medicine without a license

ZippyGBR, BSN, RN · Nov 12, 2008

actually, i think your last line comes very close to "practicing without a lic"
we know what the med is for.....what reaction to expect, we dont have the training to decide a dose.......

really

oh dear nurses in the uk must be so dangerous working from PGDs with dose ranges or PRN prescriptions with dose ranges ... before even mentioning dose adjustment protocols can be used by none prescribers ...

CoffeeRTC, BSN, RN · Nov 12, 2008

In PA LTC you are not allowed to have does ranges. If we get an order for Percocet 1-2 tabs prn...we need to get it clarified and separate the order...1 tab mod pain, 2 tabs severe pain.

georgianurseRN · Nov 12, 2008

really
oh dear nurses in the uk must be so dangerous working from PGDs with dose ranges or PRN prescriptions with dose ranges ... before even mentioning dose adjustment protocols can be used by none prescribers ...

with an order to use them and training to eequip them with the necessary knowledge to use them correctly

morte, LPN, LVN · Nov 12, 2008

really
oh dear nurses in the uk must be so dangerous working from PGDs with dose ranges or PRN prescriptions with dose ranges ... before even mentioning dose adjustment protocols can be used by none prescribers ...

have no idea what a PGD is, but by the sounds of the of your statement you have parameters....and might i guess those where determined by a physician? and see the post after yours.......also.....as a USAer, perhaps our laws are different?

georgianurseRN · Nov 12, 2008

Please give an example where giving half a med will result in more harm to the patient than withholding the entire med when a patient refuses to take the full dose? I can give you a lot of examples of when giving more of a med than was ordered will result in harm to a patient.

not referring to harm, referring to legality

allnurses Guide · Nov 12, 2008

have no idea what a PGD is, but by the sounds of the of your statement you have parameters....and might i guess those where determined by a physician? and see the post after yours.......also.....as a USAer, perhaps our laws are different?

Morte a PGD is something called a patient group directive,

Patient Group Directions (PGDs) are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment. The supply and administration of medicines under PGDs should be reserved for those limited situations where this offers an advantage for patient care without compromising patient safety, and where it is consistent with appropriate professional relationships and accountability.

PGD

You are quite right, the parameters are determined by a doctor and the protocols are very specific in what and who they cover. They can be used for initiating new medications or altering the dose of current medications however I think they are becoming less used with the development and increase in the number of independent nurse prescribers that we have in the UK.

ZippyGBR, BSN, RN · Nov 12, 2008

You are quite right, the parameters are determined by a doctor and the protocols are very specific in what and who they cover. They can be used for initiating new medications or altering the dose of current medications however I think they are becoming less used with the development and increase in the number of independent nurse prescribers that we have in the UK.

parameters are not determined by Doctors in PGDs because it's rare to see one written by a doctor , howver thy have to be approved by the senior Doctor, Senior pharmacist and the Senior people from the profession(s) named in the PGD.

this may seem like semantics but it;s important

also PGDs are not becoming lessused because of Nurse proescribers, most Emergency depts can't even to afford to pay their senior staff Nurses the correct AFC band never mind have them as Independent prescribers ...

allnurses Guide · Nov 12, 2008

parameters are not determined by Doctors in PGDs because it's rare to see one written by a doctor , howver thy have to be approved by the senior Doctor, Senior pharmacist and the Senior people from the profession(s) named in the PGD.
this may seem like semantics but it;s important

yep it's semantics because unless it's approved by a doctor then it's illegal to use.

also PGDs are not becoming lessused because of Nurse proescribers, most Emergency depts can't even to afford to pay their senior staff Nurses the correct AFC band never mind have them as Independent prescribers ...

our ENP's are nurse prescribers as part of the NP course

Anyway the discussion about UK prescribing is not really relevent to this thread as the legalities are completely different.

allnurses Guide · Nov 12, 2008

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!

I am not sure about the legalities of US medication administration. I think as a manager I would want to know why the patient felt they needed something other than the usual dose of insulin and why the nurse felt this was acceptable then take it from there. Was it a reasonable request - maybe, was the action legal - that's something that the BON would need to answer.

ktwlpn, LPN · Nov 12, 2008

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!

You have gotten plenty of good feedback here.Someone mentioned the "that's the way we've always done that" mentality that is often found in LTC.I'm surprised they have gotten away with this for so long-our DOH audits our charts very very closely and something like this would be caught right away.As the DON you can write a new P and P-I don't think you should make an example out of anyone in this instance.You have a big job ahead of you-you have to drag the staff into a new age and you want them working WITH you.You have to make it clear that "the way we have always done it" is NOT acceptable any longer and explain why.... Our DON came up through the ranks a few years ago-we had P and P in the books from the 70's and 80's (seriously) It's been challenging for us all but by working together we all keep up with the rapidly changing protocols.Except for the few people that grump and whine because they don't like change...We got smacked by the DOH a few years ago for circling meds on the MAR and noting "unavailable from pharmacy" It seems that many nurses did not bother to call the pharmacy,look in the emergency drug box or even stop to think about what the med was and why the resident needed it.So-several residents went days with out certain meds-one in particualr missed lasix...HELLO where is your brain? It has taken a long time for all staff on all shifts to work together and take the initiative to make that call to the pharmacy and follow through to make sure the meds were delivered or the doc was notified about any missed doses. So get busy with those p and p's....Sounds like fun

morte, LPN, LVN · Nov 12, 2008

yep it's semantics because unless it's approved by a doctor then it's illegal to use.
our ENP's are nurse prescribers as part of the NP course
Anyway the discussion about UK prescribing is not really relevent to this thread as the legalities are completely different.

thanks sharrie, as i suspected.......

cherrybreeze, ADN, RN · Nov 13, 2008

Look at it another way. If there is an absolute right for the patient to determine their care why could the patient not decide on what medications they want or how they took them. If a patient on Oxycodone wanted Dilaudid instead would the nurse give them this under the concept of patient autonomy?
There is a written drug order. The nurse in their professional judgement could refuse to carry it out if they felt it was improper or dangerous. The patient could refuse the order for whatever reason if they are competent. What neither party can do is modify the order without a new order. That is practice of medicine. If the provider wants to allow the patient choice then the appropriate thing to do is to provide a range order for the nurse to carry out.
Just my take
David Carpenter, PA-C

You can't compare this to the issue at hand. Oxycodone and Dilaudid are two different medications, the situation here is a partial dose of the same, PRESCRIBED medication. Apples to oranges.