Ordering meds

[PsychiatricNP]

Hi All - I work very part-time in several county correctional facilities. When an inmate comes into the facility and they are currently taking any psychotropic meds, I am called by nursing for orders to continue/discontinue medications for inmates. Many times, these are inmates that I will never see or personally evaluate (I am only at each facility a few hours per week and many times inmates are released within a matter of a few days). Any thoughts on whether or not a provider/patient relationship should be established before continuing current medications?

[zenman]

When I worked at a hospital in Santa Fe, I might admit someone after 5 pm and continue any current meds, but I'd see them the next morning. You might be in a risky situation.

[PsychiatricNP]

Thanks for the reply. The medical director has stated that this is appropriate practice because we are only ordering medications that the inmate is currently (within the last 30 days) taking and has been prescribed by a provider on the outside. He routinely does this in the facilities that he is on-call at. I appreciate your insights.

[traumaRUs, MSN, APRN]

And...some psychotropics can cause problems if suddenly stopped - I agree that ordering them for 48-72 hours until a provider can see them is prudent. And...of course everything is documented and this is written policy.

[BlueDevil,DNP, DNP, RN]

I agree that discontinuing and continuing current meds and can be safe and prudent, providing you are familiar with the drugs involved.

I think what could get you into trouble is beginning new meds, and I'd be wary of that. I think I've told the story before of a colleague of mine who's seemingly simple on-call Rx for a common antibiotic resulted in an adverse reaction (not allergic) he could not have predicted, but he had never examined the patient so they won their lawsuit (they didn't get a judgement, his malpractice insurer forced a settlement). It effectively ruined him, professionally for 10 years and still haunts him personally in many ways. He didn't do anything wrong, didn't commit malpractice, and didn't do anything thousands of us don't do every on-call night/weekend, he just got unlucky. Don't put yourself in a position that might be unlucky.

[NPAlby]

This is a good reminder not to take anything for granted.

[PsychiatricNP]

Thanks for the replies. Always great to be able to get a fresh perspective from colleagues!