Drawing up meds

awheat · Feb 1, 2012

If I did not draw it up, I do not give it. If the client wants it drawn up for the next day, and is going to self-administer, then I will draw it up, and label it, then chart exactly what was done.

merlee · Feb 1, 2012

I used to draw up insulin for more than one home health patient, for one or even two weeks at a time. I am not sure what meds were being drawn in your situation, but it is usually easy to ascertain what should be in a syringe. And we usually labeled just the baggie the syringes were in.

This is home health, not in-hospital, but I understand your hesitation. Who is giving the meds when you are not there? Whoever gives the meds when no nurse is there should do it when you are scheduled to be there, anyway.

If the meds are drawn up, the patient should receive them.

SDALPN · Feb 2, 2012

I've been asked by parents (typically the lazy ones) to prefill syringes for those times they don't have nursing. Sometimes I think its because the parents don't know the dose because they don't have to truely provide any care to their child. Rarely I've seen nurses do it on a case. I'm not comfortable with it at all. I understand most nurses are probably honest and have good intentions. But mistakes happen and I don't want to be the one that makes the mistake.

Another thought....if the parent gives meds from the prefilled syringe and is pulling them out and drops one and puts it back in with the wrong set of meds...you end up giving the med and then you are responsible for the error if its caught or leads to the patient getting injured/sick.

Even most agencies that test nurses prior to hiring them will ask the question about prefilled meds or pouring meds back in the bottle. We all know it happens. But we all know the right thing to do too. If any legal issues ever come up, you've answered that test correctly proving you knew what to do and chose not to do it.

If you are stuck in the situation such as accepting report without realizing that the only meds you have are prefilled, I would call the supervisor and report it to them for further instruction and documentation. I would document the discussion with the supervisor to cover yourself. Then I would call the Dr. so they can document it and provide further instruction. Then if you do go down, you won't go down alone. After the one shift of finding this out....RUN!!! Don't allow yourself to be put in to a bad situation if you can help it.

caliotter3 · Feb 2, 2012

You do not have to follow an unsafe practice just because the others do it. If the family insists on pressuring you to do something that you are uncomfortable with, then the answer is to leave the case after you have dealt with the immediate problem at hand (by contacting your supervisor and/or the MD and following their instructions).

allnurses Guide · Feb 2, 2012

No, I wouldn't give a med someone else drew up, 99% of the time. There are so many factors that can affect a decision like that in home nursing, though. If I knew and trusted the other nurses and it meant the child would miss a dose of his meds, it was a med that remains stable outside of it's packaging I would probably give it.

I've seen nurses make a med error with only one patient, though so I would always err on the side of caution. Luckily, I've never seen people do that on my cases and really can't think of a compelling reason why it would be necessary.

One of my clients has an 89 year old aunt that comes to stay for a few days - the staff at her ALF puts her meds for each day in plastic baggies stapled shut with the date and time she should take them written on the outside with a Sharpie. For something like that it's reasonable to do it.

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mg2312 · Feb 2, 2012

Thanks guys! I know not to give the meds that someone else drew up, I never do that. I was just wondering if it is ok to draw up the meds for the mom for the next day.

ventmommy · Feb 2, 2012

I have a serious issue with not giving meds if there is none left in the bottle. If the parents are that "not on their game" that meds are that low, who is ordering refills and why isn't there already a new bottle? An equally or more serious problem than you giving a med that you didn't draw up, to me as a parent, is you not giving any med at all. What if that is the kid's anti-seizure med? Or insulin?

Is this even possible with many meds that are "shake well" or are crushed pills with a little water.

If the parents and the agency agree on this, then they need some sort of policy and way to distinguish the meds either by color or flavor. My son had a purple med, an orange med, a disgusting smelling yellowish vitamin med, two meds that had to be crushed before each dose and 4 clear meds (one was mint flavored). The only time, I prefilled anything was for appointments. If I filled it, I gave it and our nurse recorded it as given by parent. If the nurse filled it, she gave it.

If the mom doesn't understand how to draw them up, maybe you can take that as a teaching opportunity. If it's just laziness, I don't know what to say. I don't understand hands-off parents.

mg2312 · Feb 2, 2012

I agree, it it a huge problem when parents don't refill meds, at this house if the bottle is empty it's because the other nurses prefilled the syringes for the whole month. I already straightened that problem out by telling the parents, other nurses on the case, and the agency that they must leave some in the bottle because I won't give prefilled meds. As far as teaching the parents...... This is one of those families that "because the nurse has full responsibility of the child" they don't do much with her .

caliotter3 · Feb 2, 2012

If the parents don't do much with the child, then the responsibility to call the pharmacy for refills lies with the nurses. Surely, the people who are prefilling the meds can make a phone call. If not, then you can do it, even at night, if the pharmacy uses an automated system. Now, getting the parents to go to the pharmacy to pick up the refills is another matter. Gentle reminders are usually all it takes. And for that matter, at more than one case where I have worked, the primary nurse would pick up meds at the pharmacy on her way to work with an authorization on file.

ventmommy · Feb 2, 2012

I just do not understand these kinds of parents. And in all honesty, I am not sure that I ever want to understand that mentality.

merlee · Feb 4, 2012

In my case, I had a blind diabetic whose SO and son lived with her but didn't help much. They would only bring her the prefilled syringe from the 'Morning' or 'Evening' baggie at the appropriate time. She had been giving her own shots long before her sight was gone.

The other was a woman with a history of severe depression and other mental illness who just 'got nervous' drawing up two kinds of insulin in one syringe. I always felt she could probably do it, but she would just start blubbering whenever I offered to show her how.

In both cases, these patients had those weekly pill-minders that were prefilled by us, as well.

In fact, I insisted that my patients with more than 3 pills use the weekly minders - it actually LESSENED the chance of errors!

Many people take their meds one at a time, without a good routine. And after 3 bottles, many forget which med they took, which still remained.

I bought those for my own parents, and once they started using the minders were my biggest 'converts'.

Easier to pour for a week at a time than from multiple bottles multiple times a day.

I take 14 different meds every morning, a total of 19 1/2 pills. Much easier to prepour for 2 weeks at a time than to fuss with 14 bottles every morning. Despite this, I count my pills before I take them every day. In 2 years I have mispoured only 2-3 times, usually a pill accidentally went into the next compartment.

Do not jump to conclusions about 'lazy' or 'uninterested' family members. Sometimes they are overwhelmed, or afraid.