midwife/NP problem (kinda long)

[khammond0005]

I called a midwife/NP to update on pt status while working L&D. She asked to be transferred to the pts to speak with her and then would call me back with orders. No problem - transferred call and made sure it went through. 20 mins later she calls me back. As part of her DC orders she asked me to give the pt a med to help her sleep, if she didnt have a ride home, just physically giver her the pill to take at home. I explained that I didnt feel comfortable doing that since its my license tied to the med and I have no control of what happens with it after the pts leaves. She then tried to word it different ways to the point of, "couldnt you just sit at her BS?" Once she realized I wasnt giving in, she asked me to call it into a pharmacy. Im not sure how it is anywhere else, but under the new management here, we are no longer allowed to do this. We just lost a RN on a different floor over it. Again, I had to explain I couldnt do that. After that I finally got my orders. (BTW, she decided the med wasnt that important if she had to call it in).

Through this whole conversation my clinical manager was sitting beside. After I got off the phone I made sure what I said followed policy. She said yes and then made the comment that she knew this NP knew about the policy bc she had personally shown it to her last week.

I went to review THI with the pt and she asked about the med. She had been told giving her the med to take home "wouldnt be a problem" and couldn't understand. I tried explaining it but nothing I said seemed to diffuse the situation.

What would you guys do about this situation? It bothers me that my manager was sitting there, hearing everything, but then didnt do anything about it. Do I go higher up (which prob wont do any good either), is there someone to report it to, Or am I just SOL?

And what is your hospitals policy on calling in Rx and/or giving meds for pts to take home?

[eden]

Unless it is a woman with an IUFD, we don't give sleep aids postpartum. They are allowed to take tylenol and naproxen home though. In any case I would follow policy so that you don't put your job in jeopardy.

[babyktchr, BSN, RN]

what kind of patient was this? I am a bit confused. I am also assuming that this took place in a hospital. In any case....you are correct, you should not give a patient meds to take home UNLESS they are packaged for take home use. Your hospital pharmacy should be able to accomodate that. I don't understand why the midwife was talking to the patient by phone and not physically seeing her. You certainly could always tell a patient that providers are not always familiar with hospital policy and apologize for her confusion but you are bound by your employer to follow what the hospital dictates. As for calling in scripts to pharmacy, usually not our practice. Again, I am unsure of the situation here and why the patient was being seen to begin with.

[klone, MSN, RN]

Was this a pregnant triage patient that was going home with a sleeper? That's what I was picturing in my mind as you were describing the situation. We used to do that a lot - send them home with an Ambien. Yes, we would call scrips into the pharmacy, but if it's against your policy, it's against your policy.

[beachmom]

Any time we discharge a pt. after the pharmacies close, we can call pharmacy to give us enough meds to last until morning. I've done narcotics before. Pharmacy packages them differently. They hand me the little bag with the meds. I give the bag to the pt. and chart it.

Community pharmacies always give pts meds to take home. Their license is not on the line if the pt. doesn't handle them correctly. Not sure why yours would be.

You have to follow your hospital's policy, and that NP should follow it too. Our policy is different.

[khammond0005]

Setting: Hospital - L&D. We dont have ANY practitioners onsite at night unless there is an emergency or delivery.

Pt: triage, she came in for back pain

Med: intended as a sleep aid (but that is an off labeled use).

Our hospital doesn't package meds for take home use. Heck, we dont have a pharmacist onsite after 8 pm. After pulling meds from the ommnicel we have to scan the pts band, scan the med, and chart the time we gave the pt the med. If the med wasnt administered at that time, we have a list of explanations to choose from (pt refused, NPO, Vomiting, ect)

Sorry for not being more clear, Im just frustrated. The NP knew it was against policy. My clinical manager is aware of this instance among others and nothing is being done/said. Im also tired of being put in the middle (which is how I feel after the NP tells a pt I can do something I cant). Thanks for letting me vent :)

[babyktchr, BSN, RN]

Your pharmacy can certainly package something and put it in your whatever you have (accudose/pyxis/omnicell) for use after hours. I am sure it won't go to waste sitting in there. You are absolutely right, you shouldn't let her take it home, especially if you are scanning and such. Write it up as a risk event if your manager isn't following up. It should go to a peer review for midlevels/physicans. It will stop when hands get smacked. Seriously though, your pharmacy can make take home packs that are approved and then no one is caught.

[msprisz.rn]

In my experience I have D/C pt home with Ambien but they had to have someone with they on D/C, to drive them home. I have also called in Rx for pets as well. It's unfortunate that your manager did not address the issue.

[DebblesRN, ASN, BSN, RN]

We don't give meds to patients to take home. It is also against our policy. The midwife should know better and administration should be counseling her about it.

We also do not call in prescriptions for patients. It is also against policy. The provider either calls it in him/herself or writes them a script for the med.

We will usually give the patient a medication, then send them home as long as they have a ride. If not, then they will stay if we have beds until morning and the MD will see them and decide if they need to be admitted or still sent home. If there is no space, they get sent home with nothing if they do not have a ride. Unfortunate, but it rarely happens. If we are bedless, they usually will magically find a ride if it means not getting drugs.