medicine without a license

Nurses General Nursing

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Specializes in Just about all of them.

hello, I am new to this but there seem to be some intelligent people here. I have a question about LPN changing insulin dosing without a MD order? This is a nursing home, patient said he only wanted X amount of units, nurse granted request. I am looking for some verbage or legal document stating that this is practicing medicine without a license. We are in Georgia

HELP!:nono:

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Specializes in ER.

Absolutely illegal, she could have called the doc and gotten an order, but to do it on her own was totally illegal in any state.

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Specializes in Just about all of them.
Absolutely illegal, she could have called the doc and gotten an order, but to do it on her own was totally illegal in any state.

yes, but where can I find some type of OFFICIAL verbage to post. I am new DON to this facility and apparently the old one told them it was"OK"

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You should check with your state's BON. They can point you in the right direction.

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Specializes in psych,maternity, ltc, clinic.

Actually, unless a person is committed, they have a right to refuse meds. So if a patient has an order to take 10 units of insulin but only wants 5, would this not be within a patients right? He is not asking for more than whats ordered, which would be a no-no. Now the LPN should find out WHY the patient wanted less...(probably because they know their body and know the ordered dose may be to much, based on the blood sugar) and let the Doctor know whats happening. And document! But she can not FORCE the patient to take the full dose of insulin.

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I agree with Debi49. The patient may refuse 5 units if they choose. It's another thing if the blood sugar was high so the nurse gave an extra 2 units to cover without an order- that's illegal. If the nurse would have withheld all the insulin because the patient refused the correct order or forced the patient to have all 10 units against his will- that's illegal too. It's important to inform the doctor, monitor closely and document.

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Specializes in Maternal - Child Health.

The patient has the right to refuse any (or all) of his insulin dose. The nurse needed to notify the physician if something less than the ordered dose was given, preferably prior to giving the medication.

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Yep. People don't lose their rights when they enter a nursing home. That's respecting the resident's right to autonomy, not practicing medicine.

Are you really trying to go after this woman's license for a decision the resident made? Really?

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How is this illegal? Like a few others have said, a person has the right to refuse any and all medications. The prescribing doctor should be notified of the situation, but it doesn't have to be an immediate, panic-button phone call either, just notify him when appropriate, unless by refusing a med a pt is putting his life at risk.

I have patients who frequently say "I don't want two pain pills, just one". Fine, they got one. Want 5 units of insulin, not 10, because you are pretty sure that based on your history you'll crash in the middle of the night? You're getting five, then. I appreciate the heads-up, and will know to check your finger stick later tonight just in case.

Document the reasons why only part of the medication was given, and leave a very clear trail between the med admin sheets and the charting so that there's no confusion later, that's all.

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Specializes in Trauma, Teaching.

Are you really trying to go after this woman's license for a decision the resident made? Really?

That isn't the tone I got from the question...she sounds like she's looking for what is the right thing to do, starting from the premise that we can't change doses without checking with the doc.

I'm with the others that see no problem with reducing a dose at an adult's request. Yes let the MD know, and possible set up a sliding scale regimine instead of a standard dose, but it is always okay to give a smaller dose of things like insulin and pain meds per the patient's request. Wouldn't go changing cardiac or seizure meds! (0ther than the parameters of BP and HR, etc. )

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Specializes in Just about all of them.
Yep. People don't lose their rights when they enter a nursing home. That's respecting the resident's right to autonomy, not practicing medicine.

Are you really trying to go after this woman's license for a decision the resident made? Really?

Not going after anyone's license, only trying to protect them as a good DON should do. It is alright for a patient to refuse any med or treatment for any reason, it is not alright to make a decision to dose based on a residents wishes without a doctor order. That would be like allowing a patient to take only 1/2 of their BP med because they feel so good today.

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Specializes in Just about all of them.
I agree with Debi49. The patient may refuse 5 units if they choose. It's another thing if the blood sugar was high so the nurse gave an extra 2 units to cover without an order- that's illegal. If the nurse would have withheld all the insulin because the patient refused the correct order or forced the patient to have all 10 units against his will- that's illegal too. It's important to inform the doctor, monitor closely and document.

Any and all patients can refuse a dose of medication. If you comply with their wishes to give half a dose, without a doctor order and they go into a coma or some other complication, who is at risk or fault then? The patient who is obviously ill or wouldnt be in a health care facility, or the nurse who didnt follow MD orders? So it is not ok to give less or more without any order. Bottom line... CYA

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