dispensing medications

MissouriBSNstudent · Apr 16, 2008

Do you package/label it for the patient to take home? Or package/label it only to unpackage it at the bedside?

From my understanding of regulations, I think there's a difference.

Trauma Columnist · Apr 16, 2008

In IL, it is not legal either. You might want to bring this up to administration.

Altra, BSN, RN · Apr 16, 2008

I understand where you're coming from, and both ERs where I work have grappled with the same issue.

Hospital A has the pharmacy prepackage 2 or 4 tabs of the most common take-home meds - Percocet, Vicodin, and about 6 other narcs/controlled drugs. Still, occasionally we end up giving 1 or 2 doses of some other med to the patient to take home. Technically, that's dispensing but what else can you do with patients discharged late at night?

Hospital B has a pharmacy "book" in which we must write the patient & MD's names, instructions for use, etc. There's a tear-off sticker with a copy of what we just wrote which is placed on the bottle/package of meds. Pharmacy co-signs this book (after the fact) for the record.

I'm always careful about documenting take-home meds in a narrative note, e.g., "Pt. given 2 Percocet 5/325 tabs to go per physician order, verbalizes understanding of dosage instructions."

nuangel1, BSN, RN · Apr 16, 2008

we do not dispense meds at all.it is illegal to i my state.drs sometimes ask but i always refuse.there are 24 hr pharmacies around every hospital the pt needs to get the meds.

crb613, BSN, RN · Apr 16, 2008

Do you dispense meds, and if so, is it legal?
Where I work, we do it regularly, and it is apparently illegal.
A RN or LPN legally may NOT dispense drugs at any time. Dispensing means the pouring or placing of drugs from stock supplies into bottles or containers, the labeling of such items with the patient's name, medication, dosage and directions and the giving of such bottles or containers to personnel for administering to patients. This is the role of the pharmacist and may not be assumed by nurses.

It would be legal if it was packaged and labelled by a pharmacist, but it isn't. We package and label it ourselves.

Curious what others do.

9309

We do when we run out of the pre-pkgs. I am glad you brought this up. I had just not thought about it as dispensing. We also take cotton balls pour Xylocaine Viscous, Cetacaine, & Tylenol on them....mix....label & give to the pt......guess that is the same thing too.

sfsn · Apr 17, 2008

we do not dispense meds at all.it is illegal to i my state.drs sometimes ask but i always refuse.there are 24 hr pharmacies around every hospital the pt needs to get the meds.

There are not any 24 hour pharmacies in my city, and my hospital pharmacy is not staffed at night. The closest 24 hour pharmacy is over 30 minutes away by car. We dispense meds when it is too late for the patient to get a Rx filled. I think we technically can only use the prepared packs made up by pharmacy, but we also occasionally make up our own pack of other meds to get a patient through the night.

MAISY, RN-ER, BSN, RN · Apr 17, 2008

Our pharmacy fixed this too! Pre-bottled pain killers and single doses to go are in our pyxis with labels, and a sign-out book the physician and nurse sign. It is an excellent process for those 2 percocets or whatever to get through the night.

previously, we'd fight with the doctors regarding giving meds to go. If they needed percocet for pain and were driving, I'd make them get someone to pick them up before dispensing and taking in front of me. If not, sorry.

Will not lose my license for state and hospital rules.

Maisy

b eyes · Apr 18, 2008

I work in a small rural ER. We have an automated dispensing machine in the waiting room. "Insty meds". but in the case where the patient doesn't have any $, we will send them home with a few meds. Now my DON said that as long as the MD verifies the med being packaged, that we are not dispensing. So that is how we do it. Whether it is right or wrong, I don't know. But has the approval of our DON, who was a Legal Nurse Manager prior to coming to our facility.

RedSox33RN · Apr 18, 2008

We don't dispense any meds in our ED. We have many, many uninsured pts who are always looking for 'samples', and many don't believe the we don't have any at all. I feel badly, because I know a lot are unemployed and/or uninsured, but the best we can do is refer them to either Wal-Mart for their $4 rx's (we have a list of what is on that list) or social services.

RNcDreams · Apr 22, 2008

Hmm.....

I think there is a difference between giving 2 percocets go to (in original blister packs, and Dr.'s instructions with appropriate patient teaching)

AND

Mixing a bottle of Amox and then giving the remainder to mom in the bottle after making a label with instructions on it.

My general gut instinct is that the pre packaged percs are fine, but if the doc wants me to send them home with the amox I mixed, they can fill out the label and sign it themselves.. and then I'll ensure the label is on the bottle, document that they did it and give instructions/teaching as appropriate.

What do others think?

sfsn · Apr 23, 2008

Even if we send them home with a couple of percs, don't we still need to put them in a bag/container, labeled w/ instructions? And either way there needs to be appropriate patient teaching, right?

I don't really see the difference in the example between the percs and the amoxicillin.