Homeless shelter staff administering medication

Jolie, BSN · Apr 4, 2008

I can understand the concern of the shelter administrators that allowing clients to keep medication in their own posession might not be a good idea. But why not simply keep all medications in their original containers under lock and key and have the staff unlock the cabinet when a client states that it is time for them to self-administer a medication?

That way, you are only providing safe storage of medications, not administering them.

KatzchenLSW · Apr 4, 2008

I can understand the concern of the shelter administrators that allowing clients to keep medication in their own posession might not be a good idea. But why not simply keep all medications in their original containers under lock and key and have the staff unlock the cabinet when a client states that it is time for them to self-administer a medication?
That way, you are only providing safe storage of medications, not administering them.

That is how we previously handled medication. They now want us to prepare the bags of meds in advance to save time.

santhony44, MSN, RN, NP · Apr 4, 2008

Have they really considered the implications of this?

In a homeless shelter, I think there's a pretty good likelihood that you have folks on some fairly powerful prescribed medications, such as antidepressants, antipsychotics, antiepileptics, plus heart, blood pressure, and diabetes medications, among others. What if you make a mistake? (Not saying you are careless nor incompetent, just human). The wrong medication could cause a lot of harm, and the facility could be liable.

Does the shelter have some sort of risk management, or legal representation? If so, that's who I would talk to. If not, then whoever regulates or inspects the facility and/or sets the standards.

Good luck in getting this resolved. I think it's commendable that you are concerned, and it says a lot about you as a person. They'd be stupid to get rid of you.

allnurses Guide · Apr 4, 2008

I volunteer for a couple shelters.

I've been called to help with a colostomy once and twice for problems with a trach.

I think the lock and store the medication for the clients. And glucose monitoring equipment too.

One shelter, the largest one, has a clinic on certain days for teaching and a doctor to handle routine care for asthma, DM, HTN, and such.

jalease · Apr 4, 2008

Is the shelter you are working (and your self) considering the possible implications that could arise from medication administration? Once the medication is taken out or there orignal containers, it is quite possible to mix up pills especially with those that look alike. There are certain medications that must stay in a sealed container in order to maintain its stability. Also are you not concern of the possibility of giving the incorrect medication and causing harm? Also theft of certain narcotics or pain meds.

kythe, LPN · Apr 4, 2008

Have they really considered the implications of this?
In a homeless shelter, I think there's a pretty good likelihood that you have folks on some fairly powerful prescribed medications, such as antidepressants, antipsychotics, antiepileptics, plus heart, blood pressure, and diabetes medications, among others. What if you make a mistake? (Not saying you are careless nor incompetent, just human). The wrong medication could cause a lot of harm, and the facility could be liable.

Several years ago, I stayed in a homeless shelter for a couple of weeks after I left an abusive husband. There were no medical staff on-hand, so medication was always administered by regular staff.

One resident was written up for refusing to take her meds because the staff administering it was trying to give her the wrong dose. She was mentally competent and had taken this med for years, and she was fully aware of what she should have been taking. She later complained to the director of the center, who agreed with her complaint and said she would "talk" to this particular employee. However, the write-up against the resident still stood because it wasn't actually for refusing a med, it was for "insubordination" against staff and that is something they take seriously. This resident was informed that the "right" thing for her to have done was to have taken the medicine anyway and later filed her complaint to the director.

This is obviously very wrong, but there is nothing residents in homeless shelters can do to defend themselves from being taken advantage of. In this shelter, you are evicted after 3 write-ups. There is a serious motivation on the part of residents to avoid write-ups because if you are evisted, where do you go? On the streets? To another shelter? This is why power-hungry authority figures in shelters get away with this type of behavior.

"Rights" or no, if you are in a financial state where you do not even have a place to live, they know you can't afford to take them to court to sue for whatever injustices may happen. This allows shelter employees to get away with more than they would be able to with the general population.

CHATSDALE · Apr 4, 2008

mixing meds together is not a good idea, some meds are given or held according to b/p, level of edema etc

this is not something a nurse should do and certainly not something a untrained volunteer should do

phoebebrat, ASN · Apr 4, 2008

This is my opinion of original post.............YIKES, to put it bluntly. Always CYA, and run for the hills!

jackson145 · Apr 4, 2008

There is a legal loophole for this situation. Group homes have untrained staff administering meds. I have a friend who is a judge and he said there are certain situations where there aren't legal implications for this. He said it was considered along the same lines as a family member helping an elderly grandparent to take their meds or someone with a live in "helper".

He said it is possible to sue for mistakes made but highly unlikely that anything would come of it. After all, the alternative is for the involved resident to struggle along alone doing the best they can.

Fiona59 · Apr 4, 2008

A pharmacy that serves several of our local shelters, blister packs all the meds, so all the staff have to do is punch out the pill for hs or whatever.

Most patients in the community don't monitor their BPs prior to taking meds. Coumadin is usually a set dose. The list goes on and on.

The narcotics are kept locked for the fact they have street and recreational value in that community.

Whenever dosage problems have arisen, the doctors who provide care to this community will go and alter the blister packs themselves.

A large part of this population knows their meds, doses, and schedules very well and will tell you what is what.

That's why the blister pack is the way to go.

oramar · Apr 4, 2008

I doubt very much that you would be held resposible for an error because you do not have a license. The home could find itself in trouble I fear and of course if you made a mistake you would probably be very hard on yourself. I don't know what to tell you except to get out of there.