Dropped pills - page 4

by mandaaRN 17,697 Views | 47 Comments

So last night when I was giving my patient her meds in the med cup of course, she dropped them on the floor. It was her synthroid and oxycodone. I told her I would get new pills for her but she insisted on taking them and even... Read More


  1. 0
    duplicate post
    Last edit by nursel56 on Oct 4, '12
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    Quote from Altra
    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 . . .
    Last edit by nursel56 on Oct 5, '12
    Altra, LPNnowRNhopefull, and wooh like this.
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    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.
    Last edit by anon456 on Oct 4, '12
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    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.
    FMF Corpsman likes this.
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    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.
    Last edit by smurfynursey on Oct 4, '12 : Reason: addition
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    Quote from hiddencatRN

    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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    Quote from wooh
    This is now my new favorite thread.

    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 should wash her hands prior to putting fingers in mouth. Informed patient regarding hospital policy to deliver meals on trays rather than on floor. Patient will likely need further education regarding risk of mouth MRSA. At this time, patient does not appear to be open to education on mouth MSSA. Hospital system approved "Things to not lick while you're in the hospital!" handout provided to patient with relevant passages highlighted. Patient voices ability to read. Encouraged patient to request assistance as needed for avoiding inadvertent tongue to doorknob, toilet, floor, faucet contact."

    (For the record, I'm completely undecided if I would chart patient insisting on taking pills that fell on the floor or not. Probably would depend on my mood that day.)
    Lol!!!!!! I'm laughing so hard. Don't forget to add in there that patient was able to teach back what you told them.
    wooh likes this.
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    What makes this one of the greatest threads ever on AN? Both funny AND informative with a good nursing debate!

    Quote from RNsRWe
    BPCT: The Other White Meat.
    It sounds like that pink gel stuff that was in hamburger. Can you get mouth MRSA from eating BPCT off the floor? Will have to add that to the education. Perhaps it could be part of our welcome packet!

    Quote from nursel56
    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 . . .
    I assumed they were licked up. Were they not?

    Quote from anon456

    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.
    Oh, that's nothing. Pancreatic enzymes don't easily go through a g-tube. No matter how much apple sauce you mix them with. I've seen MULTIPLE parents of multiple kids that when it clogs, stick their mouth on the tube and suck to get things moving again. I'm always of the opinion that if it works, and they don't expect ME to do the same, they can suck all they want.
    FMF Corpsman, Miss Lizzie, and nursel56 like this.
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    I would have offered to get her new pills and if she declined and wanted to eat them off the floor...fine by me! I would not have documented it anywhere and I probably wouldn't have given it a second thought.
    wooh and Miss Lizzie like this.
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    A little OT, but this reminds me of when a co-worker had a baby several years ago and was in the hospital post-partum. The RN brought in the pain med she had requested and somehow the pill got dropped. The nurse said "I'll go grab another one" and my friend said, "no! 5 second rule works, I don't want to get charged for another one!", in a half-kidding manner. The RN laughed and said don't be silly, I'll be right back!
    The bill comes a few weeks later, yup, she was charged for the dropped pill AND the one she took. And yes, they scrutinized the bill b/c insurance denied part of the claim. Seems the hospital submitted for a circ. For my friends baby GIRL!
    hiddencatRN likes this.


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