Medication Question;

What does your pharmacy say? Or, is there an order to substitute? Never substitute one drug for another unless a)there is a sub order for it; or b) approval from doc/pharmacy

I would just circle my initials and write "not avaiable, pharmacy aware" on the back of the MAR.

You could only do so under the direction of the MD or the pharmicist.

Moved to Nursing and Patient Medications for more response.

I suppose it would be a good idea to check with the pharmacy because you would be using 2 tabs instead of 1; but it really isn't substituting 1 med for another because Senna S is sennoside 8.6/docusate50. It is more like giving Furosemide 20 mg 2 tabs when you have an order for Lasix 40mg. Just my opinion; but I wouldn't have a problem with it...but I don't tell other people what they should or shouldn't do.

I see what your saying, but I don't think it's *quite* the same as giving 2 twenty mg lasix in place of 1 forty mg. I mean, if a pt were out of ultracet I couldn't just give an ultram and a Tylenol in it's place? Definetly a gray area.

Now, I don't think this is really a moral/ethical issue at all. We all know giving the sennoside and colace in place of the senna-s will do zero harm. Common sense tells us that. But then, common sense takes a back seat too often in nursing to dogmatic, inflexible policies. This is strictly a "cover your a**" dilemma.

As I said, I would go ahead and do it but everyone needs to do what they are comfortable with. My comfort level extends to giving the 2 tabs to equal the Senokot S, of course this may be related to the fact that I am not waking the doc I've worked with for over 5 years at 2 AM to ask if I can give a generic senna and a docusate because I don't have a brand name Senna S. And Brandon is right, it is probably more of a policy procedure thing; you will get a feel over time as to what is or is not acceptable in your work setting. In hospice and esp. in the home settings (and in the case of OTC meds) there is a lot more leeway.

I would call pharmacy to get the OK instead of calling the MD.

I would substitute all the time when I worked in LTC. Now I would never do that in my current hospital. There is way too much policy and procedure and I'd definitely get in trouble for that!