Giving meds that another nurse has drawn up??

DeLana_RN, BSN, RN · Oct 23, 2006

Coming to clinic dialysis from hospital nursing I found out quickly that things can be very different in an outpatient setting - all regulated (or at least tolerated) by the BON*.

According to my large national for-profit company's P&P meds had to be drawn up no more than 4 hours before they were to be given; EPO was to be stored in the refrigerator (I often saw the syringes right on top of the warm machines :icon_roll - but I digress). It was encouraged, though not required, that each nurse give the meds that he/she drew up; later our clinic changed P&P to require that the team leader (usually RN) draw and give all meds.

We had labels for each patient with the drug name (EPO/Zemplar/Venofer; rarely others), dose, date, and a place for the nurse's initials. In a pinch, I would give a colleague's meds (e.g., if their patient was about to come off the machine and they were busy with another and asked me to do so). This was fine according to company P&P, but I do realize that the BON would consider it a poor excuse if anything went wrong.

In a nutshell, you probably need to check the company's med P&P. It should have detailed instructions regarding who/what/how/when etc. But realize that there are some differences from state to state so in case of a national company it may sometimes just state "if allowed by state law".

HTH.

DeLana :)

*There are also other things allowed in this setting in some states that are far scarier than nurses giving meds drawn by other nurses: meds drawn and given (po, IM, even IV!) by UAPs, UAPs accessing central lines and even doing assessments including heart and lung sounds. For an interesting discussion on this subject see the thread "What do your PCTs do?" below.

Trauma Columnist · Oct 24, 2006

Thanks for the info. Our UAP's don't give meds. The pts have to "self-administer heparin bolus."

I did talk with the manager today (she recently took over this large unit) and she actually is addressing some things pretty quickly.

DeLana_RN, BSN, RN · Oct 24, 2006

Please don't get this wrong, and this has come up because in my state it is illegal for UAPs to give heparin (so the patient excuse was sometimes used by nurses who could not be bothered to do this for them as they were supposed to do): where did the patients get their license?

DeLana :)

Trauma Columnist · Oct 27, 2006

DeLana - I work in IL and in IL you have to be a licensed nurse (either LPN or RN) in order to give meds too. That is why the pt gives it. However, we have several patients with severe dementia (another whole story) and yes, I agree, most of my patients have no clue what they are doing.

Thanks much for the info.

DeLana_RN, BSN, RN · Oct 27, 2006

DeLana - I work in IL and in IL you have to be a licensed nurse (either LPN or RN) in order to give meds too. That is why the pt gives it. However, we have several patients with severe dementia (another whole story) and yes, I agree, most of my patients have no clue what they are doing.
Thanks much for the info.

As you obviously realize, the center(s) have no business letting the patients give their own meds (hmm... why can't they do their own assessments as well?!)! But this is how some centers try to "get around" the law in states where UAPs aren't allowed to give lido and/or heparin. And then who signs for the meds? The pt? :uhoh3:

The pace in chronic dialysis is brutal - especially during turnover - and in today's cost-cutting environment (fewer RNs and LPNs, more UAPs, and higher ratios for all) many will find a way around the law... either endorsed by the clinic, as it seems to be in your case, or on their own (a PCT friend told me that I was the only nurse who didn't require/allow the PCTs to give their own heparin - which they have no business doing! :madface:

DeLana

P.S. As for the dementia patients - that's another sad story, would be an interesting thread.