I am starting LPN school next week, and as a CNA, I was wondering about some of the things that I have seen nurses do in caring for residents, and curious if they were considered "acceptable." I have also heard some "hearsay" stories from other CNAs and LPNs about some of the things they have witnessed. I just wanted to list 3 of these behaviors, and get feedback about whether these items were common, OK, or justified, since I would like to avoid tasks that would harm people.
1. Dropping meds on the floor, and picking them up and giving them to residents/patients anyway. I know that this should not be acceptable at all, and I would always just get myself another pill if I dropped one. However, when I asked about this, I was told that the nurse would get "in trouble" if they just got another pill, especially a narcotic, because admin would wonder if the nurse kept the dropped pill for herself. This action was also justified because the resident was only prescribed a certain number of pills, and that they could never be wasted, lest it would cost the patient more money for meds to replace dropped pills. Is this practice common?
2. What about nurses who hide meds in food to give to patients, and the patients don't know about it, because the patients would refuse the medicine otherwise? I would think this may not work, one reason being that if the patient doesn't eat all of her food, or doesn't drink the drink with the med in it, she wouldn't get the full dose of the med that she needs. Plus, I thought that people had the right to refuse medicine. Is sneaking medicine in food OK? Also, what if the patient or resident has to be fed his meals, and a family member or CNA feeds the resident with the food with the meds in it? Isn't that considered passing meds by a nonlicensed person?
3. What about borrowing prescription meds in "emergency" situations? I am told that this may happen because of some error on refilling a prescription, and not being able to get the refill in time for the dose, so it's okay to get the pill from another patient who has the same script, since it would hurt a patient more not to get her pill on time, than it would hurt the patient (the one whose pill is getting borrowed) who may not need it right away. (This seems in violation of #1 above, where the nurse claims she would get in trouble if a pill is unaccounted for. )
About the hiding medicine issue - I used to work in a dementia unit where this was done for several patients. It was allowed with a written doctor's order and the signed consent of the patient's medical power of attorney. We could administer meds to patients with dementia or mental illness who regularly refuse without understanding why they need their meds, and we weren't hiding anything from those who made medical decisions for them. As long as you go through the proper channels it should be okay. What's not okay is having a mentally competent person refuse their meds and then tricking them into taking it anyway.
When wasting meds, expecially narcotics, I've always seen it required to have a witness. Basically, you find another nurse look at the pill you dropped and sign off with you that you are wasting the pill together. There should always be a witness so you don't get accused of pocketing it.
The hiding pills in food thing - if you have to crush someone's pills and put them in their food, you should be putting them in a little bit of applesauce, pudding etc. - like 2 bites worth. If pills have to be crushed and/or hidden, they shouldn't be mixed up in a whole big bowl of pudding. If a nurse crushes meds and mixes them with food (for any reason), she needs to stay there until the pills are gone. Otherwise, you could end up with a whole lot of trouble if the wrong person eats food with medication in it. Plus, like someone else said, if you mix the meds in a large amount of food, and someone doesn't eat it all, they won't get the whole dose of their meds (and you really won't have any way to tell how much they got).
So as far as #3... If pt A needs 0.2mg clonidine and there's none in the box... pt B has an extra dose and I give that to pt B. All our meds are barcoded and individually packaged... no names on them at all- also, I always use the 5 rights and all that jazz.
So as far as #3... If pt A needs 0.2mg clonidine and there's none in the box... pt B has an extra dose and I give that to pt B. All our meds are barcoded and individually packaged... no names on them at all- also, I always use the 5 rights and all that jazz.
Why is that a problem?
It's not really a problem at a hospital, for the exact reason you said (just make sure to replace pt B's pill before she needs it!).
In LTC, pt's sometimes have their own prescriptions - meaning that they pay for them. When it's time for a dose, you get out their bottle, get their pill out, and give it to them. If you run out of say, Pt A's BP meds, and Pt B next door has the exact same prescription, is it ok to take one out of pt B's personal bottle to give it to pt A? That's the dilemma. On one hand, Pt A really needs the med, and pt B has some to spare, but what happens if people start doing that on a regular basis? First, Pt B is now one pill short, and if the nurse doesn't remember to replace it when pt A's prescription gets refilled, then they are going to be missing a dose. Also, who is to say that you won't make a mistake reading the bottle, or grab the wrong one when you go to put the pill back (maybe placing a dose of the wrong medication in with the rest of the prescription)? A lot of those little pills look alike! It's just iffy practice. Probably necessary at times, since they don't have onsite pharmacies. Which is worse - a trip to the hospital for a BP of 220/110, or borrowing pt B's med?
Only one ans. here....What have you been taught? Go with that! I will tell you that as you learn more about your job, you may be able to make judgements about it. For now! Do what you have been taught. Do nothing out side of it. For those around you LOL. They have the experience of years behind them and know how to deal with it. One day you too will have that, but for now......Do what you now to do, and learn from them.
Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.
3. have borrowed non-controlled meds, once in a blue moon.
and i always reorder meds needed at that time.
leslie
I have given mainly controlled drugs from someone else - situation like this: pt arrives in ICU from ER crashing. Pt not transferred in computer yet - so unable to pull out meds under their name. Go to first person in pyxis (computerized drug storage) and pull out what is needed (ie morphine, propophol, dobutamine, dopamine, etc). When pt finally placed in pyxis go back and return meds to first person and pull them out under the patient's name - so right person is charged.
Of course this is all emergency situations, otherwise you wait and make sure you order with enough time.
Having worked LTC a number of years, I know sometimes you do what you have to do to get by and that may not always look stellar in the eyes of the scholars who write the books (that, of course, every nurse goes by.)
1. I'll just say I've seen this more than once (the patient suffered no ill effects.) I don't think it is a good practice in theory but the Man isn't worried about theory.
2. I've never seen pill hiding done with coherent patients in their right minds. The doctor knows the mindset of the people when he prescribes them medicine (it's most always a combo of psych meds for A/D). The patients refusing meds don't know enough to even know what they are for (yes, the meds must not be working but it isn't up to the nurses to decide if they need the med or not.)
3. There are several nursing homes in Tennessee facing stiff fines from Medicare/Medicaid for borrowing meds from one pt. to the next.
Sad, but true, these things do happen in LTC. I posted somewhere else about things that occur in LTC facilities being one of the reasons I got out of nursing for almost 2 years and questioned if I really wanted to continue nursing. Now I am trying to ease my way back in but you can bet I am not looking for LTC work..I just can't do it anymore. LTC is a tough and thank god there are nurses out there that love working in LTC, I am just not one of them. I'll find my niche someday!
About the hiding medicine issue - I used to work in a dementia unit where this was done for several patients. It was allowed with a written doctor's order and the signed consent of the patient's medical power of attorney. We could administer meds to patients with dementia or mental illness who regularly refuse without understanding why they need their meds, and we weren't hiding anything from those who made medical decisions for them. As long as you go through the proper channels it should be okay. What's not okay is having a mentally competent person refuse their meds and then tricking them into taking it anyway.
So if there's a doctor's order, and the medical power of attorney approves, then it's okay to hide medicine in food? I understand that in a dementia unit, the residents may not fully understand why they need the meds, so they may not comprehend what could happen if they refuse. However, I am wondering if the state inspectors who come to nursing homes would approve of a nurse sneaking medicine into food, even if there is a doctor's order. I was taught in CNA class that even dementia residents have the same resident's rights as other people, so if they, say, refused a shower, or refused a treatment, we couldn't force them to take a shower or treatment "for their own good."
So if there's a doctor's order, and the medical power of attorney approves, then it's okay to hide medicine in food? I understand that in a dementia unit, the residents may not fully understand why they need the meds, so they may not comprehend what could happen if they refuse. However, I am wondering if the state inspectors who come to nursing homes would approve of a nurse sneaking medicine into food, even if there is a doctor's order. I was taught in CNA class that even dementia residents have the same resident's rights as other people, so if they, say, refused a shower, or refused a treatment, we couldn't force them to take a shower or treatment "for their own good."
Okay, so what about the dementia pt with a sky high BP who won't take his meds? You just let him stroke out and die, and then tell his family, "well, he wouldn't take his pills." That's a lawsuit waiting to happen. And say you call the doc and tell him that the pt won't take his pills. What do you think he's going to tell you?
Just playing devil's advocate here. And I am in NO WAY saying it's ok to hide meds for an A&O pt!!!
Is this practice common?
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kythe, LPN
262 Posts
About the hiding medicine issue - I used to work in a dementia unit where this was done for several patients. It was allowed with a written doctor's order and the signed consent of the patient's medical power of attorney. We could administer meds to patients with dementia or mental illness who regularly refuse without understanding why they need their meds, and we weren't hiding anything from those who made medical decisions for them. As long as you go through the proper channels it should be okay. What's not okay is having a mentally competent person refuse their meds and then tricking them into taking it anyway.
When wasting meds, expecially narcotics, I've always seen it required to have a witness. Basically, you find another nurse look at the pill you dropped and sign off with you that you are wasting the pill together. There should always be a witness so you don't get accused of pocketing it.