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what would you have done??



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Jul 25, 2006 01:11 PM

what would you have done??

Updated Jul 25, 2006 at 01:33 PM by ajaxgirl

I am working LTC in a nsg home environment. I have only been there a few months (I did OR nsg before) and I did 1 yr of LTC back in 1997.

I work on a casual basis depending on my availability.

We had a respite pt, her second night in our facility. She asked for her cough syrup. It was the middle of the night. I checked her orders and NO order in the MAR for cough syrup and no standing orders since she is a respite and not with our house doc. She said she brought in her cough syrup from home. I check the med cart and it WAS in there (no order though but the bottle was a prescription from her doc) and it was a NARCOTIC (Tussionex with hydrocodone). She had 2 coughing spells but nothing horrible. The bottle was unopened and was prescribed in March.

Would you have given it without an order?
Is a prescription label enough as an order?

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12 Comments
No. 1
from michelle126
Old Jul 25, 2006, 01:38 PM

Default Re: what would you have done??
Hmmm. I would have given and written for a one time dose of robitussin. Was she a hospice pt? Did she have any other prns ordered? If it looked like she needed the stronger med and couldn't wait until the am, I would have called the doc.

In LTC, the order needs to be written in the chart and on the MAR. A label wouldn't stand up. You probably already know how much rules and regs we have to deal with
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No. 2
from txspadequeenRN
Old Jul 25, 2006, 01:44 PM

Default Re: what would you have done??
I would have not even accepted the med upon admission without an order to give it, especially a narc.
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No. 3
from cotjockey
Old Jul 25, 2006, 01:59 PM

Default Re: what would you have done??
More than likely, I would have called the doctor on call...that is one of the reasons you pay $75 for a 20 minute office visit...so they can handle your problems in the middle of the night too. (The doctor I worked for told his patients that, so I believe it!) Depending on who the doctor was, I would have given it and got an order in the morning. Some of our doctors would be fine with it...some would not. Also...if it is a hospice patient, here, calling the hospice nurse on call is a really good option...the hospice nurses have a huge list of standing orders that they are able to give to either implement themselves or give to LTC and hospital nurses for their patients.
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No. 4
from ajaxgirl
Old Jul 25, 2006, 02:11 PM

Default Re: what would you have done??
Originally Posted by michelle126
Hmmm. I would have given and written for a one time dose of robitussin. Was she a hospice pt? Did she have any other prns ordered? If it looked like she needed the stronger med and couldn't wait until the am, I would have called the doc.

In LTC, the order needs to be written in the chart and on the MAR. A label wouldn't stand up. You probably already know how much rules and regs we have to deal with
Thank you, I just needed reassurance>

She only had acetaminophen as a prn (no other cough meds) and some puffers. I didn't give the med. I told her I don't have an order to give it but I will check back on her in a few minutes and see how she is (then I would have called the doc for an order if needed)--when I checked on her, she was asleep.

She wasn't happy, she said "but I brought it in from home, I can take it myself at home"

She was only staying at our facility for 1 week and her doc was not our house doc.
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No. 5
from ajaxgirl
Old Jul 25, 2006, 02:12 PM

Default Re: what would you have done??
Originally Posted by txspadequeen921
I would have not even accepted the med upon admission without an order to give it, especially a narc.
I don't know who accepted the med. It shouldn't have been there and it should have been locked in the narc drawer and wasn't and it should have been counted and wasn't.
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No. 6
from ajaxgirl
Old Jul 25, 2006, 02:14 PM

Default Re: what would you have done??
Originally Posted by cotjockey
More than likely, I would have called the doctor on call...that is one of the reasons you pay $75 for a 20 minute office visit...so they can handle your problems in the middle of the night too. (The doctor I worked for told his patients that, so I believe it!) Depending on who the doctor was, I would have given it and got an order in the morning. Some of our doctors would be fine with it...some would not. Also...if it is a hospice patient, here, calling the hospice nurse on call is a really good option...the hospice nurses have a huge list of standing orders that they are able to give to either implement themselves or give to LTC and hospital nurses for their patients.
The pt was only staying for a week in our facility and there were no standing orders. It was not our house doc, so I was unfamiliar with him.

But if I gave the med and got an order in the am, what if something happened, I would be left holding the bag.
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No. 7
from banditrn
Old Jul 25, 2006, 03:20 PM

Default Re: what would you have done??
Nope, I would never give a narc anything without an order! That said, if it was there, and the patient needed it, I'd be calling the doc.

Not everyone agrees with me about calling the doc at nite for a LTC patient, and I don't call for stupid stuff, but if the patient is having distress, you bet he'll get a call. That's what his job is.
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No. 8
from achot chavi
Old Jul 28, 2006, 09:37 AM

Default Re: what would you have done??
Originally Posted by cotjockey
More than likely, I would have called the doctor on call...that is one of the reasons you pay $75 for a 20 minute office visit...so they can handle your problems in the middle of the night too. (The doctor I worked for told his patients that, so I believe it!) Depending on who the doctor was, I would have given it and got an order in the morning. Some of our doctors would be fine with it...some would not. Also...if it is a hospice patient, here, calling the hospice nurse on call is a really good option...the hospice nurses have a huge list of standing orders that they are able to give to either implement themselves or give to LTC and hospital nurses for their patients.
Unless you have the authority to give meds without a doctors order (are you licenced...) you MAY NOT give so much as a Tylenol without an order. If the patient is suffering- I don't care what time it is I call the doctor. 9 times out of 10 the doctor just forgot to add the order to the list!!!
You gotta determine what is the most important- your patients comfort or the doctors.
Of couse when you wake up the doctr do it gently and be apologetic.
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No. 9
from achot chavi
Old Jul 28, 2006, 09:41 AM

Default Re: what would you have done??
Originally Posted by ajaxgirl
The pt was only staying for a week in our facility and there were no standing orders. It was not our house doc, so I was unfamiliar with him.

But if I gave the med and got an order in the am, what if something happened, I would be left holding the bag.
TRUE STORY- my DON was a new nurse when a pt came in with a fever and requesting Tylenol- the doctor TOLD her to give the Tylenol- the nurse refused until she got a written order- the doc made a big deal out of it but shortly after receiving the order and giving the Tylenol- the Pt died.
NEVER give a thing without an order ( a standing order is OK if you have it in writing)
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