Dropped pills

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tewdles, RN

3,156 Posts

Specializes in PICU, NICU, L&D, Public Health, Hospice.

I document that behavior because I am signing responsibility for administering the med, and using a med off the floor is outside of my policy/procedure and training.

In my setting pills get dropped on the floor frequently. In my setting, pets frequently get ill and sometimes die because of those dropped pills...for instance chihuahuas and oxycontin don't mix well! I am just glad that the dog and not the toddler found it!! Another consideration is the patient who routinely takes pills from the floor. I observed a patient drop a tea bag, reach down to pick it up and found a pill by the leg of her chair...so she took it. I was alarmed and asked her what it was and she actually had no idea, she just presumed it was one of hers and that she should take it.

I suppose that these scenarios are more specific to those patients who are not in the acute care setting, but I hope they provide another perspective as to why we might want to make a note as to the habits or behaviors of our patients related to their meds.

Altra, BSN, RN

6,255 Posts

Specializes in Emergency & Trauma/Adult ICU.

I don't view this as irrational, erratic, or worthy of documentation. The patient is simply dulicating what would be common behavior at home. And ... please consider that the patient may very well be worried about the cost of being "double-charged" for 2 pills.

We're talking about a dry pill coming into probably less than 15 seconds' worth of contact with a (presumably) dry floor.

The decision to administer a pill that had dropped on the floor should be based on the circumstances at the time. I deal mostly with the elderly, and they can frequently drop the pills. If the medication is a floor stock, or a medication I know to be a cheap medication - I would not hesitate to get new medications. Additionally, if a verbal response from the patient is to give them the pills anyway - and there is not an obvious contaimination - it's probably ok to give them.

On the other hand, many people still believe that cleanliness is next to Godliness - so you have to base it on your circumstances. If in doubt, don't consider anything other than getting new medication.

Documentation on this subject is a personal choice.

Susie2310

2,121 Posts

I would have documented what happened.

RNsRWe, ASN, RN

3 Articles; 10,428 Posts

My note would then continue: "Educated patient that she should not continue to eat pills off of the floor. Informed patient that nursing staff would not purposefully administer oral meds via the floor. Patient voiced understanding. Educated patient to not lick doorknobs. Informed her of the risk of mouth MRSA. Patient also educated not to lick faucets, toilets or friends' oozing pustules. Continued to educate patient on the risks of mouth MRSA. Informed patient that after touching friends' oozing pustules that she ......edited for brevity.......

OMG, I just made this weird snorty sound when I laughed! You are now my favorite charter, hands down, lol......

RNsRWe, ASN, RN

3 Articles; 10,428 Posts

....or starts doing other bat poo crazy things......

enjoying this thread tonight! And then imagining what might constitute Bat Poo Crazy Things, lol....!

BPCT: The Other White Meat.

I think I worked too long today....

allnurses Guide

nursel56

7,078 Posts

Specializes in Peds/outpatient FP,derm,allergy/private duty.

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allnurses Guide

nursel56

7,078 Posts

Specializes in Peds/outpatient FP,derm,allergy/private duty.
I don't view this as irrational, erratic, or worthy of documentation. The patient is simply dulicating what would be common behavior at home. And ... please consider that the patient may very well be worried about the cost of being "double-charged" for 2 pills.

That's why we don't discard pills each and every time this happens in home care, too.

***

Wouldn't the wording of "ate pills off floor" lead one to believe the person ate the pills directly off the floor? People do some strange things sometimes . . .

anon456, BSN, RN

3 Articles; 1,144 Posts

Why would you document it? How is it pertinent to the patient's nursing diagnosis, plan of care, or response to treatment?

It's a patient safety issue and an education issue. Just like I document if I see a patient's mom not using sterile technique when suctioning her kids' trach or cathing her kid. We get this kind of thing a lot with our chronic total care kids that come in and parents want to participate in care like they do at home. The worst thing I ever saw was a mom bite a pill in half, crush the other half and put it down kid's gtube. Even with education sometimes the parents do things that absolutely have to be documented. If the kid gets an infection we don't want to be blamed for it but I will continue to educate until I know they understand.

5 second rule! Kidding. I would document even though she crawled on the floor and took them despite your effort to prevent it. If she ever brings up swallowing pills that were dropped on the floor to another provider, you have documentation that you advised against taking them and offered an alternative.

smurfynursey

238 Posts

Specializes in peds palliative care and hospice.

What I do in practice (offer the pt. another round of meds) and what I do for myself are different things. I would have done exactly as the OP did, and may have charted it.

As for me and my house, we observe the 5 second rule when it comes to medications.

Speaking as someone who has no insurance, I would not be happy if I had to pay for another set of pills if they appeared clean.

FLmed

159 Posts

We have a place to chart narratives everywhere I've worked. "Patient updated on plan of care, given meal tray, ate pills off floor at own insistence. Family at bedside."

This narrative made me giggle. Lol

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