Medication administration vs Patients wants

toomuchbaloney · Apr 14, 2014

In my professional opinion;

Notify the prescribing provider and get the orders changed.

An alert and oriented patient may make decisions about their health care.

Do not leave the medications at the bedside, you must observe the patient taking the meds in order to document that they were indeed taken po and not disposed of in some other fashion.

tokebi · Apr 14, 2014

Ditto that you shouldn't leave meds at the bedside.

Most often, the admin time printed on MAR is an arbitrary protocol per pharmacy. A physician just orders, "Amlodipine 5mg PO once daily." They don't specify an exact time. Pharmacy will generate the admin time for all "once daily" meds at 0900, all "once at bedtime" at 2200, etc. There's no problem to change the admin time for the above amplodipine order to 1030. I do that all the time if pt wants it. If it's a repetitive thing, I'll talk to pharmacy and have it changed so that I don't have to manually change it every time. Likewise, if a pt wants to take their HS meds at 2000 and go to sleep early, that's not a problem either.

The only time the exact timing matters is for antibiotics, which should be given exactly as pharmacy determines, meds that are given several times a day, and meds that should be specifically given with meals or between meals.

Look through each med for that patient. If any of them must be given at exactly prescribed times, explain to the patient why. For anything that's just "daily," let patient take it when she wants.

cardiacfreak, ADN · Apr 14, 2014

Never, never leave meds at bedside. I would do just what you did. Can you get the MD to change the times of admin?

Gabby-RN · Apr 14, 2014

You should never leave meds at the bedside. With that said, it is difficult for patients to understand that when not every nurse follows that rule. I usually tell patients that hospital policy states I cannot leave meds at the bedside. When they say everyone else does, I let them know I am sorry I cannot speak for what others do that i just know that hospital policy states what it states and that I would be more than happy to ask the doctor to change the med times if there is a time they would prefer them but otherwise I would have to discard the medications and chart them as refused. I try to be sympathetic and polite and not throw other staff under the bus. Sometimes people just don't understand that leaving meds at the bedside is something a nurse could be fired for even if it is unlikely. They also think that the chances of a child running by and taking all the meds or a confused patient is unlikely or something they never considered. Most people end up being understanding even if they don't like it.

silverbat · Apr 14, 2014

The hospital I worked at on Med surg once had an alert and oriented pt who the nurses would leave her meds on the bedside table for her to take "later, I am eating a snack, putting on makeup.etc.".

After about a week of this, accidentally, a CNA opened the bedisde table drawer and found a weeks worth of pill stashed. Beside the pills she found an apparent suicide note in progress. This lady took some major meds, that in the total, probably would have successfully allowed her to suicide.

Not every pt has suicide in mind, but..................

Notmarvin · Apr 14, 2014

Thank you toomuch. I did not realize that I could simply call and get the med times changed. Every day I am learning more of what I am able to do so as to be a patient advocate. If I work with the patient again I will absolutely call and request med time changes. I think that would make a world of difference and keep the pt happy as well.

nurseprnRN, BSN, RN · Apr 14, 2014

As above, know whether they are just daily meds, in which case it doesn't matter when she takes them so long as it's roughly the same time qd, or whether it makes a difference (like q12h, q8h, etc. for some therapeutic reason). These are the little things you'll be learning for years. :)

Notmarvin · Apr 14, 2014

mds1 that actual thought crossed my mind my entire shift. I get sick to my stomach thinking about leaving meds laying around, and the fear that today will be the day they aspirate. Not on my watch

Notmarvin · Apr 14, 2014

Thank you everyone for your replies. Allnurses got me through school and is now offering peace of mind as I begin a new career as a baby nurse!

SoldierNurse22, BSN, RN · Apr 14, 2014

OP, you've had great advice on this touchy question. I'd encourage you to do just as the posters before me have described. Most nurses will deal with a patient (or two or three...) like the one you've described at some point in their career.

I've had patients get downright belligerent with me when I've told them that I must visually witness them take their medication. "You don't stand over me at home and make me take my meds!" "I'm 45, you're (sinfully young), who are you to tell me what to do?"

A good thing to do in this scenario is walk the patient through your point of view. "Ms/Mrs/Mr Patient, I understand you don't like this but, I am a licensed nurse. I know your dose of XXXX may not seem terribly critical, but in a hospital, it is my job to ensure that the medications that you're getting here don't interfere with the ones you take at home. That means charting the type of med, dose, and time that you took it. As a licensed nurse, it is my legal and ethical responsibility to ensure that when I chart that you took a med, you took that med. I cannot chart that you took the med unless I actually see you take the med."

"At home, you are responsible for your care. At a hospital, you're still responsible, but so am I and the doc and the plethora of other medical professionals who care for you. That means that I, as a responsible medical professional, must ensure that the meds are taken, the IV pump is right, the diet coming up from the caf is correct, and a myriad of other activities that you don't have to worry about at home."

There are a million ways to say it, but the point is, a patient ends up in a hospital because they're sick. They're sick and they need someone else to watch things for them. That's part of your job as a nurse--a central job, it could be argued. Ensuring patient safety with drugs is just as important and ensuring that a patient isn't going to splat on the floor the first time they're up after surgery or roll over on the uncapped needle left at bedside. A hospital is an unfamiliar environment. Patients aren't at their best typically, and whether or not they like it, it is your job to keep a close eye on them!

Another good thing to point out is that you don't necessarily suspect them of abusing or being intentionally noncompliant with meds. I had a patient as a very new nurse who would swear up and down that she'd take her meds if you left them at bedside, then promptly forget them for 4 hours. Four hours later, when her next meds were due and the previous dose was still sitting on the counter, I nearly had a cardiac event upon seeing the untouched meds from four hours prior still sitting quietly in their cup!

NightNurseRN13 · Apr 14, 2014

Wait................ one day of orientation and you are on your own? Yikes!