked on the medication labels were printed the night before. They have the patents name, MRN, drug, dose, and then a spot for your initials and the time. A nurse draws them up completing the label. More often then not I would give them myself but if the RN was charging that day I would often pick up the drugs and give them. They are correctly labeled, you know what's in there as well as you do when you get meds from the pharmacy. Which is to say you really don't. You don't know what pill looks like what or what clear liquid in a syringe is REALLY, you trust the label.

    The administering nurse walks over to the patent, confirmes the correct patent, checks the order on the chair side charting against the label, administers and documents.

    The trick here is that it's dialysis. There are maybe five push drugs routinely given, and maybe the same number of IV infusions. There are no narcotics, so unless you want to divert iron that's not a concern. It's a leagal and well established practice that is done by the one of the big two I worked for in every clinic I worked at.
    You beat me to the punch...I also work HD and unless you're anemic and need a shot of epogen, there isn't anything to divert.
  11. by   dudette10
    Quote from Julius Seizure
    But the original scenario isn't bypassing pharmacy...

    1) The physician ordered a med.

    2) Pharmacy checked the order, put it on the patient's MAR.

    3) Then the charge nurse got the med out of whatever drug vending machine they use and put it into a syringe.

    4) Then the patient's nurse gave the med.

    Pharmacy is right there in step #2.
    Because this thread has many concepts brought into it, the flow of the discussion is important to consider. My original stance was unsafe due to safety checks. The counterpoint to that was "why trust pharmacy if you don't trust the nurse?" Then someone mentioned is dispensing to which another person defined dispensing as not limited to the pharmacist role. Then, my response to that, which you quoted.

    The quote was about two or three steps away from my original comment that you are now looping back to.

    Whew! Love these discussions but JFC do we all have to be so smart?
  12. by   Julius Seizure
    Quote from dudette10
    Because this thread has many concepts brought into it, the flow of the discussion is important to consider. My original stance was unsafe due to safety checks. The counterpoint to that was "why trust pharmacy if you don't trust the nurse?" Then someone mentioned is dispensing to which another person defined dispensing as not limited to the pharmacist role. Then, my response to that, which you quoted.

    The quote was about two or three steps away from my original comment that you are now looping back to.

    Whew! Love these discussions but JFC do we all have to be so smart?
    I'm just too slow for you guys!
  13. by   1TiredOldNurse
    Quote from JKL33
    No one in the OP scenario is acting as a "practitioner's assistant" but rather as a practitioner in their own right, performing duties they themselves are duly licensed to do.
    Nurses are not considered practioners or dispensing practioners, only physicians,dentists,podiatrists,and veterinarians (at least in Georgia). I understand why the OP's facility does things the way they do. I am just wondering if the facility policy is in violation of state law. You might be surprised at the number of policies some facilities have that are not in accordance with state law. Nurses are responsible for knowing what their individual state nurse practice act allows them to do. I have learned the hard way to never take anyone's word for something that could potentially cost me my nursing license. I'm too old to learn to do anything else

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