Letting CNA pass your meds, bad idea?

Nurses General Nursing

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I fill the cups and check for all interactions and whatnot, but anyone have any negative experiences or can think of any possible neg exp with this?

Thanks

Specializes in Community Health, Med-Surg, Home Health.
I don't understand why some of you are talking about giving narcotics as if that is soooooooooo different from the other meds. I have worked mostly nursing homes for the 12yrs. I have been doing this. Not once have I seen anyone go beyond looking at the mar and giving what is on there. You simply don't have time to assess a resident everytime you give meds. While I would never ask a CNA to give my meds it is not because of any training but the fact that I just don't want to take the chance of getting reported. There are residents that refuse meds and have for God only knows how many yrs. Still getting around fine. Then there are others who take so many I get sick just from pulling them all up. The truth is if you can read then technically you can give any med. But of course we don't do things that way. Complaints are reported to state constantly for all kinds of things. It is always the same senario. They come in and tell the nursing home they have been bad boys. They supposedly correct the problem and life goes on. By that I mean of course they were cleared. What I am getting at is someone can have a bad reaction to anything at anytime. You can assess till the cows come home and still have a problem. I do think it is just dumb and plain mean to report a nurse for example letting a CNA hand MOM to a resident. But just for that very reason with me the resident will just have to wait until I can get to them. I do know of a RN that did the previous example and someone told. Everyone knows whatever their reason was---it defintely was not because they are concerned about the residents safety.

If a narcartic is missing and the CNA can be brought across the table for it, then maybe I can say that it is no big deal, but in the cases that I am aware of, the nurse is responsible and accountable if the CNA makes an error.I do certainly agree, though, that a nurse does not have time to access each and every detail before giving medications...that is not realistic, either.

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Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

Oh this is a wonderrrrfull Idea(not), hell why dont we go ahead and let them (CNA's) go ahead and start are IV's and give are IM's to. Hell why dont we even have them intubate and defibrillate pts. to. Bad ideas I wouldnt risk my license this way.

Rod RN

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Specializes in nursing homes, home health..
If a narcartic is missing and the CNA can be brought across the table for it, then maybe I can say that it is no big deal, but in the cases that I am aware of, the nurse is responsible and accountable if the CNA makes an error.I do certainly agree, though, that a nurse does not have time to access each and every detail before giving medications...that is not realistic, either.
I don't see how anything could come up missing if I keep the keys. The whole thing is just stupid anyway. My point was I wouldn't be so much concerned with whether or not a resident got the med as I would someone reporting me for letting the CNA help.
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Specializes in Day Surgery/Infusion/ED.

Oh my.

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Specializes in OR, MS, Neuro, UC.

Your patient is in pain, requests a pain med and you dispense it to the CNA... for whatever reason the patient doesn't get it, the CNA gets busy, another resident falls, or they could even (rarely) pocket the med........

Your signature is on that MAR!!!!!!!

Either you leave the resident in pain for 4 or more hours or what?????

This is unethical and illegal so why risk that license you worked so hard for!

All the SNF nurses I know concurr that they do focused assessments during med pass...you're giving a patient Lasix..... do they have crackles or SOB? Lets ask the CNA, who has enough of their own work to do, how the lungs sound......

SNF nursing is difficult and challenging due to staffing and patient loads but assessment is still the function of the NURSE as is passing medications. I never want to work that hard again but you get attached to those residents and they deserve good care.

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Specializes in Community Health, Med-Surg, Home Health.
I don't see how anything could come up missing if I keep the keys. The whole thing is just stupid anyway. My point was I wouldn't be so much concerned with whether or not a resident got the med as I would someone reporting me for letting the CNA help.

But what about the guarentee that the patient actually received the medication? I am not arguing that things are busy, but for all of that, and the patient didn't receive the medication, can be an issue. I posted this earlier in this thread that once, as an aide, an LPN asked me to give medication to a patient who had a roommate. I almost gave it to the wrong patient. The one I was about to give it to was coherent, and told me that this wasn't her medication. It belonged to the other one that was 'out of it'. What if it were both of them that were unable to advocate for themselves. I took the medication back to the LPN and told her that I almost made a mistake and was not giving it. As an aide, I didn't appreciate the safety issue of what could have possibly happened. Hey, I was not going to be blamed...the nurse was. You cannot guarentee that something was/wasn't done if you were not present to witness it for yourself. And, if something were to occur, the aide will simply say "I didn't do it". Are you going to ask the aide to take the apical pulse before she gives digitalis? That is like me as an LPN giving an IV push for the RN...that is not my job. If there something occurs behind me giving the push, and the RN had to take the fall, what does that mean?

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Specializes in nursing homes, home health..

In life there are never any guarentees. I can't go around worrying about everything when working in a nursing home. I do the best I can and take care of what can get me in trouble first and foremost. Hate having to be that way but there just is no other choice. So bottom line is no matter what else is going on there is no way I am letting a CNA give my meds. Not because of the reasons stated on this thread necessarily but because I could get into trouble. Many yrs. ago I worked with an RN that didn't know what to do when she found a resident dead that was full code [the man should have been a DNR trust me on that] anyway I asked her if anything was wrong and when she told me and I tried to tell her what we needed to do she wouldn't listen and then it was such a mess. To make this shorter when I got home I called the board to see if I could get into trouble and the investigator told me it was highly possible. Well I couldn't hardly eat or sleep for three weeks. I asked him what for and he said I should have pushed past the RN and done the right thing. I have since found out I am not reguired to do that. Anyway I told him I will do things different next time and he said hopefully I will do what he said. I said no--- I will know better than to ask if anything is wrong next time. After getting my statement the state did not even report me. The RN board took four months to write me for a statement. By then I had cooled off and wasn't about to give a statement that would cost a RN her livelyhood. She made a mistake and I think she learned from it. Without my statement the BON decided to do nothing. The CNA's word alone would not be enough. Had they asked me right after the incident I was so angry at that RN that I would have gladly given a statement. I have never regretted my decision not to. It does make me sick however to know there are people out there who would salivate at the chance to get someone in trouble. Don't get me wrong---if I see any kind of abuse I wouldn't hesitate. But all of this reporting for mistakes thast anyone could make and are not that big of a deal is just ridiculous. And I might add just plain mean.

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Specializes in Community Health, Med-Surg, Home Health.
In life there are never any guarentees. I can't go around worrying about everything when working in a nursing home. I do the best I can and take care of what can get me in trouble first and foremost. Hate having to be that way but there just is no other choice. So bottom line is no matter what else is going on there is no way I am letting a CNA give my meds. Not because of the reasons stated on this thread necessarily but because I could get into trouble. Many yrs. ago I worked with an RN that didn't know what to do when she found a resident dead that was full code [the man should have been a DNR trust me on that] anyway I asked her if anything was wrong and when she told me and I tried to tell her what we needed to do she wouldn't listen and then it was such a mess. To make this shorter when I got home I called the board to see if I could get into trouble and the investigator told me it was highly possible. Well I couldn't hardly eat or sleep for three weeks. I asked him what for and he said I should have pushed past the RN and done the right thing. I have since found out I am not reguired to do that. Anyway I told him I will do things different next time and he said hopefully I will do what he said. I said no--- I will know better than to ask if anything is wrong next time. After getting my statement the state did not even report me. The RN board took four months to write me for a statement. By then I had cooled off and wasn't about to give a statement that would cost a RN her livelyhood. She made a mistake and I think she learned from it. Without my statement the BON decided to do nothing. The CNA's word alone would not be enough. Had they asked me right after the incident I was so angry at that RN that I would have gladly given a statement. I have never regretted my decision not to. It does make me sick however to know there are people out there who would salivate at the chance to get someone in trouble. Don't get me wrong---if I see any kind of abuse I wouldn't hesitate. But all of this reporting for mistakes thast anyone could make and are not that big of a deal is just ridiculous. And I might add just plain mean.

I can attest to what you state about reporting things that are simply too petty to do...there are nurses that have the 'nursier than thou' mentality...very self righteous and annoying....eating and slaughtering the young and all of that. For me, I would never give an aide medication to administer for me simply because there is no guarentee, and if I can't attest to something I didn't witness, then, I should not do it for someone else.

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Because they are sooooooo counted and sooooooo more likely to 'disappear', unlike tylenol or colace.

HELLLLLOOOOO ARE THERE ANY NURSES OUT THERE WHO ARE FOCUSED ON THE PATIENTS, NOT ON THEFT OF NARCOTIC????????!!!!!!!!!!!!!!!! My God, people, wake up! Not one response to this email, as well as the other saying they don't know what the big deal is, says anything about the patient, with whom we are ultimately responsible. Here is the big deal: If you don't have time to assess your patient before giving a narcotic medication, let me know what hospital or nursing home you work at because I will not have my family or myself subjected to such horrendous practice. Let's look at what the adverse reactions are to narcotics, specifically the opioid analgesics. RESPIRATORY DEPRESSION. Opioids depress the medulla's respiratory center. If your patient has respirations of 10, and you failed to do a quick assessment of respiratory rate, and you give them their scheduled/prn dose of narcotic, break out the Narcan, and hope you have IV access. Now since I do not work in a nursing home, I am only making the assumption that the patient more than likely will not have ready IV-access if they are in a long-term facility. "Death from an opioid overdose is commonly caused by respiratory arrest; the victim stops breathing...Accumulated doses, especially in patients with liver or renal failure and in the older adult, can cause an overdose." K. Gutierrez & S. Queener (2003). Pharmacology for nursing practice (p. 175). St. Louis: Mosby, Inc. Older adults have a reduced clearance and medication doses can accumulate in their tissues, thereby effectively causing an overdose. The reason for this pharmacology lesson is two-fold: 1) Is it possible for a CNA to learn and know what will happen or how it happens physiologically in a two week course? I don't know - I was pretty astute as a CNA but it still took me an entire graduate semester of Pharmacology to understand and beaucoup hours on the floor to comprehend the responsibility. 2) Why aren't more of you concerned about what the outcome for the patient will be if we don't have time to assess or we delegate this important responsibility to one with fewer credentials?

Any comments or thoughts?

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
HELLLLLOOOOO ARE THERE ANY NURSES OUT THERE WHO ARE FOCUSED ON THE PATIENTS, NOT ON THEFT OF NARCOTIC????????!!!!!!!!!!!!!!!! My God, people, wake up! Not one response to this email, as well as the other saying they don't know what the big deal is, says anything about the patient, with whom we are ultimately responsible. Here is the big deal: If you don't have time to assess your patient before giving a narcotic medication, let me know what hospital or nursing home you work at because I will not have my family or myself subjected to such horrendous practice. Let's look at what the adverse reactions are to narcotics, specifically the opioid analgesics. RESPIRATORY DEPRESSION. Opioids depress the medulla's respiratory center. If your patient has respirations of 10, and you failed to do a quick assessment of respiratory rate, and you give them their scheduled/prn dose of narcotic, break out the Narcan, and hope you have IV access. Now since I do not work in a nursing home, I am only making the assumption that the patient more than likely will not have ready IV-access if they are in a long-term facility. "Death from an opioid overdose is commonly caused by respiratory arrest; the victim stops breathing...Accumulated doses, especially in patients with liver or renal failure and in the older adult, can cause an overdose." K. Gutierrez & S. Queener (2003). Pharmacology for nursing practice (p. 175). St. Louis: Mosby, Inc. Older adults have a reduced clearance and medication doses can accumulate in their tissues, thereby effectively causing an overdose. The reason for this pharmacology lesson is two-fold: 1) Is it possible for a CNA to learn and know what will happen or how it happens physiologically in a two week course? I don't know - I was pretty astute as a CNA but it still took me an entire graduate semester of Pharmacology to understand and beaucoup hours on the floor to comprehend the responsibility. 2) Why aren't more of you concerned about what the outcome for the patient will be if we don't have time to assess or we delegate this important responsibility to one with fewer credentials?

Any comments or thoughts?

(you quoted me)

First, never is the pt. less important than the theft of a narcotic to me:uhoh3: . Just because i didn't say it on here, doesn't mean my priorities are out of whack TYVW. To me it goes without saying that the pt. and outcome would come first :angryfire .

Second, caps lock (i.e. yelling) is rude.

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Specializes in nursing homes, home health..
HELLLLLOOOOO ARE THERE ANY NURSES OUT THERE WHO ARE FOCUSED ON THE PATIENTS, NOT ON THEFT OF NARCOTIC????????!!!!!!!!!!!!!!!! My God, people, wake up! Not one response to this email, as well as the other saying they don't know what the big deal is, says anything about the patient, with whom we are ultimately responsible. :idea: First of all my dear you need to calm down. I have to say if this is the way you react to most things that upset you or don't agree with your way of thinking I am so glad you are not in the nursing profession. Let me assure you that if you or someone you love go into the hospital or nursing home then there are going to be times when you don't get assessed. Well not so much the hosp. because they have the automatic vital sign thing and other neat stuff you are not going to find in a nursing home. Look----for what it is worth I can tell right away if a residents resp. are low like you say. For one thing they will not be able to take their meds. So I will send them out immediately since I don't want to get into any trouble. See how not wanting to get into trouble can automatically make you do the right thing. If I don't see any reason then I don't do an assessment on a resident when I do my med pass. You better wake up and smell the coffee if you think anyone who works in a nursing home does that. Most of the residents that get narcs. have been taking them for yrs. I guarentee you it no longer affects them. At least not so they would notice. ANd there is no Narcan in the nursing home. But EMS will have some when they get to the home. ;)
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HELLLLLOOOOO ARE THERE ANY NURSES OUT THERE WHO ARE FOCUSED ON THE PATIENTS, NOT ON THEFT OF NARCOTIC????????!!!!!!!!!!!!!!!! My God, people, wake up! Not one response to this email, as well as the other saying they don't know what the big deal is, says anything about the patient, with whom we are ultimately responsible. :idea: First of all my dear you need to calm down. I have to say if this is the way you react to most things that upset you or don't agree with your way of thinking I am so glad you are not in the nursing profession. Let me assure you that if you or someone you love go into the hospital or nursing home then there are going to be times when you don't get assessed. Well not so much the hosp. because they have the automatic vital sign thing and other neat stuff you are not going to find in a nursing home. Look----for what it is worth I can tell right away if a residents resp. are low like you say. For one thing they will not be able to take their meds. So I will send them out immediately since I don't want to get into any trouble. See how not wanting to get into trouble can automatically make you do the right thing. If I don't see any reason then I don't do an assessment on a resident when I do my med pass. You better wake up and smell the coffee if you think anyone who works in a nursing home does that. Most of the residents that get narcs. have been taking them for yrs. I guarentee you it no longer affects them. At least not so they would notice. ANd there is no Narcan in the nursing home. But EMS will have some when they get to the home. ;)

:uhoh3: Yes, I am in the nursing profession, but, I think you missed the point. You should be glad I am in the nursing profession because I seem to be the only one mentioning the patient as the point of concern. In the hospital I work in and teach in, I see so many new nurses that forget about what the patient is in the hospital for and are too caught up in worrying about their career, and judging from the replies to the email wondering about having the keys to the med drawer, or making sure the MAR is signed for, or that a CNA might take the medication for herself/himself instead of the patient still implies that the best interest of a patient is the last thing considered. And, by the way, I was positing an opinion, not slamming anyone who "disagrees" with me. You do make a very valid point - nursing homes do have a high patient-to-nurse ratio, and you can get absolutely slammed. I know I couldn't work in a nursing home because the loads placed on nurses is beyond safe measures. I applaud you. But, it still concerns me that the first statement you make is that you don't want to get in trouble, not "the patient is in trouble therefore..." It sounds as though the DON may not managing the facility very well. It is still unacceptable that assessments are not made, especially when meds are given. Are you telling me you don't always take a blood pressure before you give a blood pressure medication or having an aide get the blood pressure for you? These are simply reasons that it is not a good idea to let CNA's pass meds. The really neat stuff we use in a hospital is our critical thinking skills that helps us the most. I especially like the stethescope. It is really cool and very helpful.

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