mixing medications

[GmaC13]

I work in a small rural HH/hospice agency. Recently one of my co-workers did a visit with a hospice pt. She found that this pt had multiple bottles of medications. She apparently is on some type of automatic refill plan. The problem is she would open a new bottle each time she got a delivery resulting in many bottles of the same drug with different expiration dates. The nurse decided to combine the meds into one bottle (like meds of course but different dates) 5 out of 6 nurses in our office were concerned that this is a violation, Poor practice at least and expressed our concern to our director. We were told there is no problem with mixing these together as long as they are the same strength. I still disagree but am not sure how to find some guideline that says this is wrong. Anyone have similar experience or input.

[BinkieRN, BSN, RN]

If it's the exact same med, the same strength and same dosage instructions on the bottle then I see no problem with it. It would seem the patient would get less confused with less bottles to keep up with. I think that was a smart thing for her to do. I would have done it too. The pills will be long gone before the expiration dates roll around

[mondkmondk]

I take several different meds myself and the best thing that worked for me is to set my pills up in a pill box designed for qid and each separate day of the week. I even got my dad to do this too and I set his up for him every week. That way you are extra sure not to miss any doses. Just my 2 cents!

Blessings, Michelle

[ChocoholicRN]

I would not have mixed the meds all in the same bottle because of the issue with the expiration date. If she keeps getting so many bottles of the same med, then whose to say that they will be long gone before the expiration date? And what about the ones with the earlier expiration date, she doesn't know which is which? I agree, bad idea to mix with different expiration dates.

[kenny b]

If I were going to do it, I'd mix them into the bottle with the earliest expiration date. That way the worst that could happen is that the meds would be wasted early.

Regards,

Kenny B.

[AnnaSL, BSN, RN]

Hmmm... i have never encountered such case yet but for me, I think there's a problem there... One major concern there is the Expiration date...

It's much better if they could combine the same medication with the same expiration dates and consume the near to expiry to the latter.

If the medication is consumable in a month or two, I guess it possess no concern but if it takes long-term therapy of the said meds then that poses concern..

I guess if you decide to put it in one bottle, it's good to still put them in by layers, putting the much longer to expire at the bottom and the near expiry to the top most...

[TeresaB930, BSN, RN]

Let me see.....this patient is on hospice, then not expected to live more than 6 months. I anticipate she will pass before the meds will expire.

Teresa

[GmaC13]

Teresa

You are correct in that the pt is not expected to live more than 6 months as a matter of fact she passed last weekend. My concern was nursing practice in general. All of the guidelines that govern how nurses handle medications say that meds need to stay in the original bottle. I really didn't think it would harm the pt but is it leagal? Still not sure my self. If I had been the nurse finding this I would have advised the family to use the oldest meds first and put the other bottles away until the oldest was used up. I wish the legal aspects were more clear. thanks for your input