I am being too anal?

[caholbr]

As a little background.. I work in an LTAC in a very rural area. My situation involves an elderly man who has a terminal illness and is vent dependant. His family wants him to take "herbal medications" in belief that it will cure him. Now I really don't have anything against alternative treatment but these herbs are two trashbags full of glass bottles with papers tapes labeled "AM herbs" and "PM herbs". Now there are bottles like you would get from GNC but they want you to give 4* the amount as recommended on the bottle. When I looked closer at who prescribed these meds I saw it was from a Phd in South America.

So anyway, I approached the MD who approved these "herbs" and all he said was "look, I just wanted the daughter to shut up". I asked "Well, do you think their safe?" and he said "I don't know". So with that, I refused to give. I told the CN I wasn't comfertable giving this stuff but if she was, go right ahead. So anyway, I got a lecture on how alt therapy has healed grandma and grandpa and I shouldn't judge. I tried telling them it wasn't that I didn't believe in alt therapy, my problem was I didn't know what I was giving and how it was going to affect the patient or interact with his other meds (heart meds, seizure meds..) Furthermore, this man is a full code and his family does not believe he will die anytime in the near future.

So its a mess... I am catching grief at work about how I am making things too complicated and that I should just give the meds to make the family happy.

What do ya think?

Allison

[Silverdragon102, BSN]

Sorry but if it was me I would not give. I would explain again to management and family but at the end of the day it is your license at risk and your job. If they want it giving then they either give themselves or provide a list of what is in the bottles. OK for alternative medicine but should be used in conjunction with ordinary medication

[santhony44, MSN, RN, NP]

I wouldn't give them either. You are still legally responsible for what you give, and you don't know what you are giving here. As you mentioned, it's entirely possible that some of these things could have interactions with his prescribed medications.

Also, consider that this family seems to have totally unrealistic expectations of what's going to happen to Grandpa. I would not be at all surprised if they were to be lawsuit-minded when the outcome here is not what they expect.

No, you are not being anal. You are being smart.

[busy-bee]

Not anal at all. I would not give the med. I am surprised the facility would allow unmarked drugs of any kind allowed to be placed in the med cart in the first place.

[CT Pixie, BSN, RN]

I'm not a nurse yet but I can tell you after working so hard for a license I wouldn't give that stuff either. As the others said, at the end of the day its your license on the line. Anything happens and they are going after the nurses who administered these "herbs".

In all the LTC's I've worked at meds, herbs etc brought from home would never be put on the med cart for the nurses to give, MD order or not. They'd have to be ordered through the facility pharmacy. who knows whats in those bottles.

I don't think you are being anal at all. I think you are protecting your patient and yourself. I'd never give them.

[classicdame, MSN, EdD]

what if what is in the bottle is a controlled substance or causes harm? Do not give. I would get the BON involved in this too.

[rehab nurse]

I agree with the others. You are NOT being "anal" about this. You are right.

At the end of the day, YOU alone are responsible for the medications you give. The BON wouldn't care that the doctor and your manager wanted "the family the shut up". They would only care that you didn't follow what a prudent nurse would do.

Your management sounds like my former management. They were so far removed from patient care, they only want the families to be quiet and leave them alone. They like to provide lip service to the families so they are not "bothered". And doctors that are too busy to do much of anything but scribble orders and avoid families. So who gets the brunt of the questions? The nurse!!

Don't let them make you feel like you're doing something wrong. It sounds like you're the only one there who knows what best practice is. What if one of those "herbs" interacted with his seizure meds? Or his heart meds and he suffered an adverse outcome? YOU would be responsible for it if you administered it. Don't let them (management/doctor) fool you.

I am sure the state or whatever organization audits your care would be very happy about a bottle of medication labeled "AM HERBS" and "PM HERBS" in your cart. We were never allowed to put anything from the family in our carts without having the pharmacy verify what was in it and provide a label with the proper prescription information on it. I would contact your pharmacy and see if they can help you. I would tell your manager about this. In my state, the facility would be fined big time if someone did what you are describing.

The doctor too is playing russian roulette with his license. Did he write an order to administer this? Doesn't every order have to state WHAT the drug is, how much to give, when to give it, etc?? That's basic nursing 101 and your managers/doctors don't support you?? This puts them in a precarious legal situation.

You are right on!!! Don't let them bully you into administering this until the pharmacy helps and properly label this stuff and they are certain it won't interfere with any of his other meds. I am an advocate of alternative therapies as well, but it has to be done the proper way!!! It's hard being the one who stands up in a place like that, and I admire you for doing so. Remember, it's your license. YOU ARE RIGHT in what you did!!!

Good luck. Let us know what happens, ok?? I am interested to find out. Maybe you could even call this in to your state as a complaint. I know in my state I have done that when things like this happen. They usually came out to investigate within a few days.

[AngBthatsme]

Dont give. What a lame excuse for the doctor to give you. I just want them to be quiet. Whatever!!!!!!!!

[jjjoy, LPN]

Isn't it crazy that you have to defend yourself for looking out for patient safety? And then, of course, your own liability in this out of the ordinary demand. You superiors and colleagues (both medical and nursing) should be backing you up!

I suppose it's that trying to work something out with the family over this is too daunting for either the doctor or your superiors to deal with it. But it's not fair to brush it off on you without any kind of clear documentation and legal verification that the family has insisted on this and takes full responsibility for any adverse effects. And that's only if you know what exactly it is they are insisting the patient have. If it's an unknown herb and they insist on it, then at the very least, they shouldn't expect any medical personnel to administer it for them.

It sounds like your facility should get legal counsel on dealing with this family's demands.

[pinksugar]

No, you are not being too anal at all. There is no way I would give those 'meds'. As the others have already said, you are still responsible for them! No way!

[kstec, LPN]

At the facility I worked at we typed up all the names of the medications, the doses and the possible risk of interaction and that we were not help liable if something went wrong and had the family and MD sign it. We would give them but atleast were we not being held accountable if something went wrong. The DON even explained everything in a family/staff meeting so that everyone was on the same page.

[Jo Dirt]

The poor old man is dying and these herbs will not make him better. I imagine he has been getting the herbs anyway but I would still feel uncomfortable giving them myself though I don't know what the circumstances surrounding the situation are so I can't say whether I would give them or not. But I don't think you should have to if it goes against what your heart tells you is right.