Leaving Meds at the Bedside?

[joanna73, BSN, RN]

Hi everyone

Although we are responsible to ensure safe, accurate administration of meds, I have noticed on occasion that some nurses will leave pills wlth the pt, and check on them after. This is never a safe practise, and I have had to explain to pts that I need to be present while they take their pills. Under no circumstances will I leave pills. During this time, I also have the opportunity for teaching, if required.

For rationale, some nurses have said: "I know the pt, and they will take the pills." Or, "I'll just be back in a min anyway."

I'm sorry, but if the pt drops the pills, hoards them, or another pt takes them, I have no way of knowing what the outcome is, should I walk away. I also cannot sign off in the MAR if I am not sure. Either way, it's my responsibility. What are your thoughts? Just curious...

[anon456, BSN, RN]

I'm still in nursing school and of course leaving pills is a big no-no. I have never seen a nurse do that either. Usually they have a bag to put the pills in even if they have to just simply run to get water, or wait for the patient to get out of the bathroom. I agree with you about never knowing for sure if they took the pills or not. I have seen patients lose them in their bed or on the floor. Also, pills are a choking hazard! I like to make sure they are swallowed okay, esp. those bigger ones, or with patients who have a hx of stroke or are just very elderly.

[nurse2033, MSN, RN]

You didn't list your job but I'm assuming staff nurse. Speak to the nurses who are doing this directly and tell them you don't think it's safe. You could speak to the boss, without naming names, and say you believe some education or reinforcement in this area would be warranted. That doesn't mean anything will happen though. You are responsible for your own practice, and doing what you can to ensure safety. Leaving pills is, of course, not safe practice. Don't do it yourself, and do what you can to influence others. But in the end, it is not your responsibility to police the practice of other nurses (unless they commit a reportable offense of course).

[joanna73, BSN, RN]

I am a new nurse, and I have worked with some amazing nurses throughout my four years as a student. However, I have noticed the med issue with probably 4-5 different nurses in a couple of units I was on. When this happened, I did question these nurses, and the attitude seemed basically, that leaving pills was not a big deal, even when I mentioned to them "ok, but what if.." On one unit, I did have a talk with the charge nurse about it.

[joanna73, BSN, RN]

And of course, I'm not interested in policing other nurses. I was just interested to have some feedback about this, because I know it happens...

[RedhairedNurse, BSN, RN]

I have been guilty of leaving pills, not narcotics, but maybe a nexium or a lactulose, something like that. It is not often I do this but at times, I'll have to wake a pt up out of a hard sleep and they just don't want to rouse up enough to take the pills when I offer them. If I see they're not going to take them at the time, I have been know to place them in a drawer safety tucked away until I can get them roused up enough to take them, instead of leaving them on the breakfast tray or something.

We have the computer scanners so sometimes it's a big pain to place them some where else after they've been opened, so when this does happen on rare occurences, I may place them in the bedside drawer and come back in few minutes to remind the pt to take the pills.

Like I said, this doesn't happen often, but it has happened on a few occasions. I don't like doing it and will Never leave narcotics, but sometimes i just don't see what any other options I have at the time, especially when I'm so super busy passing 8-9-10 oclock meds to 6 patients.

Anybody understand where I'm coming from and ever have the same problem of pts not wanting to wake up this early to take

his/her meds?

Please, No flaming me, I"m just being honest here. I'd love to hear some constructive advice on what other's do with this type of situation, which I'm sure most of you know what I"m talking about, that is, if you work on a medsurg floor :)

[joanna73, BSN, RN]

Hi redhairednurse :)

I have worked on 2 very busy med surg units. When the pt was asleep, or didn't want the meds for some reason, I got into the habit of putting them back in their med drawer until later (as in vitamins or lactulose). Would that work for you?

[regularRN]

In the exception of liquid PO meds, even standing over a pt and "watching" them "swallow" their pills, doesn't necessarily mean they've actually swallowed them... unless you insist on looking in their mouth.

When administrating controlled drugs, never leave these at the bedside. If a pt states "I'll take them later", I always say, "Well, in that case, I'll take them back and you can call me when you want them" - they nearly always take them then and there.

As for regular meds, they take them at home themselves.... just like you or I, and I am sure there are discrepancies as to compliance. But in an effort to build a therapeutic relationship based on trust, sometimes one has to make allowances....

[RedhairedNurse, BSN, RN]

Hi redhairednurse :)

I have worked on 2 very busy med surg units. When the pt was asleep, or didn't want the meds for some reason, I got into the habit of putting them back in their med drawer until later (as in vitamins or lactulose). Would that work for you?

I could put them back in the med room, but since I'm at the bedside, if they won't wake up, I usually just put them in the bedside table and come back in few mintues. I just want to get them scanned and scan the bracelet cause at times it so overhwelming busy, I just try to most time saving method. Maybe not the best way to do it, but most people are very compliant and will take them when I offer, but there is usually a few now and then that just want to wait until they're good and awake.

[anon456, BSN, RN]

Just wanted to add-- I have seen inhalers left at the bedside. These were brought from home and the pt was familiar with how and when to take them. With those we just ask if they took the inhaler, when it was taken, and chart that pt reports having taken it at such and such time.

[Davey Do]

Sorry. I often tell patients, "That pill is mine until you get it in your stomach." In other words I'm responsible for a medication until I am sure it's administered.

What's the difference in leaving a pill in the little cup in the med station with the patint's identifying information verses leaving it on the Patient's bedside table? You have some control over the med locked in the med room.

Dave

[joanna73, BSN, RN]

We had a different system where I was. The scanning does make it more complicated...

And yes, vitamins are really not a big deal. But if they fall on the floor/ get lost in sheets or whatever, and I'm signing off that they were taken, when I don't really know, that can add up too. On the unit I was on, we had many psych patients, and confused pts, so we could not necessarily trust what they said.