Leaving Meds at the Bedside?

[joanna73]

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...

[blondy2061h, MSN, RN]

A few years ago I had students someplace where a few RN's would pull all their 4-5 patients' meds from the Pixis/Omnicell, then go to the hallway computer, log into each patient's electronic MAR and mark it given "so I won't forget to mark it given later when i get back to the nurse's station." Then they'd visit each pt, do assessment and whatever, which usually took 90 min. But the meds were charted as being given "on time". Now, it got complicated when a student had the pt and we withdrew the med and then discovered that RN had already marked it given- when we caught up with the RN she'd say "Oh, I have A-9's colace and Advil- does the student want to give them since it is her pt?" If med was still in "bubble wrap" with ID info, we'd do it, but I would remark on that fact that the student needed the experience of charting that she gave the med, but MAR showed it was already done." this might be 1 hr later, so the time really given and the time marked in MAR were not the same. Knowing when to give the next dose is then compromised. I did eventually go to the manager and report the repeat offenders, but that meant the students got even less help and nurturing on the unit, as I became the "tattle-tale." I'm much happier now in a clinical site that uses bedside scanner MAK for all meds!

It meds can't be given on time simply because there isn't enough time to give them on time with a certain assignment, I sign them out late. I think it's better management sees that I don't have enough time to do things "right." Granted, I am lucky to work in an environment where this isn't punitive, but I know many are not.

[Up2nogood RN, RN]

Where do you put the used inhalers if not in the patient's room? We used to put this back into the patient's pyxis until we got fined by the DOH (and rightly so), we're now required to leave them in the room if they've come in contact with the patient.

We can put the inhaler in a clear ziplock plastic bag and place back in the patients own bin in the Pyxis. No one has ever told us we can't do this. The inhalers are not coming into contact with anything else and all other floorstock meds are in a totally different section behind another door. I certainly wouldn't just leave them at the bedside unless ordered, I've seen many patients take way too many toots from their inhalers thinking more was better. If the patient is on isolation we do have a locked cupboard in the pt room that we can leave inhalers, eye gtts in that case so we don't have to take back out of room. Otherwise all others do go back to Pyxis.

[CapeCodMermaid, 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 :)

No flames from me, but try working in long term care where you have to pass meds to between 20 and 40 residents many of whom are demented and many who take at least 2 minutes to swallow each and every of the 27 pills they get every morning.

And let's not forget the residents who pretend to swallow their meds, but don't and then try to sell the disgustingly spitty pill to another resident.

[niecejr]

Hi I'm a new nurse and have a job at a Retirement and Rehab facility, I've been working there two weeks and have only been on a certain hall for 3 days. It was my last day orienting with a nurse, and I found out I had left a PRN Norco at the bedside. When I was about to give the Narcotic the patient said they couldn't drink without a straw, so I told her I would run and get one after I gave the rest of meds for that room. When I left the room another task was brought to my attention and I got side tracked. I know it's bad to leave it and I did not mean to, I may get a write up.

In my opinion I do not think it's fair that I should get a write up, maybe a talk about how we should take our meds with us out of the room until we plan on giving it, but I was thrown into a hall as a new nurse with 30 patients on my hands. Mind you I am the only nurse to a hall and these older patients can take more than a handful of medications. To top it off I was still orienting and trying not to drown. I don't know how I plan to survive.

[caffeinatednurse, BSN, RN]

I had a pt once who took her meds crushed in yogurt. Literally about 20 pills crushed in yogurt. She took probably 1 hr to eat her small 30 ounce cup of yogurt. Needless to say, I did not stand there and watch her eat her cup of yogurt. I did poke my head in the door 2-3 times to make sure she was making "progress" on it, though. My fellow nurses did the same thing w/this pt because we simply did not have an hour to spend on watching her take her meds.

I've not, to my knowledge, left anything else at the bedside, though. Either they take it then, they refuse it (if a scheduled med) or I bring it back later (if PRN). Given those options, most pt's will go ahead and take their meds.

[CapeCodMermaid, RN]

We're supposed to stay with someone while they're getting a nebulizer treatment. Out of 20 residents, probably 15 had nebs at least 4 times a day. We ended up writing orders which said: May self administer after nurse sets up. We did an assessment and all was good

[RNKPCE]

What about the patients that sip their powder potassium in juice like an evening cocktail?

[CapeCodMermaid, RN]

The DPH will cite you for that unless you have an order that the resident may self medicate. It is all so ridiculous. No one watches these peeps take their meds at home.....