Nurse-patient relationship and self-administered medications

[SunshinesArt]

I work in a residential detox facility. When a client comes in for detox, we work under Dr orders for their specific protocol and any PRN medications. Once their time in detox is over, they can transfer into our 30 day residential rehab program, but they are no longer under a Dr's care.

It was explained to me when I started working here about a month ago that the policy is for the 30 day clients to come to the nurses station when it is time for their medications (both prescriptions that came in with them and OTC meds.) and that they are self-administered.

The problem is that we do not have anyone who is unlicensed trained to do self-administration in our program, so even if we follow the self-administration procedure, it is still a nurse handing medications to clients.

The nurses on staff came to me the first day I worked there and are all concerned that there is an implied nurse-patient relationship here and that we could be putting our license at risk by being the ones to hand the bottles to the clients, not so much the prescriptions, but the OTC meds.

I have brought these concerns to management, but I am the highest level medical person in the company and I am told that it's "no big deal". I have attempted to explain the issue but it falls on deaf ears.

I have put in a call to my state board of nursing, but I have not received a return call yet. The Dr that we work under for detox told me that he believes that there is an implication here and that it would be better if we were not involved at all. I have passed that along to management but they have requested documentation to that effect.

What is my liability if I handed someone the bottle while I was on duty as a nurse and they had a reaction to the medication?

Any suggestions on how to handle this with management, or resources that I can point them to that will help explain?

Thank you!

Susan

[SpeeDemonRN]

I also deal with self administration of psych and medical medications on my outpatient assertive community treatment team.

We are in the process of opening a new clinic and have had to change some of our practices and documentation so that we are exactly following regulations with the self administration part.

In Arizona, there are a few definitions that are important for this topic.

Dispensing or administering meds comes with responsibility and potential liability for the well being of the patient if they have an adverse reaction to the med, or get the wrong dose. Storing the med, handing the bottle to the patient, and providing supervision to make sure they take the med correctly is assistance with self administration, which is what I do. I am responsible for making sure that the patient is given the right med bottle and that they understand how to take the med.

It sounds like you are not required to monitor them and make sure that they take the med correctly. If this is documented correctly it is possible to do without putting your license at risk. Several things need to be in place.

1) a policy that states that you are responsible for storing the meds and giving the bottles to the patient so that they can take the meds.

2) a prescriber order for each individual that states that the patient may administer their own meds. This puts the responsibility for evaluating safety on the doctor. You say that they are not under the care of a doctor but if they are getting rx's someone is prescribing them. Each prescriber needs to put this in writing.

3) in your documentation you need to have a sign out sheet that the patient signs and you cosign each time you hand the bottle to the patient. When they enter the program there needs to be a policy/waiver that the patient signs stating that they are responsible for correctly administering their own meds.

4) Since you store them it is your responsibility to CYA by making sure that the patients aren't taking too many meds. That can be done by reporting to the doctor if the patient runs out early. That is easily tracked by the last date filled- just check the number of days supplied against the date filled when you receive the med delivery and you will notice. If they are running out early notify the doctor and document it.

5) when you are documenting, if you write a note, specify that the bottle was provided to the patient for self administration, and leave it at that.

I am assuming that none of these meds are controlled substances. There is a lot of liability involved with those, since you have to count them, which could be considered monitoring and not just storage. We have had to stop storing benzos for this reason.

If you have all of these in place, you should be fine. You need to check the regulations to make sure that they are not different in your state, but I think that these definitions are pretty much universal.