Giving residents non-prescribed meds?

[prinsessa]

Has anyone else heard of other nurses doing this? Several nurses have told me (or hinted without really saying) that they will give some of the residents medications that aren't prescribed to them or increase a dose (without a MDs order). When I first heard this I was shocked. I have told them that I don't agree with it and they better be careful doing it. Mainly it is done to help residents sleep. I'm just wondering if this is done at other facilities. Does anyone else think this is crazy?

[nurse2033, MSN, RN]

I've seen this practice before.

One of my former coworkers admitted to giving her sundowning residents IM injections of Phenergan to make them drowsy and "more quiet."

She must have another job skill as a back up because she'll be lucky not to lose her license or end up in jail. Phenergan especially can be a dangerous drug. I work nights so I know how tedious those patients can be. She is playing with fire just to make her job easier, bad news.

[CapeCodMermaid, RN]

Writing a telephone order for a medication, even an OTC, giving it and hoping the MD will sign it is not good practice. You are not the MD or the NP. It's illegal. Even MOM can cause problems. You are risking your license. Glucagon in a true emergency is a bit different. It's pretty much standard practice for those with very low blood sugars who aren't responsive, but anything else is risky.

I've known nurses who medicated every resident with everything to keep them sleeping throughout the night but at least these meds were prescribed by a doctor.

[totally_nuts]

We have certain meds that we are allowed to nurse-initiate. They include paracetamol, mylanta, coloxyl (but not senna) and a couple of other things of a similar nature that I can't remember offhand.

Anything other than a single dose needs to be ordered by the doctor so if it is an ongoing issue it needs to be written up by the doctor.

[caliotter3]

I can assure you this is not the only illegal or non-standard practice occurring in your facility. The fact that anyone has hinted at this activity to you indicates they are placing a small amount of trust in you or believe you won't get anywhere by making accusations.

[Forever Sunshine, ASN, RN]

I do give meds that aren't prescribed like mylanta, tums, immodium, however I do write out a T. O. and make sure the pcp signs it. I'm not waking up the doctor at 1030pm for an order for tums.

Also, one resident was unresponsive due to hypoglycemia. I gave her glucagon which was NOT ordered at the time. MY don gave the ok and we got the order later. So I guess it depends on the situation.

For me it depends on the situation(and the doctor) too. I wouldn't go around giving Phenergan to the patients lol

[traumaRUs, MSN, APRN]

Since when can the DON (if not an APN) give medical/med orders???

Uh this is going to result in a disaster.

[CoffeeRTC, BSN, RN]

OOPs....I lie. I have given glucagon and put O2 on without an order. Yes, these were emergent situations and at that time we didn't have orders for the glucagon and don't have a P and P in place.

*We now have orders for all of our diabetics but still no P and P in place*

some OTC meds are unsafe to give without orders.

Tylenol in a liver failure pt

Motrin in a GI bleed

MOM..a dialysis pt

Immodium can mask C diff

Tylenol or Motrin can hide the infection

cough syrup..can hide the infection

Tums or mylanta...can hide an ulcer

It might be okay to give these meds once or twice, but sometimes if they are getting them more regular you can miss the underlying causes of the symptoms .

[nicenurselpn, LPN]

I value my nursing license way too much to do this type of thing. On new admits we had "house orders" like for Tylenol, MOM or colace, or Mylanta or Tums etc. O2 in an emergency situation is fine, but we also have standing orders for O2, suction, and cpt as needed as well.

Wendy

LPN

[sbbnurse]

CRAZY!! No way should anyone be doing that!

[217shana]

In the facilities that I have worked we have standing orders to cover simple pain, cough, indigestion, and diarrhea for 3 days. After that if the patient still has the complaint we refer them to the MD. I know of a nurse at another facility that was reported by the CNA's for giving a patient a shot every night that she worked and that none of the other nurses did it. Upon further investigation they found out the patient did not have an order for the injection and the nurse was fired.

[CapeCodMermaid, RN]

In the facilities that I have worked we have standing orders to cover simple pain, cough, indigestion, and diarrhea for 3 days. After that if the patient still has the complaint we refer them to the MD. I know of a nurse at another facility that was reported by the CNA's for giving a patient a shot every night that she worked and that none of the other nurses did it. Upon further investigation they found out the patient did not have an order for the injection and the nurse was fired.

Fired? Is that all? First I would have called the BON and then the POLICE...at the very least that could be considered assault.

[rn_nxt_dr]

My first job was like onaclearday's description. I was being trained by an LVN and doing exactly that---pulling other patient's medication to supplement the lack of the other and it goes on and on. Including insulin.

And these nurses has no remorse! they looked at me in the eye, and asked me, "would you rather not give the patient their medication or use someone else's packet?" And I said, this justifies the means? And what happens to the next patient you encounter without medcs.?

Find a different place to work unless you're willing to be one of them.