Patient Taking Own Meds

LadyStorm · Jul 2, 2005

I admitted a patient the other night at work. He pulled out a bottle full of several different pills and proceeded to take one out and tell me that he has to take his "blood pressure pill." He didn't know the name of the pill, just knew that he had to take it. I asked him to please wait and that I would check the doctors orders to see what they had written for. I would then get his meds from pharmacy. Well the patient wasn't satisfied with that answer and proceeded to take the pill anyways. He did agree to allow me to lock up the rest of the pills in the bottle, which I did. I had never experienced this before, although I'm sure it happens quite often. I asked my charge nurse what the protocol was for this type of situation and she said "Oh we don't do anything. We just pretend it didn't happen." I said "Do you document it." She said "Oh no, it's not really that big of deal anyways. Patients do this all the time. I just wouldn't worry about it."
I walked away from the situation and took a moment to think. Why would someone not document such a thing? It is not my fault that the patient took the medication. But it is my responsibility to document that it occured and took watch for potential problems. I did document that he took the med and I took his blood pressure a few times afterwards.
I guess my question is...what would you do in a situation like this? Any thoughts or ideas.

I am with you on this one. You didn't say what his admitting diagnosis was. In certain instances, a doc may want meds held. I believe you did the right thing in documenting the medication, the time taken, that you asked him not to take the pill until you checked the doctor's orders. You can never be too careful in today's suit happy world.

TreetopAngel_RN · Jul 2, 2005

He did agree to allow me to lock up the rest of the pills in the bottle, which I did. . . But it is my responsibility to document that it occured and took watch for potential problems. I did document that he took the med and I took his blood pressure a few times afterwards.
I guess my question is...what would you do in a situation like this? Any thoughts or ideas.

You did the exact right thing. I've actually had to wait until the person was asleep to get the meds from them. We give them back at discharge, but if the patient is not able to comprehend any changes in their meds we will only give them back to a responsible family member.

KJRN79 · Jul 2, 2005

I ran into this situation when my mom was admitted to the hospital with a kidney stone. Her dx's are: diabetes, hypertension, mitral valve prolapse, arthritis, breast cancer, and now the stone. The hospital pharmacy didn't carry several of her regular meds, including one b/p med, one diabetes med and her arimidex for breast ca. (This is a level 3 trauma center, the only hospital in our city with 300 beds.) I was surprised. I was asked to bring her meds in. So, I went and got them, all in their original containers and they all had to be sent to the hospital pharmacy for for identification. That took HOURS!!! Needless to say, her med schedule got all thrown off and she was very upset. What a pain in the butt. I can completely understand WHY patients would want to take their own meds after that experience.

AND I had surgery and was an inpatient for 3 days. I take Zyrtec daily for multilple allergies and I was "told" I couldn't have those in the hospital. Until I asked my doc, who said "WHAT????"

Of course, we should check doc orders and contraindications before letting patients self-medicate, but with the way the "system" is working now, I won't be surprised if this becomes much more common.

live4today, RN · Jul 2, 2005

I too would have documented the med taken, and the teaching you gave the patient prior to him taking the med anyway. After you document what happened, I'd put a sticky on the front of the chart or the doc's progress notes to let the doc know the patient took 'unknown med' from his pill bottle he brought into the hospital. Then, BEFORE I would give the patient ANY med, I would call the doc and let him know the patient took "unknown pill" from his pill bottle on admission, and you want to know if you should go ahead and give the patient the meds ordered for him to take following his admission just in case the doctor wants to see the patient first before he takes anymore medication.

Usually when a patient shows me meds they are on, and tells me they do not know the name of the drug, I ask them to show me the pill so I can try let the doc know what the pill looked like, it's size, shape, and why the patient stated he takes the pill. It may be a pill you recognize. Know what I mean?

SharonH, RN · Jul 3, 2005

I admitted a patient the other night at work. He pulled out a bottle full of several different pills and proceeded to take one out and tell me that he has to take his "blood pressure pill." He didn't know the name of the pill, just knew that he had to take it. I asked him to please wait and that I would check the doctors orders to see what they had written for. I would then get his meds from pharmacy. Well the patient wasn't satisfied with that answer and proceeded to take the pill anyways. He did agree to allow me to lock up the rest of the pills in the bottle, which I did. I had never experienced this before, although I'm sure it happens quite often. I asked my charge nurse what the protocol was for this type of situation and she said "Oh we don't do anything. We just pretend it didn't happen." I said "Do you document it." She said "Oh no, it's not really that big of deal anyways. Patients do this all the time. I just wouldn't worry about it."
I walked away from the situation and took a moment to think. Why would someone not document such a thing? It is not my fault that the patient took the medication. But it is my responsibility to document that it occured and took watch for potential problems. I did document that he took the med and I took his blood pressure a few times afterwards.
I guess my question is...what would you do in a situation like this? Any thoughts or ideas.

Your facility needs a protocol to deal with this type of situation, otherwise they are asking for trouble. Your charge nurse states this happens all the time. Well when a patient is inevitably overmedicated or has a drug interaction she will be held liable because she knew her patients are doing this. At most facilities that I've worked, the general policy is that patients are to send all of their meds home. If that is not feasible, the meds need to be sent to the pharmacy for identification and kept locked up at the nurses' station. You were right to document and you are right that you needed to watch for potential problems.

medicrnohio, RN · Jul 3, 2005

Thanks for all of your replies. I knew I did the right thing by documenting and watching for a reaction. I just can't believe that others wouldn't find this important to document. The night shift at the hospital I work at is a nightmare. The average experience for the nurses on night shift on my floor is 9 months. We have a few that have been nurses for 2 years but that is it. I see a whole lot of things happen that I know are wrong. I report them and I get blown off like it is no big deal. I always try to do what I know is right and to document, document, document. I like my nursing license too much to be ignorant. That being said, our patients meds are supposed to be sent home or locked up. If the doctor orders it then the patient can take their own meds. But that is only after pharmacy checks them. Usually that only happens if a patient has specialized meds that the hospital doesn't carry.

Tweety, BSN, RN · Jul 4, 2005

Our protocol is patients are not to take their own meds. We are to send them home with the family, or to gather them up and take them to the pharmacy for storage. If the med is not available in our formulary an MD can order for patient to take their own med.

Sometimes patients insist on taking their meds because they don't want to pay for ours, or for whatever reason and docs write the order "may take home meds". But this is against hospital protocol.

On the other hand, it's a free country and what can you do when a patient who has had it drilled into their head to take their meds every day without fail, comes into the hospital and insists on taking them. Just document that you instructed the patient not to take them and educated the patient and notify the md that patient wishes to be on this particlar med and took it. Maybe do an incident report.

Luv2BAnurse · Jul 4, 2005

Yes, at our hospital we also have to send "home meds" to pharmacy to be identified, then we can use them for the patient if the MD writes such an order. This happens frequently. I would have asked the patient not to take the meds either, because the MD may have an order to hold for whatever reason. But of course if the pt. did take it, document. Who's to say what pt's take before they come to the hospital anyway? And, since you did witness the pt. taking his/her meds you did a great follow through by checking those vitals.

UM Review RN, ASN, RN · Jul 4, 2005

I'd definitely document the patient taking an unknown medication against advice. With every admission, I explain to patients that the Dr. might change some of their medications, and that they should anticipate that.

Thunderwolf, MSN, RN · Jul 4, 2005

It works the same where I'm at... as Tweety and Love2banurse describes. If the med is identified per pharmacy, the doc writes the order to give home meds...I'm all for it. I agree with the patient in that why pay for a med one already has...more likely the hospital will charge more for it anyway. I encourage family to bring IN homemeds so that we as nurses KNOW EXACTLY what the person is taking. It is a good time to take advantage of the situation in order to do med teaching on the spot...especially with compliance. If meds can't be identified, they are not used, but sent home or locked up. 99% of our docs write "may use home meds" order if presented to the doc. It makes the patient happier. I've learned that on admit, when a patient hands over a list of meds they take and how they take them, the list is often out of date or inaccurate. I don't hesitate to have the meds come in for initial inspection and for me to have a sit down with the patient in order to discuss them. And if the patient should ever just pop one in their mouth because he/she refuses to wait, I document it that the person took their "own med" for "such and such reason as stated by the patient". It happens very infrequently.