Administering pt supplied mess from OPEN multi-dose vials. Opinions?

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I've been an RN, BSN for 18+ years and have worked in healthcare for 29 years in multiple roles/settings. 2 months ago I accepted a position in a large Primary Care practice. There was 1 LPN when I started, then I was hired. Two weeks ago a 2nd RN was hired and today a third. I have many questions that I would like to ask your opinions on. I'll start with the most pressing. Keep in mind this clinic has only been in existence for 2 years and has gone from 7 Providers to 26 since the beginning of October.

It is common practice for pt's to bring in vials of meds for MA's and nurses to inject into them. The part of this that has me concerned is once these vials have been opened, they go back home with the pt (they're multi-dose) to be brought back later for us to administer from again. I'm told by our Senior Practice Manager this is common practice in clinics. Our Senior Practice Mgr, Practice Mgr and Clinical Supervisor have NO medical training and our Clinic Coordinator is an MA. They all feel that purchasing foil labels to go over the top of the vial once the cap is removed and the vial has been accessed by a needle is adequate and that it is safe to use as long as the foil sticker is in place when the patient brings it back in. I don't think this is good practice at all. One common med. used this way is Testosterone. This Clinic elects not to stock controlled substances. Other pt. supplied meds are Vit B12, Haldol... We don't know the meds haven't been tampered with once the vial has been opened and leaves our facility. It would be different if the pt or family member were giving the injection. I'm desperate for your opinions as I'm having no luck researching this online.

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This is common in our clinic as well and testosterone and b12 is def one we inject a lot. We don't have the foil stickers for the tops. I always check exp dates and then document in the chart that the "pt was given an injection of (drug/dose) from self supplied medication per protocol with no adverse reaction noted". Before I started at this clinic they did not document but we do now. I also would like to hear others opinions on this!

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I would not do this unless it is very carefully researched and you have written protocols. Contact your board of nursing. It's your license.

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Specializes in Nurse Leader specializing in Labor & Delivery.

It is common practice for pt's to bring in vials of meds for MA's and nurses to inject into them. The part of this that has me concerned is once these vials have been opened, they go back home with the pt (they're multi-dose) to be brought back later for us to administer from again. I'm told by our Senior Practice Manager this is common practice in clinics. .

Per our facility policy, we are NOT allowed to administer meds brought from home that are already open, for the concerns you mentioned. If you PM me your email address, I would be happy to scan and email you our policy on it so you have something to work with.

And if I'm not mistaken, this is actually a Joint Commission guideline. Is that clinic certified by JC? If so, they are in complete noncompliance, which the higher ups might be interested to learn about.

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Per our facility policy, we are NOT allowed to administer meds brought from home that are already open, for the concerns you mentioned. If you PM me your email address, I would be happy to scan and email you our policy on it so you have something to work with.

I'm not sure I'm replying correctly but here goes.....

Klone, thank you so much for your input. I would really appreciate your policy. I access All Nurses.com by signing in directly (not via my FB acct), how do I PM you here so I can get you my e-mail address? Not sure if we're accredited by JC or not. I'm thinking we aren't but will find out. We are part of a large healthcare entity in our area.

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I would love to see your policy as well :)

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Specializes in Nurse Leader specializing in Labor & Delivery.

I think you can't use the PM function until you have more posts. Not sure if the minimum is 10 or 15? So you need to get posting! My email address, both home and work, give my full first and last name, so I can't post it in this thread, otherwise I would just give you my email address and tell you to email me and I'll send you the policy. If I have time today, I will also see if I can dig through the Joint Commission website to see what they have to say on the matter.

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I would change jobs before I would do this because if anything negative ever happens as a result all the fingers will be pointed at you and you will be thrown under the bus so fast it will make your head spin.

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We only have a few patients who get injections. When they bring in the vial from their pharmacy we lock it in a special medication drawer. We add a label with the date opened and keep it in its original box. The vial is kept in that locked drawer till it expires then we either toss out the vial or return it to the patient.

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