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Glucosamine - This might be a dumb question but....

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In a care plan I had written up recently, I had suggested that the patient try glucosamine for their arthritis pain in their back, and I was chastised for this. I am not really sure why. I was under the impression that glucosamine was an OTC product, and that OTC were okay for nurses to advise patients of. Can someone please enlighten me?

There are two reasons you should be chastised:

1. You seem to feel you can always advise the use of OTC products for anything simply because the product is OTC. This is wrong. For instance, would you tell someone complaining of fatigue to go buy some "5 Hour Energy" bottles?

2. There is no peer reviewed evidence that glucosamine does anything to help with back pain from arthritis.

Problem is it is a mineral or supplement. Even though they mau be natural doesn't mean they may be safe for some individuals. The FDA has not made any formal type of approval.

Gulcosamine can also contain other additives or compounded usually in the form sufate or chondroitin.

Some of these just like any drug can have adverse side effects, most likely not but in some instances can be mild or very serious. Because they have no FDA approvals and may not go through exhaustive fundamentally sound testing methods, they may in some ways be actually more unsafe because of possible unkown effects. For example aspirin is a regulated OTC, we know it can be an effective OTC drug,however we know their are better NSAIDS like tylenol or Ibuprofin to use if the person has gastrointentinal or bleeding conditions, or Reyes Syndrome in children. Conversely other NSAIDs like Tylenol and Ibufrofen may not be the right thing for a patients other medical conditions. So with OTCs we know the documented adverse effects and interactions ( all though there are always exceptions of new ones ), but in the case of minerals and supplements we don't always know the adverse effects and can't count on independent non FDA approved tests and statements.

Many doctors and researchers do however also strongly agree that these supplements have strong merits and will indeed highly recommend them to their patients and sometimes in conjunction with other FDA approved drugs. And beleive they are in many cases a safer alternative. Always got to wiegh the benfits to the risks. Glucosamine is denfinitely a widely used and somewhat proven and effective and safe alternative for joint health conditions. So don't beat yourself up over it. I have taken it also. Even doctors sometimes need to be aware of adverse interactions with certain FDA approved drugs when combined with supplements as many have not been trained in because they are not always recognized in the MD/ American health care system since they are not FDA blessed. You could always suggest that they ask there physician if there are any other alternatives they could try instead or in conjunction. In most cases they will probably say don't waste your money but they may also say try it it can't hurt.

Edited by NURD
Forgot to clarify one thing about OTC neg effects known versus supplement unkown.

Even advising someone to use an OTC medication is, essentially, prescribing without a license and outside the RN scope of practice. There may be reasons why glucosamine would be contraindicated for this particular person that you don't know about.

You can advise someone to ask her/his physician whether some particular medication or supplement might be helpful, and you can reinforce the physician's recommendations about medications or supplements, but you can't, as an RN or LPN, advise someone to take anything on your own.

VickyRN, MSN, DNP, RN

Has 16 years experience. Specializes in Gerontological, cardiac, med-surg, peds.

even advising someone to use an otc medication is, essentially, prescribing without a license and outside the rn scope of practice. there may be reasons why glucosamine would be contraindicated for this particular person that you don't know about.

you can advise someone to ask her/his physician whether some particular medication or supplement might be helpful, and you can reinforce the physician's recommendations about medications or supplements, but you can't, as an rn or lpn, advise someone to take anything on your own.

i agree we all need to be very careful about recommending any otc/ herbal/ vitamin/ nutraceutical products, to make sure we are not exceeding our scope of practice as defined by our particular state board of nursing.

the north carolina board of nursing has recently come out with this position statement on the role of the rn concerning otc medications and non-prescriptive devices:

rn role:

1. may recommend the use of over-the-counter (otc) pharmaceutical products

(including dietary supplements and herbal remedies) and non-prescriptive

devices for an identified health-related need of a client as part of her/his nursing

practice.

2. when making recommendations rn is accountable for having the knowledge to

make such nursing care decisions safely and to monitor the outcomes of her/his

actions.

3. the practice of recommending over-the-counter pharmaceutical products and

non-prescriptive devices must be consistent with the established policies of the

system in which the registered nurse practices as well as consistent with the

client's overall health-related plan of care.

lpn role:

1. does not have the authority to independently recommend the use of over-the-

counter products and non-prescriptive devices.

north carolina board of nursing (ncbon). (2009). over-the-counter medications and non-prescriptive devices - role of the rn. retrieved from http://www.ncbon.com/content.aspx?id=682

VickyRN, MSN, DNP, RN

Has 16 years experience. Specializes in Gerontological, cardiac, med-surg, peds.

BTW, the North Carolina Board of Nursing has just revised its position statement on nursing and the use of Complementary Therapies:

Issue:

Complementary therapies refer to a broad range of modalities such as, but not limited to, massage therapy, therapeutic touch, biofeedback, magnet therapy, reflexology, imagery, hypnosis, aromatherapy, and acupressure. Some of these therapies are inherent in basic nursing practice while others require additional education/training prior to performing them. Complementary therapies are intended to be used in conjunction with the existing treatment plan, not to replace it.

Both RN & LPN Roles:

A. It is within scope of practice to perform complementary therapies provided licensee

has:

1. Documented knowledge, skill, and competency necessary to carry out the

therapy in a safe manner,

2. Employing agency's policies and procedures support nurse's use of

complementary therapies.

B. When complementary therapy is used as a nursing intervention, this should be:

1. Reflected in the patient's plan of care, and

2. Documented in the patient's medical record consistent with requirements for

reporting and recording

Notes:

(1) Any state or local laws, which require licensure to perform the complementary

therapy, must be followed. For example, massage may be utilized as a nursing

intervention in a health care setting but a massage license is required to practice

massage as an independent business.

(2) Acupuncture can only be performed if the individual is licensed to perform this

modality in North Carolina consistent with NC GENERAL STATUTES 90, Article 30

(Practice of Acupuncture).

Reference

North Carolina Board of Nursing (NCBON). (2010). Complementary therapies - Position statement for RN and LPN practice. Retrieved from http://www.ncbon.com/content.aspx?id=682

i agree we all need to be very careful about recommending any otc/ herbal/ vitamin/ nutraceutical products, to make sure we are not exceeding our scope of practice as defined by our particular state board of nursing.

the north carolina board of nursing has recently come out with this position statement on the role of the rn concerning otc medications and non-prescriptive devices:

north carolina board of nursing (ncbon). (2009). over-the-counter medications and non-prescriptive devices - role of the rn. retrieved from http://www.ncbon.com/content.aspx?id=682

thanks for sharing that, vicky -- i hadn't seen that statement before. however, one needs to keep in mind that what is allowed in one state may not necessarily be allowed in another state, and we are each responsible for keeping up with the npa and sop in our own state.

even though i'm in nc and the bon has now said it's okay, i am still not personally, professionally comfortable with the idea of recommending medications to others.

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