Leaving Meds at the Bedside?

[joanna73]

Hi everyone

Although we are responsible to ensure safe, accurate administration of meds, I have noticed on occasion that some nurses will leave pills wlth the pt, and check on them after. This is never a safe practise, and I have had to explain to pts that I need to be present while they take their pills. Under no circumstances will I leave pills. During this time, I also have the opportunity for teaching, if required.

For rationale, some nurses have said: "I know the pt, and they will take the pills." Or, "I'll just be back in a min anyway."

I'm sorry, but if the pt drops the pills, hoards them, or another pt takes them, I have no way of knowing what the outcome is, should I walk away. I also cannot sign off in the MAR if I am not sure. Either way, it's my responsibility. What are your thoughts? Just curious...

[CrazierThanYou]

I'm a student nurse and I haven't been allowed to give meds yet since I'm first semester. However, I am also a medication tech at my job. I always watch my residents take their meds. We have one with dementia and she requires that you hand her one pill at a time and tell her what its for before she will take it. The other day, I went to change her bed. When I pulled the sheet off, pills flew everywhere. One of the other techs has evidently just been handing them to the resident. So, how many doses of each of her meds has she missed??

[Not_A_Hat_Person, RN]

I don't leave meds at the bedside without an order. It became a problem at one job, where I was encouraged to leave some meds at the bedside, then written up for doing so.

[joanna73, BSN, RN]

I'm also not referring to inhalers or eye drops that have been authorized and happen to be at the bedside. Those I would monitor as well, and ensure the pt could take them appropriately. However, pills of any sort I cannot rightly sign off if I am not sure. The pts I have worked with are mainly geriatric and psych, so we need to be very careful. On occasion, when I was on my last unit, we would change the linen and find pills in the sheets, on the floor... One pt we found, for some reason had shoved his pills up his nose, instead of taking them. Plus, if for whatever reason, a pt is suicidal, and starts saving up tylenol....enough can kill them. You really just never know. I have, on occassion also looked in mouths. I live in a busy downtown city, and, believe me...anything happens with some of these people. Yes, I am new, with a lot to learn, but I have also been around. Thanks to everyone for your insights :)

[CoffeeRTC, BSN, RN]

Just wanted to add-- I have seen inhalers left at the bedside. These were brought from home and the pt was familiar with how and when to take them. With those we just ask if they took the inhaler, when it was taken, and chart that pt reports having taken it at such and such time.

In this case, we have an order that may leave at bedside for resident to self administer.

[wooh, BSN, RN]

Please, No flaming me, I"m just being honest here. I'd love to hear some constructive advice on what other's do with this type of situation, which I'm sure most of you know what I"m talking about, that is, if you work on a medsurg floor :)

I, of course, would NEVER EVER leave medication at the bedside. But if I were say, a peds nurse, and had learned that a patient with a severe case of nurse-itis will better take his medication from mom after I leave, and let mom distract him from the horror that was having a nurse in the room, I could totally see where someone may do that.

I could also see, where say a peds nurse, as part of creating a therapeutic trusting relationship with a teenager, who takes a billion non-narcotic meds daily, would make them take the couple of controlled substances while in the room, then allow them to take their other medications that they're expected to take on a daily basis (at home being, of course, without the nurse) slowly over the course of their breakfast like they normally do at home instead of in one fell swoop with the nurse watching them.

My thought is, to get by, EVERY SINGLE NURSE OUT THERE, no matter how holier than thou they might be, has to take certain shortcuts to get through their day. So we all figure out what we're comfortable with, knowing that at some point, we might get caught and have to pay the piper. Anyone that wants to lecture on the safety of my practice, I'll be happy to find what it is that they do that **I** find unsafe.

[wooh, BSN, RN]

On the unit I was on, we had many psych patients, and confused pts, so we could not necessarily trust what they said.

Which is a completely different situation. If one made it through nursing school, I generally hope that their smart enough to know the difference between a psych patient and a typical A&O patient.

[wooh, BSN, RN]

I'm also not referring to inhalers or eye drops that have been authorized and happen to be at the bedside.

It's the same thing as a pill. You're signing that you gave them at x:00pm. Would you swear to a judge that they took those eyedrops at x:00pm? What if they took them EVERY HOUR because you'd left them in the room. What if they dropped the open eye drops in their used bedside commode and STILL used them after? You'd have no way of knowing because you broke the cardinal rule of leaving meds at bedside.

Narcs, I'm particular with. Other things, I don't have a hard and fast rule, as apparently you don't either for all meds.

[joanna73, BSN, RN]

no actually wooh, regarding the inhalers, it depends on the unit protocol. The inhalers are written in the pt MAR, and signed off as "self". This is, of course, the way we were instructed to do this on my unit. That was acceptable. An inhaler that they have been permitted to have at the bedside, I am not going to be as concerned about. A pill that I have given them to take, however, and signed that they took is a different matter.

[nerdtonurse?, BSN, RN]

With inhalers or drops, I get the doc to write me an order "may leave at bedside for patient use" and then have it taken off the MAR, if the patient wants to take them on their own schedule.

With other meds, I watch you swallow it; if I think a patient's "cheeking" the pill, I get an order for liquid or IV meds. My 3rd day on the floor as a nurse, a patient OD'd and died because they had their family bring in meds from home after asking the nurses to "oh, just leave my vicodin right here, it takes me a while to swallow" and the nurses said "no, swallow it or I can bring it back later." If her nurse had done what the patient asked ("Just leave them for me to take later"), it would have been all too easy for the family to say we'd "let" the patient gather enough pills to OD, and nobody would have had a leg to stand on (and it was one of those kind of sue happy families). It stuck with me and I never, ever, EVER leave a med unless I have an order. Fright and watching your first code makes a strong impression....

[Pappilli0n]

I've always thought that you learn best through your errors......I still do.

I quit leaving pills at a patient's bedside when one patient whom I considered the most "with it" patient yelled

out for the whole floor to hear, "WHAT ARE THESE PILLS IN THE CUP FOR?" You simply cannot assume that

even your most stable patient is aware of every thing going on around him/her. Even a stable patient's memory

may not sustain him/her as you might assume.......oops, there's that word again, ASSUME!! There is NO

ASSUMMING ('cuse my spellling if it's wrong) IN NURSING.

It's like the other comments say, you can't chart something if you can only ASSUME it's been done.

[joanna73, BSN, RN]

And for sure, all nurses find shortcuts, myself included. For the most part, everyone is stretched for time. However, for me personally, medication administration is not an area where I am comfortable taking shortcuts. To each his own. At the end of the day, I know that no one is going to back mr up if I documented a med that wasn't taken. Of all things, med errors are one of the fastest ways to face disciplinary action. No thank you. What other nurses choose to do is their business.

[Janey CNM]

A few years ago I had students someplace where a few RN's would pull all their 4-5 patients' meds from the Pixis/Omnicell, then go to the hallway computer, log into each patient's electronic MAR and mark it given "so I won't forget to mark it given later when i get back to the nurse's station." Then they'd visit each pt, do assessment and whatever, which usually took 90 min. But the meds were charted as being given "on time". Now, it got complicated when a student had the pt and we withdrew the med and then discovered that RN had already marked it given- when we caught up with the RN she'd say "Oh, I have A-9's colace and Advil- does the student want to give them since it is her pt?" If med was still in "bubble wrap" with ID info, we'd do it, but I would remark on that fact that the student needed the experience of charting that she gave the med, but MAR showed it was already done." this might be 1 hr later, so the time really given and the time marked in MAR were not the same. Knowing when to give the next dose is then compromised. I did eventually go to the manager and report the repeat offenders, but that meant the students got even less help and nurturing on the unit, as I became the "tattle-tale." I'm much happier now in a clinical site that uses bedside scanner MAK for all meds!