Giving pts. medications to take home at discharge

Nurses General Nursing

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I know we are not supposed to send anyone home with their hospital insulin pens/inhalers, even though they will only be thrown away by the hospital afterward, but can anyone tell me exactly *why* we aren't supposed to? I've been telling patients that it's against hospital policy (which it is) and that prescription medications can only be given to them through a pharmacy and with proper packaging and literature; but is there any other reason? It kills me to send some of my pts home that I KNOW don't have any intention of filling their prescriptions because they have no money/insurance. Perhaps if I understood why I can't give them their meds I won't feel quite so upset by this. (I'm in PA, if it matters)

I also work in the ED and send meds home all the time.

All discharged patients get a computer printout of their home med list and we write any prescription meds on it that are written in the ED.

We also list any starter packs of vicodin or tylenol #3, ODT zofran, mag citrate, or any other meds given from the omni with directions for taking them.

Other than the six-packs of vicodin and tylenol #3, pts will get only 1 or 2 tabs to take home though.

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At the hospital I work at medications are often dispensed in the ER and urgent care because it is a small town and there is no where to pick up prescriptions outside of normal business hours.

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The pharmacy at my hospital recently adopted a policy of printing & applying 'to go' labels for inhalers, eye gtts, insulin/pens at discharge.

I for one am glad for it. It has ticked me off for years (both as a nurse and a patient) to to see the wastage of throwing that stuff away. The patient (and their insurance) paid for it, it's belongs to them. I can't help but question what 'right' the hospital has to keep it from them, if the patient is to continue the medication after discharge the hospital should be obligated to repackage to satisfy dispensing laws.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I also work in the ED and send meds home all the time.

All discharged patients get a computer printout of their home med list and we write any prescription meds on it that are written in the ED.

We also list any starter packs of vicodin or tylenol #3, ODT zofran, mag citrate, or any other meds given from the omni with directions for taking them.

Other than the six-packs of vicodin and tylenol #3, pts will get only 1 or 2 tabs to take home though.

As a life long ED nurse I KNOW this is common practice............. but it is WRONG...... you should not be giving the meds to the patient the EDMD should! To had those meds to the patients is dispensing and you do not have a license to dispence........Do you have the knowledge to answer any questions about the drugs........are the patients allowed to ask the "Licesnsed" pharmacist any questions?, how do you label the doses to go home? does the patient get a patients hand out informing the patient how to take and side effects? Do you label "May make drowsy or do not drive or operate dangerous material? If you don't there can be a serious problem and you can get in trouble. If properly labeled and instructed it's fine.......if not you can be liable.

These are newer guidelines, rules and regs with the DEA and other regulatory agencies but EDMD's continue the old practices because "it's always been done that way" and besides "they will cover your back"......that is until something goes wrong. You as a nurse have a license to administer....NOT dispense........just because everybody does it does not make it right nor will it save you in the event something bad happends. You need to check with your Board of NUrsing and your hospitals policy and procedures. The EDMD should write the order.....you may remove it from the "pyxis" (the pharmacy has already dispensed it when they filled the machine) and place it into a labeled container with the instructions....when, how much,how often,how long, side effects precautions........the EDMD goes and explains this to the patient waits for questions........you may hand them the SEALED, LABELED package after the EDMD spoke with the patient. There are variations state to state just be sure you are following your states nurse practice act, rules and regs.........I have seen too many really good nurses get unfairly treated because they were unaware of the fine print........:twocents::twocents:

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Specializes in floor to ICU.

We send inhalers, insulin pens, etc... home w/ the patients. The pharmacy puts a layman's label on it so the patient can read the directions.

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Specializes in Pediatric/Adolescent, Med-Surg.

At the hospitals I work at currently it is against policy to send pt's home with meds (even inhalers, insulin pen, things that you know will be thrown away). That being said, working in an inner city hospital and knowing that many of the pts are under/uninsured most nurses will just send it with the pt anyway. I know this may be a bad practice to get into, but when my diabetics can't afford their insulin what are we supposed to do?

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Specializes in ER.

How would any of the above examples be different from dispensing samples in a clinic setting?

At my work, we hand out free samples to uninsured, to patients who are going to test trial a certain medication before they purchase it.

Of course, the RN's have an order to give a certain sample from the Dr, but we still hand them out, with hand written instructions on a bag.

Come on, everyone loves free samples, and I highly doubt the DEA is going to bother raiding every doctors office and clinic across north america

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Specializes in Family NP, OB Nursing.

Where I work as an NP, the RN can hand the samples to the patient only if the sample is in its original packing and only after the doc or NP writes out an RX label that has pt name, DOB, medication name/dose and instructions on it. The label is put on a ziplock type bag and then the meds are put in the bag and sealed. THEN the nurse can give the bag to the patient.

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As a life long ED nurse I KNOW this is common practice............. but it is WRONG...... you should not be giving the meds to the patient the EDMD should! To had those meds to the patients is dispensing and you do not have a license to dispence........Do you have the knowledge to answer any questions about the drugs........are the patients allowed to ask the "Licesnsed" pharmacist any questions?, how do you label the doses to go home? does the patient get a patients hand out informing the patient how to take and side effects? Do you label "May make drowsy or do not drive or operate dangerous material? If you don't there can be a serious problem and you can get in trouble. If properly labeled and instructed it's fine.......if not you can be liable.

These are newer guidelines, rules and regs with the DEA and other regulatory agencies but EDMD's continue the old practices because "it's always been done that way" and besides "they will cover your back"......that is until something goes wrong. You as a nurse have a license to administer....NOT dispense........just because everybody does it does not make it right nor will it save you in the event something bad happends. You need to check with your Board of NUrsing and your hospitals policy and procedures. The EDMD should write the order.....you may remove it from the "pyxis" (the pharmacy has already dispensed it when they filled the machine) and place it into a labeled container with the instructions....when, how much,how often,how long, side effects precautions........the EDMD goes and explains this to the patient waits for questions........you may hand them the SEALED, LABELED package after the EDMD spoke with the patient. There are variations state to state just be sure you are following your states nurse practice act, rules and regs.........I have seen too many really good nurses get unfairly treated because they were unaware of the fine print........:twocents::twocents:

If I don't have a license to dispense medications (and I agree that I don't), then I shouldn't be able to administer them either. I don't see a difference if, by your logic, I can't answer all of the questions about medications that a pharmacist would. I do have the knowledge to answer questions about any medication that I give in the ED, like any RN should, but if I'm asked something that I don't know, I get the answer.

The "handout" that patients get when leaving the ED is, as I already stated, a computer printout of their home medications. On this printout is space to write in any prescription medications or medications given from the ED omni, along with all of the instructions that they need to take the medication properly.

Patients are also ALWAYS instructed on side effects to watch for, which is part of an RNs job anyway, and ALWAYS, ALWAYS, ALWAYS instructed that they shouldn't work, drive, or operate other machinery while taking narcotic medications or others that may make them drowsy, which is ALWAYS documented in the computer charting. I also explain that just because they have a prescription for a certain medication it doesn't make it legal to take it while driving.

Medications themselves, are always given in the original packaging from the omni.

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Specializes in Critical Care.
Agree with Esme 12. Law prohibits hospital pharmacy from dispensing.

I'm confused, what law? Hospital pharmacies dispense all the time, that's pretty much all they do.

" "Drug dispensing" means an act entailing the interpretation of an order for a drug or biological and, pursuant to that order, proper selection, measuring, labeling, packaging, and issuance of the drug for a patient or for a service unit of the facility."

Handing the patient a medication that has been labelled and packaged for home use is not dispensing, and instructing the patient on it's use (in conjunction with printed prescribing info) is well within the scope of an RN.

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Specializes in Spinal Cord injuries, Emergency+EMS.

Right pondian perspective here , so the legals may be different

the drug should be labelled as a community issued prescription would be i.e. with a dispensary label giving doses , patients name and other pertinent info, it should also be supplied with the relevant patient information leaflet

we routinely get all patient specific drugs labelled this way ( and each patient has a bedside locker and we use steam driven hand written prescription charts), it's only basic ward stock and IVs that aren't labelled this way so people can be issued these on discharge - Neither the Prescriber nor the ward staff have dispensed this medication the pharmacist who signs the check-out on the prescription dispensed it.

you are only dispensing / supplying if you label the drugs yourself - which for Emergency Department take homes we do do - well fill in the blanks on a preprinted dispensing labelled on the standard 'patient pack' ( which includes the information leaflet) .

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Specializes in Spinal Cord injuries, Emergency+EMS.
I'm confused, what law? Hospital pharmacies dispense all the time, that's pretty much all they do.

" "Drug dispensing" means an act entailing the interpretation of an order for a drug or biological and, pursuant to that order, proper selection, measuring, labeling, packaging, and issuance of the drug for a patient or for a service unit of the facility."

Handing the patient a medication that has been labelled and packaged for home use is not dispensing, and instructing the patient on it's use (in conjunction with printed prescribing info) is well within the scope of an RN.

Exactly, the closest you'll come to dispensing is if you have to fill in the blanks on a prelabelled Take home pack in the Emergency dept - even then they have been 'pre dispensed' when they were labelled and sealed by Pharmacy.

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