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

BabyLady, BSN, RN · Sep 18, 2010

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

This has happened at our facility.

We have a computer program that identifies every pill when you type in the description and a picture of it pops up with a good zoom, so you can be sure it's the same thing and what concentration it is or if it's expired...b/c the bottle that they brought may not even be the original bottle. Contamination...you don't know that with any home med anyway, labeled or not.

Just because someone brings in a prescription bottle, doesn't mean the contents match what is inside...you still have to be responsible for identifying it.

So, as long as someone went through and positively ID'd every pill...yes, I would be ok with the administration.

BrnEyedGirl, BSN, MSN, RN, APRN · Sep 18, 2010

I'm curious as to what software you use that can tell if a med is expired? I don't work LTC, and I do understand the cost savings of a pt being allowed to take there own meds....however there is no way I'd give a med that didn't come from the original bottle,..and even then I'd look them up to be sure that what the label states is really what's in the bottle.

When I worked on the floor we used to have respite hospice pts that were allowed to bring their own meds,..however we turned them into the pharmacy and the pharmacy dispensed them just like the other meds,..and yes there was a charge for that,..the only way around it was for the pt to take their own meds without the assistance of the nurse,...I charted meds taken per pt.

Sarah010101 · Sep 18, 2010

7 rights of administration: right patient, right dose, right drug, right time, right reason, right route, right documentation.

The same thing happened to me. I could see how even thought you KNOW what the drug looks like... you still cant tell where its been, how old it is etc. however what happens when you get a blister pack?... its the same thing.. (except you know it comes from pharmacy.. but mistakes DO happen). Perhaps in the future ask for the actual bottles.. or request the family brings in the Rx reciepts or even bottles. Maybe even a call to the pharmacy with pt family permission to double check the medications. It is YOUR name that goes onto that mar. YOUR responsibility. and if you feel uncomfortable giving those meds, DO NOT GIVE THEM. Who cares if nobody else has a problem with it, dont go with the flow just to prevent rocking the boat. if someone else is comfortable doing it let them. But it is your licence... your job... your responsibility to protect not only yourself but your patient :)

steelydanfan · Sep 18, 2010

Any meds that a person brings from home must be sent to the pharmacy for inspection and relabeling. Giving a med which has not been so inspected leaves a nurse open to "dispensing without license".

HamsterRN, ADN, RN · Sep 18, 2010

Any meds that a person brings from home must be sent to the pharmacy for inspection and relabeling. Giving a med which has not been so inspected leaves a nurse open to "dispensing without license".

Definitions and requirements for dispensing could vary by state, but in my state this is not dispensing since the drug is not being packaged and labelled for a patient to self-administer. Even if it was, Registered Nurses are allowed to "dispense" in at least some states.

From the State of Missouri DOH: (not my state)

"Dispense

The act of dispensing includes the selection and labeling of prepackaged medications ordered by the physician or advanced practice nurse to be self-administered by the client. Medications may only be dispensed by a physician, pharmacist, or registered nurse."

HamsterRN, ADN, RN · Sep 18, 2010

I'm curious as to what software you use that can tell if a med is expired? I don't work LTC, and I do understand the cost savings of a pt being allowed to take there own meds....however there is no way I'd give a med that didn't come from the original bottle,..and even then I'd look them up to be sure that what the label states is really what's in the bottle.
When I worked on the floor we used to have respite hospice pts that were allowed to bring their own meds,..however we turned them into the pharmacy and the pharmacy dispensed them just like the other meds,..and yes there was a charge for that,..the only way around it was for the pt to take their own meds without the assistance of the nurse,...I charted meds taken per pt.

I use "magic expiration date finder 2.0 for Mac" (just kidding)

While the expiration date of pills in an organizer is unknown, there isn't any way of knowing for sure that a med brought in the original bottle is not expired either since you can't confirm that the pills in the bottle weren't in another older bottle at some point. This came up with our policy on patient's-own-meds, the decision from pharmacy was that since medications typically have a 2 year shelf life and are usually dispensed in 30 to 90 day quantities, it's very unlikely that a patient's own med supply of regularly scheduled meds will contained expired meds; there is a chance but it's not nearly enough of a threat to outweigh the benefits to the patient of using the patient's own meds.

As you point out, whether in an original bottle or not all pills still have to go through the same ID process, making the presence of the original bottle sort of irrelevant.

There is still is a charge for administering a patient's own meds, but CMS and the insurers who won't cover hospital supplied medications for observation patients will still cover the administration costs, just not the cost of the meds themselves (it's hard to blame them at $8 for a single Tums).

BabyLady, BSN, RN · Sep 18, 2010

I use "magic expiration date finder 2.0 for Mac" (just kidding)
While the expiration date of pills in an organizer is unknown, there isn't any way of knowing for sure that a med brought in the original bottle is not expired either since you can't confirm that the pills in the bottle weren't in another older bottle at some point. This came up with our policy on patient's-own-meds, the decision from pharmacy was that since medications typically have a 2 year shelf life and are usually dispensed in 30 to 90 day quantities, it's very unlikely that a patient's own med supply of regularly scheduled meds will contained expired meds; there is a chance but it's not nearly enough of a threat to outweigh the benefits to the patient of using the patient's own meds.
As you point out, whether in an original bottle or not all pills still have to go through the same ID process, making the presence of the original bottle sort of irrelevant.
There is still is a charge for administering a patient's own meds, but CMS and the insurers who won't cover hospital supplied medications for observation patients will still cover the administration costs, just not the cost of the meds themselves (it's hard to blame them at $8 for a single Tums).

THANK YOU!!!!!!

The home meds our patients take are actually kept in the room by the patient...we simply remind them of when too take them.

island40 · Sep 18, 2010

When I set up a cassette for a client in their home I have to make a label for the cassette just like the label that a pharmacy makes - describe the pill, directions for taking, prescriber information and everything and tape it to the cassette. If my clients go to in-patient care they get medication filled in new bottles for use there. I wonder if your client does not have medicaid/medicare and that is why they were not refilled in labeled?

island40 · Sep 18, 2010

We have had a couple of problems with clients getting pulled over by police and having their unlabeled cassettes in the car - quite a tangle with the cop thinking they were hauling drugs - if they have controlled substances (ritalin, ms...) in a large enough quantity in an unlabeled cassette it is a night in the pokey here in IA.

TDCHIM · Sep 18, 2010

We have had a couple of problems with clients getting pulled over by police and having their unlabeled cassettes in the car - quite a tangle with the cop thinking they were hauling drugs - if they have controlled substances (ritalin, ms...) in a large enough quantity in an unlabeled cassette it is a night in the pokey here in IA.

My goodness! I never really thought about that sort of thing being a problem. I keep an emergency container of about 2 days' worth of my meds (some of which are controlled substances) on a key chain. Out of curiosity, what quantity is consider sufficient to land one in jail where you live?

BabyLady, BSN, RN · Sep 19, 2010

We have had a couple of problems with clients getting pulled over by police and having their unlabeled cassettes in the car - quite a tangle with the cop thinking they were hauling drugs - if they have controlled substances (ritalin, ms...) in a large enough quantity in an unlabeled cassette it is a night in the pokey here in IA.

One suggestion that I give to parents (and anyone else that may need the info), is that most people have no idea that the pharmacy will print them off a list of the medications that they are on...and I encourage people to get a new one and to use the same pharmacy EVERY time to make sure that drug interactions are checked for.

I have only given this information, to only about one or two people that were already aware that you could do that...everyone else was unaware and were appreciative of the information.

VicksburgNurse · Sep 19, 2010

We are taught to never give meds that another nurse pulled and signed for. I don't see how this would be any different legally. You didn't pull them...... however your NM or DON might not think your high ethical stand is productive to his/her standard of care however low it may be. Good luck