general question about medications

[Amy2005]

I have read that it is sometimes okay to leave some of

a patient's medications at the patient's bedside (like their

respiratory inhaler as an example).

I was taught in the past to stay with a patient to make

certain that the patient swallowed his/her pills.

Yet, recently I discover medication cups that contain a

group of medications left at patient's bedside.

Why is this acceptable? Is this acceptable?

How can staff know for certain that the patient has

taken the pills (remembered to take the pills) if the staff

hasn't seen the patient take them?

[MikeyJ, RN]

I was always taught to watch the patient take the PO med -- you should never leave them at the bedside. I work with ped's patients, so it is a bit different... but with the older kids, if they are not ready to take their PO meds, I put them in their bedside med lockbox and come back 20 or 30 minutes later to give them. I never leave them at their bedside and hope they take them.

[NotFlo]

At my workplace, we have to get MD orders to leave certain things at bedside.

First, the nurse has to perform a self-administration assessment, and see if the patient is physically and mentally able to manage the item (usually MDIs, creams or eyedrops). It is usually our alert and oriented short stay rehab patients who request to have their inhalers or drops at bedside.

We even have to have one of these assessments signed by an RN and MD to leave a patient with a neb treatment running...if we don't have that form technically we're supposed to stay with them the whole time the neb is running (a neat trick if you have 30+ patients and ten or twelve are supposed to get duonebs at 9 am and each one takes ten minutes...)

Our MDs will write orders that an inhaler, or a cream, or an eyedrop can be left at bedside and administered by the patient if they meet certain criteria as determined by the self-administration assessment and the MDs own assessment of the patient's ability to manage these things.

I've also had patients who want to self-admin. everything, and they can, as long as they can pass the assessment criteria. I had one lady with an insulin pump who did all her own accuchecks and operated her pump completely independently, just letting us know when she need a vial of humalog from the fridge to refill it.

A few have had all their pill bottles at bedside or a pill box that they pour themselves. Most people in rehab figure they might as well take advantage of having a nurse and just let us bring them their meds, even though they do this on their own at home.

Anyway, yes, the nurse is always supposed to stay with the patient and watch everything go down the hatch. This is obviously especially important with a confused patient. Sometime I go nuts because the pills usually don't take long (with the population I work with, anyway) but the liquids and supplements take forever. No one wants to take their miralax, beneprotein, benefiber, two cal etc. etc. that I serve up to what seems like everyone.

[Thornbird]

What Cynop said is what I have seen in practice. It is not acceptable to leave any meds at the bedside without such an order. There is no way to know if the patient took those meds, which they didn't if you are finding them later. Also, if it is LTC where there may be confused patients wandering around the wrong person could take the meds.

[SoUTICURN]

as a side note, you may also be charged with falsifying documentation if you say you admistered a medication without actually doing so.