Giving pts. medications to take home at discharge

Esme12, ASN, BSN, RN · Mar 19, 2011

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

Technically.......the med can be pulled but it must be labled with the instruction on how to take and how often side effects ect by someone with a DEA number.that proves they have the training and knowledge to prescribe medications.........APRN,PA,ParmPHD,MD sealed in a bag then you may hand it to the patient. Every state has very specific rules and regs concerning this including the dispensing of "free samples" that must be adhered to. The DEA doesn't have time to raid every MD's office or hospitals emergency department, let's hope it's not yours. I am just trying to educate nurses about their liability and to say "I had no idea" when something happends won't save you. Ignorance is no excuse of the law.

minwich is right quote: 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.

This is federal law......yes it's essentially ignored......until they get busted then everyone says " I had no idea" it is your profession obligation to know your limitations of your states stature and BON nurse practice act, rules and regs. Call them......ASK...you just might be suprised.......:twocents:

linearthinker, DNP, RN · Mar 19, 2011

I am not licensed to dispense. And I never threw them away, I took them to Haiti.

Esme12, ASN, BSN, RN · Mar 19, 2011

Often, in the ER, docs will write for a med "to go." When I come across this, I always chart "Dispensed by physician for home use."

Yes but did he.........if he didn't then you have improper documentation of medications which can cost you your license. I know in reality that most ED nurses chart this.......I just want everyonr to know the dangers.......iIve seen this blow up at nurses when convenient by the powers that be and it's really messy.......and when the docs know they've messed up they run for the hills!!!!!

Esme12, ASN, BSN, RN · Mar 19, 2011

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.

I really think you should check with the state....I know you will be suprised. I have been at this for 32 years and only recently had to stop working for health reasons........just because it's usual and customary doesn't mean they are doing it right.......and the original packaging from the omni doesn't have the instructions and precautions as required by law to be approved by someone that can prescribe/dispense meds.....someone with a DEA number so they can be traced and tracked...........just saying..

I<3H2O, BSN, RN · Mar 19, 2011

Oh wow, I know on our floor we send all respiratory meds home with the pt. at the end of their stay. I have even seen RTs send home meds that weren't going to be prescribed for them at home.

LaughingRN · Mar 20, 2011

technically.......the med can be pulled but it must be labled with the instruction on how to take and how often side effects ect by someone with a dea number.that proves they have the training and knowledge to prescribe medications.........aprn,pa,parmphd,md sealed in a bag then you may hand it to the patient. every state has very specific rules and regs concerning this including the dispensing of "free samples" that must be adhered to. the dea doesn't have time to raid every md's office or hospitals emergency department, let's hope it's not yours. i am just trying to educate nurses about their liability and to say "i had no idea" when something happends won't save you. ignorance is no excuse of the law.
minwich is right quote: 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.
this is federal law......yes it's essentially ignored......until they get busted then everyone says " i had no idea" it is your profession obligation to know your limitations of your states stature and bon nurse practice act, rules and regs. call them......ask...you just might be suprised.......:twocents:

how incredibly uncalled for.

you have made many unfounded assumptions in your post and completely directed them towards me. first and foremost, my example wasn't directed at how samples were dispensed, but more towards the arguement that a pharmacy needed to dispense any medication as opposed to mds and rns.

i am not sure how my post stated that we randomly discarded the original package, and handed a patient a med with no instructions whatsoever.

what i actually said was that we hand wrote all information on a labeled bag. in fact let me quote myself

"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."

last time i checked, handwriting isn't illegal.

our facility follows all laws, procedures and policies and for you to insinuate otherwise is, again, uncalled for.

if you would like me to elaborate on the 5 pages of charting and mandatory patient education that is required to "dispense" a med at my work place then just ask.

GM2RN · Mar 20, 2011

I really think you should check with the state....I know you will be suprised. I have been at this for 32 years and only recently had to stop working for health reasons........just because it's usual and customary doesn't mean they are doing it right.......and the original packaging from the omni doesn't have the instructions and precautions as required by law to be approved by someone that can prescribe/dispense meds.....someone with a DEA number so they can be traced and tracked...........just saying..

Uh huh...that's why it's written on the home med list, as I already stated, which is signed by the doc BTW.

GM2RN · Mar 20, 2011

I did go to the BON for my state and meds dispensed from the omni are not required to have instructions and precautions printed on them, only that they are dispensed in packaging that "shall have affixed upon each package and container in which the substances are contained, a label showing in legible English the name and address of the principal manufacturer or the distributor, and the name, quantity, kind, and form of controlled substance contained in the package or container."

I also found the following from the Board of Nursing Guidelines for the Use of Controlled Substances for the Treatment of Pain:

"Nurses should not fear disciplinary action from the Board or other state regulatory or enforcement agency for prescribing, dispensing or administering controlled substances, including opioid analgesics, for a legitimate medical purpose and in the usual course of professional practice. The Board will consider prescribing, ordering, administering or dispensing controlled substances for pain to be for a legitimate medical purpose if based on accepted scientific knowledge of the treatment of pain or if based on sound clinical grounds."

In addition, nurses in my state are specifically allowed to dispense non-controlled substances under the direction of physicians.

NPinWCH · Mar 20, 2011

You must check with the BON. Each state has its own rules on dispensing meds.

Just a note about the DEA. As an NP, who can work independently without an MD/DO involved, you don't need a DEA number UNLESS you prescribe controlled substances and in Ohio, NPs really aren't able to prescribe them. The DEA has no say over prescribing/dispensing any other medication.

And just to be clear, technically APRNs in Ohio can prescribe some controlled substances, but the rules are restricted to a controlled substance first prescribed by an MD/DO, only for "terminal" patients and only enough for 24 hrs.

Old.Timer · Mar 20, 2011

I should probably don my flame retardant suit right now, but.....for me, I'm willing to occasionally take a risk, go the way of common sense and skip the beauracracy if I sincerely believe the circumstances warrant it and that it will benefit the patient.

Esme12, ASN, BSN, RN · Mar 20, 2011

How incredibly uncalled for.
You have made many unfounded assumptions in your post and completely directed them towards me. First and foremost, my example wasn't directed at how samples were dispensed, but more towards the arguement that a pharmacy needed to dispense any medication as opposed to MDs and RNs.
I am not sure how my post stated that we randomly discarded the original package, and handed a patient a med with no instructions whatsoever.
What I actually said was that we hand wrote all information on a labeled bag. in fact let me quote myself
"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."
Last time I checked, handwriting isn't illegal.
Our facility follows all laws, procedures and policies and for you to insinuate otherwise is, again, uncalled for.
If you would like me to elaborate on the 5 pages of charting and mandatory patient education that is required to "dispense" a med at my work place then just ask.

I meant no disrespect at all. I am sorry if you felt that way. I guess I was just rying to protect one so young to this profession and share some hard earned experience. You have truly misinterpreted what I said.

I am truly sorry I offeneded you.......I insinuated that you need to protect yourself always and educate yourself to be sure you are safe, no one will protect you but you. I have been at this a long time and I have learned that hospitals are not all that alltruistic.

Again....I am sorry I offended you........I wish you good luck

Esme12, ASN, BSN, RN · Mar 20, 2011

Uh huh...that's why it's written on the home med list, as I already stated, which is signed by the doc BTW.

I am glad you checked with your state. In my state nurses are NOT allowed to give patients "meds to go". They must be labeled by the MD,PA,PharmD,APRN, sealed in a bag by the labeling personel and then the nurse may had the pre-packaged meds,in their original packages, to the patient. As an emergency room nurse for 32 years i will tel you I know what goes on and some of the rules in some states are different for the ED's than the clinics,hospitals,offices or LTC"s.

I have witnessed a very good friend lose her job and license becasue of tis very argument. It turned out the hospital,the EDMD saved themselves and sacrificed her..........

I meant no harm, so you can stop throwing fuel on the fire.......