Hand Hygiene-PO Medications

[wendiwhiner]

Good Afternoon everyone. I am an LPN with many years of healthcare experience, mostly in psych and addiction. I just started a new job with an alternative drug rehabilitation. The owners are a married couple with no medical background from as far as I can tell. I am the "sole" nurse, although they have 2 other LPN's but chose to call them "CSR-Customer Support Reps/LPN". They do mostly tech duties such as supervising the clients, vital signs and medication observation. I am responsible for all the nursing duties and supervised by the owners, COO and ARNP and MD!! It is the most unusual job I have ever had, but the best paying.!!

Anyway!! One of the owners questioned why we need medications cups. When the staff asked me why we need them I told him so that the clients don't touch their pills with their hands and transfer germs. He went back to the owner and she stated that we are to use an alcohol swab to clean a designated plate in the nurses station and have the client wash their hands. They are to put each pill on the cleaned plate and then take them. The purpose of the plate is so that we can see the amount of pills that they are taking out.

If anyone can help guide me to a site with some information to back up my "argument" that we need medication cups so they don't transfer germs it would be appreciated.

[MunoRN, RN]

What are you referring to by "transfer germs"?

[JKL33]

Honestly I wouldn't say that's the reason paper medication cups are used. I thought it was so the nurse doesn't have to handle the pills with his/her hands, and so that they're in an easy-to-handle container (rather than being dropped on the floor, etc). Why would there be any more problem with a client touching the pill s/he is about to take than say, eating a snack that doesn't require utensils?

If you're talking about clients removing pills from their own medication bottles and doing something like dumping out several into their hand and then using the edge of the container to scoop all but one of them back into the container - yes, that is not a great idea, but the med cup itself is not really what makes it possible to get out only one pill without touching the rest.

Or am I misunderstanding?

[marienm, RN, CCRN]

All of our pills come single-packed (not in pill bottles as mentioned above) but I think this is still relevant: Many meds are considered Hazardous Drugs and should not be handled by anyone other than the pt who is supposed to be taking them. I'm not sure how many of these you give in your practice...the ones I'm thinking of include stuff like tacrolimus, mycophenolate (both anti-rejection meds for transplant patients), and duasteride (given for prostate enlargement), among many others. Do you give the fast-dissolving pills like risperidone? I never want to touch these bare-handed in case there is any moisture on my hands. To even handle intact capsules we are supposed to wear nitrile gloves. The FDA has a big list of drugs that require handling precautions and your employer is required to make the appropriate materials/equipment available to protect their employees. Med cups could reduce the amount of handling that the pills require (though I would argue that gloves are still needed for any Hazardous Drugs).

Now if the employee NEVER touches the pills and the client handles their own pill bottle, opens it up, takes out a designated number of pills, places them on the plate for inspection, and then takes all the pills right there in front of the employee, I'm not sure a med cup is truly helpful. The client can pick up the pills from the plate and put them in their mouth; this might even minimize the possibility that they will hide a pill in the cup (taking advantage of a momentary distraction) to either take later or discard. I think the "wipe the plate off with alcohol each time" sounds a little cumbersome, but maybe the owners are very environmentally-conscious? I work in a hospital where we generate TONS of garbage each day and I don't feel very good about that. If there's a safe way to reduce waste AND get each client their meds that is also safe for the employees, I don't think that's a terrible idea.

[klone, MSN, RN]

Why would it matter if the patient touched their own medication?

[Julius Seizure]

Why would it matter if the patient touched their own medication?

Good question. I touch my own medications every day and things seem alright so far. I think the little med cups are more to keep the pills separate from other stuff, not from the patient's hands.

[canoehead, BSN, RN]

If a med cup makes things easier, just get the little condiment cups, and wash them between med passes.

[wendiwhiner]

It matters because we have people in and out of our facility. People discharged and new people admitted weekly. Its a temporary situation, almost like a sober house. Every residential I have worked in taught us to discourage the client from touching their pills, have them us a med cup.

[dream'n, BSN, RN]

I'm sure that Joint Commission or state surveyors would have an issue with this weird plate idea. Tell that to the COO and owners, maybe then they'll cough up the money for disposable medication cups.

You are supposed to verify medication compliance, therefore set up some medication pass rules. Things like a cup of water to take the pills followed by eating a cracker and drinking another cup of water. Have the client cough and do a mouth sweep with a penlight and tongue blade.

I've never had an issue with a client picking up their medications with their hands, some like to pour them all in their palm from the cup before taking them. The GI system is not sterile and I've never heard anything, anywhere, that they can't touch their own medications.

[wendiwhiner]

No, the GI system is not sterile but we do say "hand hygiene" for a reason and isn't the mouth a portal of entry??? We also wash our hands before we eat??

[JKL33]

No, the GI system is not sterile but we do say "hand hygiene" for a reason and isn't the mouth a portal of entry??? We also wash our hands before we eat??

Yep. Wash your hands before you take your pills. And you already say you are cleaning the plates between uses.

[osceteacher]

We use medicine cups so we don't handle their drugs, I've not heard it for that other way round. I'm sure these guys are snacking on foods throughout the day without doing themselves any mischief, I still think cups should be used but I think you should supply a better reason.