Can I - as an RN - recommned OTC drugs?

[mischaj718]

hello all,

so i have a question for all you lovely nurses. i tried to find the answer in the nurse practice act, but can't seem to find it (then again, maybe i'm not looking in the right spot).

being a fairly new nurse, i am wary of what i can and cannot do (what my scope is). i am even wary to recommend otc drugs. then the nurse that i was training with was telling me that if a patient calls in with chest pain, you can recommend that they try maalox to see if that helps, while you inform the md (i work in ambulatory nursing, but my title is not advice nurse, but, sometimes pts call with sx, so i do a little bit of "triage" - if you will.). i am honestly scared to advise them to take otc's because what if they have some condition that contradicts maalox etc.....i asked the other rn's and they said "yes, you can recommend otc's". so, i accepted this as true.

then, today, i was perusing the brn website with the disciplinary actions and came across one where a nurse was disciplined for giving (pt who was c/o chest pain) maalox without an md order to a pt. (however, i believe the more relevant reason for the discipline was that he sent the pt back home telling him to wait for the md in the morning). however, on the list of things he was being disciplined for was "respondent's administration of maalox without a physician's order exceeded the respondent's score of practice".

so, i beg the question: can rn's advise/recommend otc's to pts? i worked so hard for this license, i will be struck dead before i lose it to something dumb.........

thanks in advance!!!!! :d

[CFitzRN, ADN]

I think there is a pretty big difference between recommending an OTC to a patient and actually administering something in a hospital or other facility setting. There are usually standing orders in the hospital for stuff like that, and if there is one, then the RN can administer it. As a family practice nurse and a recovery nurse, I recommend OTCs all the time. But I only give one when the doctor has ordered it.

[SuesquatchRN, BSN, RN]

I sure wouldn't, unless you have a set of standing orders from the physician or practitioner under whom you work setting up a protocol for said telephone triage.

When you prescribe, even a Tums, you are diagnosing. No-no.

[labrador4122, RN]

No not at all.

I used to give tylenol to my patient's parents all the time (I'm a peds nurse) and just the other night, I heard the nurse manager telling all of us RNs on the floor to stop doing that because one RN got sued for doing that, and the parent got a reaction from the tylenol.

so no way. If the headache is really bad, they need to go down to the ER to be seen.

sorry. I am not putting my license on the line for anyone.

[RunningRNBSN]

Absolutely not -- in fact, when we discharge our patients, our physicians write prescriptions for OTC meds (I think most physicians do) to have a record that they recommended the patient take the OTC med.

"Recommending" an OTC med is essentially practicing medicine without a license. If a patient asks about an OTC med, I might tell them the purpose of the medication and tell them that if the doctor did not prescribe it, it would be best to talk with the pharmacist to see if they recommend an OTC med.

[CathyLew]

I'm sure many here have been in the situation.... 2am, they served something spicy and nasty in the cafeteria that day....the patient calls, has heartburn....says at home they always take Tumms or Maalox at night for sour stomach..... assure you its not chest pain, not nause, not anything they are in the hospital for.... there is a bottle of stock Maalox on the med room shelf.

call the Dr? **** him off? or give a small shot of Mylanta. What can that hurt? Its just mylanta......

well, it is dispensing a med without first dose review. It is perscribing without a MD order, or licence to do so. Its administering a chargable medication without being able to charge for it. ...It's putting your licence on the line.

One of our nurses lost her licence for giving Maalox without an order.

MD's will not always back a nurse on a judgement call.

I'll give the pt crackers, give them gingerale...if that doesn't work, I'll call the MD at 2am and listen to them yell at me.

The patient can tell me....What's the big deal? They gave it to me last night.... Still Not worth it.

and as far as talking to the pt about OTC meds... I have told patients in conversation differen't OTC's I have taken, and different herbal medsI have taken. But always follow up with...you need to do what your doctor and you decide is best.

[mamamerlee, LPN]

Try to avoid recommending anything to anyone. You don't know their hx, all the sx, dx, allergies. I have been known to occassionally say 'sometimes when I feel xxxxx, I have taken yyyyy with good results. But I don't know if that would be right for you.'

[mischaj718]

thank you all for your replies. i will stick to my original gut feeling.....i just flat out don't feel comfortable telling them to take any kind of med without the md okaying it first. i told the md i work for and he said "you can always feel free to ask me first."

i feel much better now. it's just isn't worth losing my license that i worked so hard for.....

heart-felt thank you to all!!!!!

[firstaiddave908]

I would play it safe and let the MD do it so your license is protected

[TakeTwoAspirin, MSN, RN, APRN]

I have become very careful not to suggest OTC drugs, even to friends and family. If the person knows I am a nurse then there is no way that they can separate my personal opinion from a professional one. There will always be that thing in their head that she's "a nurse" so has some professional insight behind my recommendation when the truth is that I'm actually probably just recommending what works well for me. The distinction can be gray though when you have an RN after your name. I just don't get into it. Same goes when friends/relatives want to show me something (usually on some part of their body I really don't want to see) just to see what I think!

[MomBSN]

First off, I'm going to recommend that you contact your local board of nursing. They are experts on the scope of practice of RNs in your area :)

Second, I am assuming you are in an outpatient setting and if the job expectation is that you will do some "light triage" there should be protocols, telephone triage reference and policy available to you.

I'm hoping the recommendation of maalox for chest pain is just a quick example of part of the recommendations and not the complete telephone triage (as this recommendation is incomplete as well as dangerous). I have done triage for a number of years in person as well as via telephone and I have recommended the use of OTC meds (which were per the recommendations protocol/algorithm, policy and therefore well within my scope of practice).

I want to encourage you to seek out these resources so that you may grow confident in your role as an RN. Good luck!

[Patricia Emery]

You can recommend OTC drugs to friends and family as you are not practicing nursing in your private relationships. If you think an OTC med might benefit a patient, run it by the attending physician. If he agrees with you, you might say something to the patient like, "Dr. Attending thinks that (drugs name) might help with your (symptom being addressed.)" Or, you might simply ask the MD to recommend the drug.