Med questions

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Specializes in assisted living.

Hi all!

I am new to private duty and had a couple questions about meds...my client only takes a variety of vitamins and has an albuterol neb. The POC doesn't have a dose for the neb...just says "one ampule." There is a box of them in the med cabinet that are used but the problem is that it actually has the client's sisters name on the box...apparently they have the same prescription and will share them for cost reasons or something. What do I do about that? I have only been in the hospital environment so I am not how big of a deal this is but it makes me uncomfortable. The nurse I mentioned it to says it doesn't matter?

My my second question is how it works with vitamin supplements. One of the vitamins is a different dose than what is on the MAR and POC. Does this matter or can a client take whatever OTC things they want? I am just a worrier and I like to do things by the book. I just don't know what things to make a big deal about and what things are really not issues in home care. Meds seem like kind of a big deal. Or am i just too paranoid? I am new on this case and don't want to cause problems right from the get go. Any thoughts?

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Private Duty is a little more relaxed than facility nursing. If the neb meds are the same drug and dosage, use them.

The vitamins...can you calculate the proper dose? If not, look into a clarification order.

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Specializes in assisted living.

Thanks! And as for the vitamin...the order is for 300mg and the one they have is 1000mg. How do OTC things work? Say you are out and about with your client and they want to stop at walgreens and buy cold meds or supplements etc. can you administer them or do you need an order? It seems like they should be able to take any OTC thing that they want...but I certaiy don't want to be liable if they have a reaction or decide to take some crazy thing they read about online lol.

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The order can be written so that they can use any OTC brand as long as it matches generic name of meds and amounts contained. Calculate correct amounts from current bottle in use and educate the client to be consistent with future purchases. As for the client buying a new OTC med, go by your agency policy regarding obtaining the order. One of my recent agency supervisors said ok to give as long as you have written the doctor's order for signature and are submitting the original with the day's notes. Another agency refuses to deal with a new order unless it has come from the doctor's mouth (or pen). As for the neb med, I would give the med if the ampule clearly states the correct med and concentration as well as shows an unexpired date. Again, I would educate the patient to provide their own meds. Technically, if you are uncomfortable with this, then you can ask the family member to administer, as you are correct in insisting the meds come from a box or container with the patient's own prescription label attached. All OTC meds require an order to be included on future 485's.

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Specializes in nurseline,med surg, PD.

You can also call the doctor and get a specific order for the albuterol. A med order isn't complete if a dose isn't ordered. "One ampule" isn't specific enough. As for OTC meds, a parent can give their child anything they want, however if you can get a specific order that would be better. Just tell the mom that you want to call the doctor to get the orders clarified. She can't argue with that. It's always best to CYA.

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As said above...CYA. A parent can administer without an order, but they will try to get you to do it eventually. I have parents who want to play doctor. I let them as they have the final say. I simply document like crazy. If there is an OTC they want to give, the day shift nurse usually calls the MD to get an order...sometimes the MD agrees and sometimes he doesn't. When he doesn't and the parent wants to give it anyway, I tell them that they can do so if they wish, but I will document that they gave the med.

I understand wanting to play by the book, but in home care it's not always possible. Just remember that the parents and the agency both view you as "just another nurse". You worked to earn that license, so listen to your gut. Don't let parents (or even the agency) bully you into ANYTHING. The parents can turn on you for any reason at any time and the agency will most likely NOT have your back.

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Specializes in Pedi.
Thanks! And as for the vitamin...the order is for 300mg and the one they have is 1000mg. How do OTC things work? Say you are out and about with your client and they want to stop at walgreens and buy cold meds or supplements etc. can you administer them or do you need an order? It seems like they should be able to take any OTC thing that they want...but I certaiy don't want to be liable if they have a reaction or decide to take some crazy thing they read about online lol.

They can take any OTC thing that they want. You cannot administer it without an order. The parents can administer it until you obtain an order.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

I worked with an agency that wanted orders written for herb teas and diet supplements. Had one adult case where it seemed like every week you'd see a bunch of his latest jars and bottles of God knows what...you do feel sort of silly asking for an order for seaweed powder, but you have to and most of the MAR was zillions of OTC meds.

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Specializes in Pediatric Private Duty; Camp Nursing.

Sometimes an OTC med is contraindicated in certain diagnoses, and/or prescription meds they might be taking. It's always prudent to document meds and treatments given by caregivers right before or during your shift, to keep a record of all care given within the time you're responsible for the child.

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Specializes in assisted living.

Thanks everyone!! I don't work for an agency...so no policy there. I think that working without an agency is more common in WI?? It seems like the PDN nurses I meet are all working that way...probably because the pay is much higher and it is very easy to sign up to do so... anyways, the patient is also an adult so no parents giving meds. I don't have to actually give the supplement that is supposed to be 300 mg and is actually 1000 mg. It is calcium and obviously many people take 1000 mg but I really would like the MAR to be accurate. As for the albuterol....can I just call the Dr. on the POC to confirm the dose?? I know my client has a prescription, but I don't think he knows the actual dose...he just said "it is exactly the same as my sister's" I feel silly to be the new one on the case and questioning things when everyone else has been there quite a while. It is just awkward because it sounds like I am questioning what they are doing. I really like the other nurses, but I am new to PDN so I am not sure what to worry about and what not to! Thanks for your advice!!

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Specializes in assisted living.

Also what do you do if the patient always declines basic assessments....respiratory, GI etc. This is a very stable patient who only used to have CNAs and isn't used to all the documentation and assessment or so he says. I tried to sweetly talk him into a quick listen to to lungs etc. but he adamantly refused. the nurses all just chart "patient refused." What do you do if they ALWAYS refuse?

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You chart that he refuses. Simple as that. It may good to have the care plan updated to state that VS will be done only when desired by client due to frequent refusal (or however your company wants to state it)

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