legalities in giving a med

Nurses LPN/LVN

Published

Ok so my pt has an order for ty pm but we ran out on house supply and the facility has yet to get some because there cheap. They wrote in the nurses communication book to give 2tabs es ty with 1benadryl. Is this legal? It the same ingredients as ty pm (aside from that one med is diphenhydramine hcl and the other has no hcl and idk if that makes a difference) but I feel uncomfortable giving it because its not what's stated is orderd. Should I get the dr to change order to 2ty and 1 benadryl so I can say I'm giving what's ordered?

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You must have a doctor order for ALL medications even OTC. Someone just writing that on the MAR does not count.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Should I get the dr to change order to 2ty and 1 benadryl so I can say I'm giving what's ordered?
Yes, and your order must be exact: "Okay to administer Tylenol ES 500mg, 2 tabs po, at bedtime, along with Diphenhydramine 25mg po at bedtime."
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Our pharmacy has the right to do "therapeutic interchanges" for any med ordered. For example, docs order IV Zosyn q6h but it's always changed to q8h based on industry standard....pharm can legally do this. Also, they interchange Protonix for Prilosec, etc. The pharmacy puts it in the EMAR properly so our meds scan. After all, pharmacists are the experts in medication, not MDs.

Wanted to add... if pharm isn't involved with this and this is just management or other staff telling you to do this, then that's totally illegal!

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Thank u both for the answer. I brought up my concerns with admin and my DON states she talked to the pharm and its ok and ty pm is on the way. Its hard working in a cheap facility :(

U are both right and there should be an order from pharm for therapeutic interchange before giving the ty and benadryl.

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Specializes in Ambulatory Care-Family Medicine.

In my state pharmacist are not allowed to change drugs without a doctors order. They can change out brand and generic but not the drug. There is a reason the doctor wrote it the way they did and it needs to be clarified.

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Specializes in Critical Care.

Tylenol "PM" is tylenol and benadryl, it's just the trade name for the combination of those two drugs. This is not a 'therapeutic interchange' as you are not substituting one drug for another. You really shouldn't need to change how the order is written if you aren't changing the drugs,which in this case you are not.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Tylenol "PM" is tylenol and benadryl, it's just the trade name for the combination of those two drugs. This is not a 'therapeutic interchange' as you are not substituting one drug for another. You really shouldn't need to change how the order is written if you aren't changing the drugs,which in this case you are not.

The OP works in long term care, which is one of the most regulated healthcare sectors in America. It is far more regulated than acute care hospitals. Trust me when I say that a state surveyor would cite the nursing home and tag the facility if this order is not clarified.

If the facility has run out of the Tylenol PM pills (APAP + Benadryl combo pills), a state surveyor is definitely going to want to see an order that reads: "May administer Tylenol ES 500mg, 2 tabs po, at bedtime, along with Diphenhydramine 25mg po at bedtime until Tylenol PM pills arrive."

I know the rules and regulations of long term care seem silly and asinine, but what happens in the hospital would never fly in the nursing home setting.

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Specializes in Critical Care.
The OP works in long term care, which is one of the most regulated healthcare sectors in America. It is far more regulated than acute care hospitals. Trust me when I say that a state surveyor would cite the nursing home and tag the facility if this order is not clarified.

If the facility has run out of the Tylenol PM pills (APAP + Benadryl combo pills), a state surveyor is definitely going to want to see an order that reads: "May administer Tylenol ES 500mg, 2 tabs po, at bedtime, along with Diphenhydramine 25mg po at bedtime until Tylenol PM pills arrive."

I know the rules and regulations of long term care seem silly and asinine, but what happens in the hospital would never fly in the nursing home setting.

That would appear to be highly state or even surveyor specific. I sit on a P&T committee that oversees my hospital as well as two ECF's and a SNF. We have clarified this with the DOH in terms of the ECF's med administration policies (specifically in terms of Vytorin), and the DOH responded that they consider this to be no different that any other generic substitution; so long as the MD has not specified that generics cannot be substituted, an order for vytorin may be interpreted as an order for ezetimibe and simvastatin without any further clarification necessary. As far as they are concerned it's no different than giving pantoprazole when "protonix" is ordered, it's same drug, same dosage, etc.

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I'm not saying you need a doctor's order, I'm saying pharmacy should enter it as exactly what it is.. 2 different drugs, which happen to be given at the same time. Ours has to do this because we scan our meds.

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Pick your battles. You will come by bigger ethical/legal issues than this.

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Pick your battles. You will come by bigger ethical/legal issues than this.

I do pick my battles and any situation that can put my license at risk is a battle worth fighting. Being an LVN is how I provide for my son! I won't let a facility take that away from me, having me give meds that are not ordered. It was no big deal for me to call the dr and get an order. I just wanted confirmation i was right.

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