Am I expected to give medicine from unlabeled home cassettes??!!

[lashuna1028]

Ok, for the nurses working in long term care and assisted living facilities you may have run across this issue. We have a respite client admitted from home that will be staying with us for a few days. I have orders from MD in the chart for his meds but the family brings all of his meds already prefilled in those home cassettees (you know the ones with the days of the week on them) UNLABELED. No prescription pill bottles or even OTC bottles for that matter...just these cassettes...And whats even more surprising is the director of nursing here, RN BSN knows about this and these pills were actually written on the MAR for us to give. The morning nurse has been giving them and has been signing them out on the MAR but I am the only one that seems to have a problem with this. I am NOT giving these pills to this man and I am going to sign them as NOT given! I dont know what they are and even if I could identify some of the pills I still dont know if they are contaminated or expired! I need input from other nurses regarding this. I would like backup on my decision and even where I could find where it talks about this somewhere in Nursing Practice Act as a resource. Thanks

[nurse2033, MSN, RN]

I wouldn't give an orange to a patient without the proper labeling. Protecting your license comes right after your life and your family. If possible, talk to the pharmacy. Where I work, they identify and label unlabeled pills. If the meds are in other forms they may not be able to do that. You are right on! Even if your employer is lax enough to allow it, they should recognize your right to refuse to play along. Good luck.

[HamsterRN, ADN, RN]

We do give these where I work after we have identified them. We use micromedix for identification and this is done either by nursing or pharmacy. We are required by CMS to allow "patient's own" meds (if they can be reasonably identified) to observation status patients since CMS will not cover facility provided medications for these patients. It's a pain in the butt, but not as much of a pain as paying $14 for a tylenol is for someone on a fixed budget.

[AgentBeast, MSN, RN]

We would buy my grandmother's prescription drugs and then provide them to the nursing desk at the LTC facility she was in and they would dispense them to her as prescribed. However, we would provide them still in the original bottle still stapled into the bag. The receipt and the informational flier were still attached to the bags.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

Signing the MAR means you're completely responsible for knowing what you're giving, what side effects and interactions to watch out for, etc, etc. You're absolutely right in not giving, signing for, and taking responsibility for what could be candy, medication, or rat poison for all you know. My suggestion is that you go with your gut on this even if it means finding a new job. I don't want to hear about you on the news as "The Nurse that gave unknown pills to a patient and killed him." I hope that if I or my family need health care, you or someone as well trained is their nurse. Nurse long and prosper, sister.

[HamsterRN, ADN, RN]

It's really not that difficult to ID medications with a decent resource. I'm not sure that it's better nursing practice to un-medicate a patient than just identify and label the meds. It's not really fair of nursing to encourage use of these organizers and then punish patients for following our advice.

[lashuna1028]

Well being able to identify the drug is not the only point here, even if I could identify the pill (which most of them I can) that still doesnt validate its expiration date or contamination, especially with capsules which can be opened. I like to be able to open my pills out of the package or bottle it came in. Thats just like giving a prefilled syringe to someone with a written label another nurse put on it for you. If I didnt draw it up out of the bottle it came from, I'm not giving it. Its not that Im so suspicious of foul play but this should be standard nursing care.

And Im not saying its not okay to use your home meds because I know people are on a fixed income and etc but whats not okay is to just hand me some lose pills in a sandwich bag or cassette and say give this to my father at this time.

For those that want to use their home medicines they should be required to have them still in the prescription bottle or OTC bottle

[diligent-trooper]

Oh my goodness!

[diligent-trooper]

Well, it is not following the basic proper policy and procedure: The five Rights of medication administration. How is one able to determine if it is the proper drug(s), and dosage? My goodness! The awkward situations and circumstances they force the Nurse to deal with are unconscionable. Stop the Insanity!

[HamsterRN, ADN, RN]

Well, it is not following the basic proper policy and procedure: The five Rights of medication administration. How is one able to determine if it is the proper drug(s), and dosage? My goodness! The awkward situations and circumstances they force the Nurse to deal with are unconscionable. Stop the Insanity!

Commonly available drug identification resources which will tell you the medication and dosage.

[lashuna1028]

Commonly available drug identification resources which will tell you the medication and dosage.

True and again with that being said does it also tell you if that medication is expired or contaminated? That pill could be 2 years old or even coated with cyanide or lead poison. Isnt the quality of the drug also important? If these are not legalities then maybe its ethics. I work with Alzheimer's patients so I am even more of a patient advocate... maybe I am being a little over protective??

[whiskeygirl, LPN]

I would call the Doc for orders for a few days worth of current meds. Then take the order to a pharmacy and have the few days worth filled. I would discuss the matter in front of the the DON and the home administrator.