Letting CNA pass your meds, bad idea?

rn/writer, RN · Oct 18, 2006

I wouldn't set up meds for another NURSE to give. Nor would I give meds someone else had set up for me. It isn't ONLY the lack of training of the unlicensed personnel but also the messy issue of divided responsibility.

If one of my patients needs a pain med while I am busy, one of my co-workers will get that med from the ADU, give it, and sign it off herself. That's okay because she is the responsible party from start to finish.

In the case of setting up meds for someone else to give, there are too many pitfalls. And heaven help you if a narc goes missing.

sloppy_joe · Oct 18, 2006

I work as a CNA in a private run Assisted Living facility. Our DON lets us pass meds (i believe it's her license on the line) We do a like 3 or 4 day training (i haven't gotten passed yet b/c i got hired at the end of the summer before i went back to college in another state) We're not certified by the state or anything but from what i understand, we can do it at our place b/c it's private run. I think our DON does it so she doesn't have to hire more nurses and cut costs, but i have other CNA friends that work in assisted living private run facilities that pass meds. I'm a student now working my butt of, and i know when i'm a nurse i wouldn't want to take that risk

rktele · Oct 18, 2006

Don't do it. You can't confirm that the pt took all of the pills, besides, it's illegal!

sister--* · Oct 18, 2006

I always rely on MY assessment of the pt. BEFORE administering any medication! If you just hand 'em out to be given by others then where is your assessment? Where is the patient's safety considerations? What about the 5 rights?

Also I'd never, ever, ever, ever give any medication that I did not set-up myself after check, check, and double check. How in heavens would you know that what someone else set-up is the actual medication indicated? PO liquids, stock bottled meds, syringe contents......

What a frightening way to practice nursing!!

lmaldo · Oct 18, 2006

I was a CNA before being a Master's prepared nurse and even I knew then, without going to nursing school that it was ILLEGAL for me to pass meds. In fact, not only is it illegal, but completely irresponsible and and an incredible liability for any health organization to allow it, in California, anyway. Think about this. Let's say that, hypothetically speaking, it was NOT illegal. Okay, so you are a smart nurse and you know about all the interactions and contraindications for this medication about to be passed. So what. First. If you pass a med to patient, as an RN, you are responsible for watching the patient take the medication. That way, if the patient is dysphagic, you can use critical thinking skills to either crush the med, get orders for a different route, or chokes on the medication, you can be there to correct the situation, contact the doctor, take doctor's orders for treatment (which I might add is also illegal for any CNA to take orders directly from a doctor). If you gave this task to the CNA, (who is not required to be a critical thinker) who became distracted by the other patient in the room who suddenly had emesis and diarrhea and the patient took the meds left at the bedside by the CNA, choked... By the time the CNA got back to the patient, there was a code situation... Ooops, the patient just died. Although the CNA can be held liable, you, the RN, who had the patient under your care, is completely responsible for the entire affair, even though you were not in the room. Next, a complaint is filed with the board of nursing, you lose your license and you are convicted of a felony charge of negligent homicide and all the work you put in to school is gone and perhaps you will never be able to go into healthcare period. Except, I understand as a trustee you can work in the prison infirmary.

This is just food for thought and not meant as an inflammatory response to a ridiculous question

Marie_LPN, RN, LPN, RN · Oct 18, 2006

Wow great response, to save some face, I'm a student doing this for a essay so don't string me up just yet...

You should have specified this in your OP, so people weren't answering to false pretences. :madface:

pagandeva2000, LPN · Oct 18, 2006

I fill the cups and check for all interactions and whatnot, but anyone have any negative experiences or can think of any possible neg exp with this?
Thanks

I think that it can be a bad idea, but can comprehend why an overwhelmed nurse would be tempted to do so. If you work in a nursing home, and are overwhelmed, it is hard to keep up, but I would be too afraid to do it. The aide has nothing to lose by making a mistake, and with you signing for it, you are ultimately responsible for the outcome.

When I was a nursing assistant at a nursing home, an LPN asked me to give meds to a patient in a certain room that housed 2 clients; one was oriented x3 and the other was spacy. Being naive, and proud that I was assigned a nursing responsibility, I went in there to give it. Come to find out that I offered it to the lucid one, and she told me that it was NOT hers. I checked her ID band, then, went and told the LPN that I was not giving it. What if it was a drug like Lopressor, and I gave it to a person who already had low blood pressure, and they passed out. Do you think that I would have admitted to that...and it was not my job to begin with? Of course not. What explaination would the aide give? What guarentee would you have to know that it was administered? NONE!!

I had another situation where the nursing assistant came to me in the clinic I work in and told me that the blood pressure was high. I told her to take a manual, and she told me that it was 200/100. I told the provider, and he told me to give clonidine 0.1 mg. I came to the patient and retook the pressure before I administered it; (got the same reading), and the aide was furious with me, because she felt that I didn't trust her. I administered the medication, because then, I deemed it to be safe to do so. I then explained to the aide, who happened to also be a friend of mine that it would be MY license on the line if I just took her word.

You really place your license on the line when you give it to someone else, especially a person who does not comprehend what medications are, the risks, and responsibility. Only you can account for yourself.

TINKERBELL83 · Oct 18, 2006

I don't think it is a bad idea. I'm a CNA going to school for nursing and I work in a CBRF facility and I pass meds out everyday that I'm at work. Most places require you to take a class on med passing. Then you have the option of taking a state license test depending on the facility you are working in. In my opinion at my facility the nurse would be over worked with passing out meds due to we have over 1000 residents in our facility and thats all they would be doing all day. We of course don't do injections that is the nurses responsibility unless you are in school for nursing and a nurse is there while you are doing the injection. I guess it all depends on the training on what you are doing. I can understand that if someone has no clue what they are doing or giving then yes I would have to say no they shouldn't.:monkeydance:

lmaldo · Oct 18, 2006

Sorry, I just thought of another good example why it is a bad idea. It again goes to critical thinking. Let's say you, the RN, have to give atenolol. You know you need to first take a blood pressure. Okay, the CNA could take that for you. Let's say the blood pressure is 85/55. A CNA does not have the responsibility of ASSESSING this patient and making the appropriate decision to hold the med and to continue ASSESSING the patient's blood pressure and other vital signs. If the CNA just went ahead and gave the med, tha patient would be in a hypotensive crisis and end up in ICU, or worse yet, dead. It would still be the RN's responsibility for the outcome and the Nurse Practice Act would not be able to overcome the error committed.

Food for thought

lmaldo · Oct 18, 2006

Well, Tinkerbell, you obviously don't work in California. I hope the meds you pass don't include cardiac medications or narcotics :/

angel5 · Oct 18, 2006

First of all, the correct term is "personnel" not personal.

25(2)+2 · Oct 18, 2006

i am a certified med aide and one day i was giving a prn to a resident and a cna took it upon herself to give a resident a scheduled med. i came back and told her i was going to give the gentlemen his midnight med and she said she took care of it. i lost it. told her she is not suppose to be giving meds. she replied that the nurse has had her do it numerous times. i explained that puts our licenses in jeopardy. the other problem with this what if the resident would happen to choke or not swallow the pill. never a good thing to allow anyone to give pills that are your responsibility to pass.