Meds at bedside

night owl · Apr 2, 2003

Originally posted by baseline
One of the major rules of passing medications. Watch the patient take the med. Period.

.....and make sure they're swallowed. There have been times in LTC we'll find pills on the floor, in the sheets or in their clothes. But it always amazes me how a resident will take a bunch of pills with a whole cup of juice or water and manage to keep the pills in his/her mouth. I don't think I could do that myself.

montroyal · Apr 2, 2003

Originally posted by Disablednurse
When we talk about meds at bedside in LTC, that does not mean taking med during med pass and leave them there for them to take at will. We are referring to mostly ointments and drops that the MD and IDCP team feel that the resident is oriented enough to apply themselves. No one where I worked ever kept any p.o. meds at the bedside. That would be too dangerous.

If you have an order to leave these meds at the bedside and the patient can take these meds by themselves, they should not be on the MARS. The only thing which can be legally documented on the MARS are the meds you have witness the patient take. To document that a aptient applied these meds without you physically watching them do so is illegal. That MARS is a legal record which states the meds were given and witnessed by the person who signs them off. To sign the MARS and not have witnessed the patient taking the meds, opens you to several legal problems and places your liscence at risk.

JNJ · Apr 2, 2003

I'm supporting 'disablednurse' on this. It is reasonably common in (physical) rehabilitation units to have orders/special policies and procedures which relate to a patient taking medications without the nurse present. How else does the patient go from inpatient to assisted living/self care without a supervised transition period? It's also the time when the patients get used to using those pill containers divided by doses and days.

Of course there is an absolute acute care rule about no meds. at bedside and watching the patient take those meds.

But there is also an argument for expert practitioner (see "From Novice to Expert") getting certain rules changed, legally, in order to advocate for the patient who needs to learn this skill before discharge. Circumstances alter cases.

nimbex, RN · Apr 3, 2003

Quote"Believe it or not, threats of loss of licensure/job don't help. We are hoping to appeal to them by showing what can happen to a patient when meds are left at bedside."

Appeal to your policy and proceedure committee or med. exec., or pharmacy committee to write NEW policy which will "prevent" this from occurring. Then give a 5 minute inservice where EVERY nurse signs their name to the policy and a copy is kept in their file. to quote a movie from here on "son, you're on you're own...."

RNKerry · Apr 3, 2003

i work in a respiratory unit in an Australian private hospital. Patients complain if arosols are taken away. One patient was abusing his Salbutamol and so the puffer was locked up, he rang Admin and we recieved a phonecall on the ward from the CEO demanding we returned the patient's property!

Disablednurse · Apr 3, 2003

We did run into having one patient who was very demanding and her doctor would give her anything she wanted no matter what. She got an order to have some of her meds at bedside and could not exhibit that she could get them out by herself. She was a nurse who had bad arthritis. We had to try to explain why the CNA could not give her her med. It was a battle to get that taken cae of. I personally felt that no one should have their meds at bedside, but with resident rights, there were so many things that we were left with quite a problem to figure out. Patients wanted to keep their NTG at bedside, or pain pills. It kept the Care plan team running. We told social services to talk to the family and the patient, since we had to deal with the MD.

boggle, ASN, RN · Apr 5, 2003

Years ago I had a patient who was stocking up on sleeping meds. (I'm thinking they were Dalmane, but can't remember exactly.)

On several occasions, the med was left at bedside for her to take "when she was ready".

We found a cupful of those sleepers in her overbed table one day. She stated she wanted the extras on hand for the nights when one sleeper just wasn't enough.

That sure shed a bit of light on the occasional mornings when she was soooo hard to arouse.

nurseBe · Apr 5, 2003

Very Good points, I agree that meds should not be left at the bedside. We do not know if the pt. will take them or forget about them. Also I do not know how many times my patients have dropped there pills on the floor or in the bed, with me right there!

TazziRN, RN · Apr 6, 2003

A few years ago I went to a university hospital for a nephrectomy. I was told that a) most pts brought their meds from home to take while in house and b) the meds I was on at the time, it was no big deal if I did without them for a week and could leave them at home if I wanted. I opted for B. My nurses were very good about bringing me the meds ordered that were related to the surgery but I never saw any of my maintenance meds. On discharge, when I was packing up my stuff, I found several still-wrapped pills. Lo and behold, they were the same as my maint. meds! No one...not one nurse...ever handed them to me. I took them out to the desk and complained to the charge nurse and stood there while a note was written in my chart about it.

jude11142 · Apr 6, 2003

I work in a LTCF and we have several alert/oriented residents who always try to get the nurse to leave their meds with them(stating that they'll take them later, after they eat, before bed etc). I get the same thing from them, "the other nurse leaves them"..."you're the only one who won't leave them"....etc....I tell them, "well, I'm not the other nurse, so if you don't want them right now, I'll come back with them"..........patients/residents can be very sly too,lol.......I had one guy who take Percocet Q4H round the clock and he asked me twice if I could give him another percocet 2hrs after giving him one. I said, "no, it's too early, you have to wait atleast another hour" I also asked him if he was having increased pain that the one percocet wasn't helping, thinking he would say yes,lol but no, he says the pain is alright......duh!! What am I missing,lol, why did he want another pain pill then,lol.......bottom line, I still said no to his request...what does he tell me? Here we go again,lol, "the regular nurse does, she checks it off as the next Q4h dose and so on.....

There is not way that I am going to lose my license by doing this and further more it is dangerous to leave meds at the bedside. I do see others leaving meds, even found an Ambien on a nightstand, but no way will I do that. There was this one resident who took a med that was left on her room-mates nightstand(a cna saw this)and when the nurse was questioned she said that she placed it down on the nightstand while she went to wash her hands???? The resident was unharmed by this incidence but still............

It's sad too that nursing students are seeing it done and having the nurse tell them that it's ok to because they know the patient and that they will take it afterwards......Our instructors told us that we will see things done the wrong way during our orientations and to always remember what we learned and the right way to do things. Also, if we felt that something was done wrong to come to them and they would handle it.

Last word........it's not good practice to leaves meds with a patient no matter what...

JUDE

mamabear · Apr 6, 2003

I work midnights on an acute adult psych unit, and, by some cruel twist of fate, we pass the 0800 meds while days are still in report. We can accomodate up to 16 patients, and some of them have 10-12 QAM meds. I stand there and watch them until they take each and every med :saint: I've been told more times than I care to remember that so-and-so doesn't hover over them, or so-and-so "trusts" them enough to leave the meds on the table (we pass QAM meds while they're eating breakfast). :rolleyes:

I point out that I'm not so-and-so, who is also a low-grade idiot, but I keep that to myself I would be derelect in my duties if I didn't make sure ALL meds were taken as ordered.

The only thing they can keep at their bedsides are Chap Sticks and LacHydrin. I worked too hard to get my license, and I'm not compromising my principles to win a popularity contest with the patients:nurse: