Giving perscription drug and not documenting it.

[akascrubs]

I have a client in HH that get's eye infections frequently due to not washing hands well enough, even though she's been taught and reminded to do so by all of her nurses. She was seen by her doctor and perscribed Tobramycin eye drops for one week. That infection was cleared. When in occured again, the primary nurse said the client did not want to go to see the doctor again, and just wanted to use the medication we still had. The medication is not ordered prn, and is not documented on the MAR. This nurse says that the client can refuse or take meds as she wants, however she is incapable of administrating the drops herself, so we nurses do it. I feel that we are not in compliance, and asked to get an order for it, and the primary nurse said no. The clinical manager agreed with her. Is this okay because it's HH care?

akascrubs

[MrChicagoRN, RN]

No. The patient is free to do whatever she wishes with her own property. But if the nurse is administering it, it should be ordered

[iluvivt, BSN, RN]

Can she give it to herself or have a friend do it. I often have pts that want to change their premed dosage and I just have them self administer and chart that as such. If they take it as ordered than I have no problem administering and then documenting as such.

[nursel56]

Best practice doesn't change when we're in a home environment though there have been a few times when patients have asked family members to give things we don't have a current order for. I would call the doctor and tell him or her what the patient's current symptoms are before proceeding as if it was the same thing, putting the legal responsibility for diagnosing back in the doc's hands.

He or she may have something different in mind for what is starting to look like a chronic problem. Not sure if you meant the order was never in the MAR or the home chart, but if not it should be. We had to put all our OTCs, and even some herbal products in the MAR with a current order in place. It gets nuts sometimes, I'll admit. Some day I'll tell my story of the horrible, very bad, awful toenail fungus and the ensuing drama.

[mariebailey, MSN, RN]

There may be a good reason why she was only prescribed it for one week. Prolonged use of tobramycin can lead to ocular hypertension, possibly affecting her vision. I would not continue to administer those drops beyond the prescribed length of time, nor would I encourage the patient to find another means to continue it without another visit to her doctor.

[morte, LPN, LVN]

not exactly the question asked.....but is there some intervention that could be done to get her to wash her hands more often? Is she WC bound and finds the sink hard to reach? Would liquid soap be easier to handle? Perhaps hand sanitizer? Perhaps a weekly "manicure", ie short, clean nails........good luck.