Leaving Meds at the Bedside?

Nurses Medications

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Hi everyone

Although we are responsible to ensure safe, accurate administration of meds, I have noticed on occasion that some nurses will leave pills wlth the pt, and check on them after. This is never a safe practise, and I have had to explain to pts that I need to be present while they take their pills. Under no circumstances will I leave pills. During this time, I also have the opportunity for teaching, if required.

For rationale, some nurses have said: "I know the pt, and they will take the pills." Or, "I'll just be back in a min anyway."

I'm sorry, but if the pt drops the pills, hoards them, or another pt takes them, I have no way of knowing what the outcome is, should I walk away. I also cannot sign off in the MAR if I am not sure. Either way, it's my responsibility. What are your thoughts? Just curious...

I've been guilty of this. When I have a healthy, nice normal postpartum mom whose hands are full because she is breastfeeding I do feel comfortable leaving her senna or ibuprofen on her bedside table for her to take when she finishes. We have a complicated scanning thing and I don't feel the need to interrupt the feeding an observe her swallow her iron and colace or something. Yes, I know this isn't allowed, but I sometimes do it anyway when I'm busy.

Specializes in Med/Surg/Onc, LTAC.

I seem to have every alert and oriented (or not oriented) independent pt who drops their pills. If I'm giving a controlled med, I am ALWAYS standing over them and I will not stop watching them until they take it. I don't care if I'm annoying because I'm usually not in the mood to crawl on the floor looking for dilaudid tablets. :p If a pt has a single tums in a med cup I'll give them a break, but that's basically about it lol. I've had too many 'accidents' with meds. Not to mention all of the stuff to deal with if they dropped... say their lopressor. It's better for everyone, especially the pt (!!!) if they just take them as they are being given.

You can leave meds if the doctor has written an order that says you can. Otherwise, no. But that doesn't stop some nurses from taking the chance anyway.

Specializes in CVICU, anesthesia.

I have a little different perspective working in an ICU...but I don't remember the last time I did NOT have meds at the bedside. (Wait, actually I do, it was when JCAHO was here :)) Nearly all of my patients have pressure issues, and I am just not a happy camper without a neo/nitro stick nearby. I don't want to be that nurse who runs frantically to the med room, leaving the pt unattended, to grab a neo stick when the pt's MAP is in the 50's. I'll keep atropine at the bedside if my patient has been known to brady down dangerously low. I don't care what anyone says, I'm not going to stop this practice...it's my license and my patient's lives on the line and sometimes there just isn't 2 minutes to spare to run to the med room.

The one that I do feel guilty about is narcotics...it is common practice in my unit for a pt who has prn fentanyl 50mcg q1h to give the 50mcg and leave the other 50mcg/1mL on the CVP line because you're just going to give the other 50 in an hour or so. Bad practice, I know...who knows what other RN/RT/family member, etc. will decide they want to take it home with them (or give it to the patient...) Maybe my new year's resolution will be to be more diligent with my narcotic administration and wasting. :)

No meds left at bedside. Not ever. If you can't see them, you do not know what has happened to them.

And leaving a narcotic-filled syringe attached on a CVP line???? Wowee - - what an accident waiting to happen! Too scary for words.......

Specializes in Oncology.

I never leave meds at the beside. Too often I find pills on the floor wondering when they're from. Often they're important meds- immunosuppressives, antibiotics, cardiac meds. Patients can often become confused, and it may take awhile to realize that patient who was totally with it walky-talky now thinks they're on the moon eating mud pies. I've seen family members do some crazy things too. I've seen patients go through the motion of taking them and not realize the pills actually slipped out of their hand. Just seeing the pill cup empty isn't enough. I just don't feel comfortable signing my name off that a patient took a med when I am not positive they did. They're more than welcome to refuse them. They're more than welcome to say "later" and call me back when they're ready.

Specializes in OB, ER.

My biggest fear with this is not what the patient will do with the meds but what the next nurse will do to my license. What if you forget to go back in the room and have them take the meds. What if they leave them sitting and the next shift finds them. What if they are on the breakfast tray and dietary removes the tray and they go in the trash. What if a child visitor finds them and it looks like candy. What if a CNA that doesn't like you sees them and either tattles or steals them. So many things can happen.

Specializes in Oncology.
I have a little different perspective working in an ICU...but I don't remember the last time I did NOT have meds at the bedside. (Wait, actually I do, it was when JCAHO was here :)) Nearly all of my patients have pressure issues, and I am just not a happy camper without a neo/nitro stick nearby. I don't want to be that nurse who runs frantically to the med room, leaving the pt unattended, to grab a neo stick when the pt's MAP is in the 50's. I'll keep atropine at the bedside if my patient has been known to brady down dangerously low. I don't care what anyone says, I'm not going to stop this practice...it's my license and my patient's lives on the line and sometimes there just isn't 2 minutes to spare to run to the med room.

The one that I do feel guilty about is narcotics...it is common practice in my unit for a pt who has prn fentanyl 50mcg q1h to give the 50mcg and leave the other 50mcg/1mL on the CVP line because you're just going to give the other 50 in an hour or so. Bad practice, I know...who knows what other RN/RT/family member, etc. will decide they want to take it home with them (or give it to the patient...) Maybe my new year's resolution will be to be more diligent with my narcotic administration and wasting. :)

That's totally different. You're not planning on the patient taking the meds them self later. We occasionally get orders to leave atropine at beside, or something, and we'll tape it to the wall with a filter needle and syringe where whichever nurse gets there first should they brady can see it.

My biggest fear with this is not what the patient will do with the meds but what the next nurse will do to my license. What if you forget to go back in the room and have them take the meds. What if they leave them sitting and the next shift finds them. What if they are on the breakfast tray and dietary removes the tray and they go in the trash. What if a child visitor finds them and it looks like candy. What if a CNA that doesn't like you sees them and either tattles or steals them. So many things can happen.

I had another nurse accuse me of leaving a med on the bedside table when in fact, I know that I did not. This was a perfect example of workplace backstabbing. I never leave meds. But the nurse who does leave meds on occasion is opening her/himself up to someone making accusations like this.

We have a few frequent flyers with whom I will leave meds at the bedside. One in particular, she has 4 different eyedrops, and she takes them exactly 15 minutes apart at home. I can't stay in there for an hour, and neither can I pull myself away every 15 minute on the dot to give them to her. I leave them at the bedside, she takes them as she does at home, and I come back later and gather them for her drawer. Another frequent patient, she has 18 different meds, she is totally alert and oriented, and she takes her pills one at a time, with a breather in between. Med administration takes at least 20 minutes, usually closer to 30. I leave them at the bedside.

If it's a narc, never. If family is in the room, never. We've had instances where family has taken the patient's meds. I mean, we're talking a freakin saline lock to flush an abx, a family member took and then the other family member reported that they injected it and "got high" from it, and that we endangered everyone by leaving those drugs lying around.

It's only in very rare circumstances I will leave a med at the bedside. But never say never.

Specializes in Emergency & Trauma/Adult ICU.
I have a little different perspective working in an ICU...but I don't remember the last time I did NOT have meds at the bedside. (Wait, actually I do, it was when JCAHO was here :)) Nearly all of my patients have pressure issues, and I am just not a happy camper without a neo/nitro stick nearby. I don't want to be that nurse who runs frantically to the med room, leaving the pt unattended, to grab a neo stick when the pt's MAP is in the 50's. I'll keep atropine at the bedside if my patient has been known to brady down dangerously low. I don't care what anyone says, I'm not going to stop this practice...it's my license and my patient's lives on the line and sometimes there just isn't 2 minutes to spare to run to the med room.

The one that I do feel guilty about is narcotics...it is common practice in my unit for a pt who has prn fentanyl 50mcg q1h to give the 50mcg and leave the other 50mcg/1mL on the CVP line because you're just going to give the other 50 in an hour or so. Bad practice, I know...who knows what other RN/RT/family member, etc. will decide they want to take it home with them (or give it to the patient...) Maybe my new year's resolution will be to be more diligent with my narcotic administration and wasting. :)

You will care what anyone says, someday, some time, when there is suspicion of diversion in your unit (and it will happen, sooner or later). Then Pharmacy will go over all med administration records with a fine tooth comb, and there will be "evidence" of sloppy narcotics handling procedures by you. You'll care then, trust me.

I've been guilty of this. When I have a healthy, nice normal postpartum mom whose hands are full because she is breastfeeding I do feel comfortable leaving her senna or ibuprofen on her bedside table for her to take when she finishes. We have a complicated scanning thing and I don't feel the need to interrupt the feeding an observe her swallow her iron and colace or something. Yes, I know this isn't allowed, but I sometimes do it anyway when I'm busy.

It is actually not uncommon--and was the practice on the Mother/Baby unit where I worked L&D--for it to be standard to have APAP and IBUPROFEN at the bedside. They were given some sort of administration sheet to fill out to docunent what time and and what they took. There was pt teaching on admit of course where the nurse explained the system and how often they could take things and what not. Guess they figured if the mom was at home she would be able to take these meds on her own. The nurse would then include her monitoring of this self-admin report in her shift note/documentation and the record I think became part of the chart.

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