Pill falls on pt gown...is it safe to give?

Good Morning, Gil · Mar 9, 2012

If the pill falls on the floor, I get a new one for the patient. Hospital floors are gross. If it falls on their gown, they can take it. However, never hand an agitated or confused patient their pills as you're increasing the likelihood that they will either be intentionally thrown on the floor or dropped everywhere, respectively. I place them into their mouth if I have any doubt that the pills will not land in their mouth otherwise lol.

The whole issue is avoided that way. Also, always wait to make sure the patient takes their pills (even when you're no longer a student). I always watch my patient take their pills to ensure they get all of them. It doesn't matter if they're A/Ox4, just do it lol.

Esme12, ASN, BSN, RN · Mar 9, 2012

Floor NEVER....gown yes as long as it wasn't saturated in urine or stool. For school both are a no no...but it is not a med error, it an error of protocol. This is an example of the school world and the real world.

KelRN215, BSN, RN · Mar 9, 2012

I am a student nurse in the second med-surg clinical of my BSN (two more quarters!) The other day I had an agitated pt who put his med in his hand and missed as he flung it into his mouth. The tablet just landed on his gown near his collarbone. Both the pt and reached for the tablet and I picked the tablet up with my clean glove and better positioning to make sure it didn't slip and fall on the floor. My pt took the med after it touched his gown. My instructor reprimanded me upon leaving the room, she said that I had made a med error and that the drug was contaminated. I understand this completely and took it seriously. When I told my fellow nursing students about it they all said that they would have given it, as long as the pt was not neutropenic and the pill did not land on the floor. What would another RN do about a tablet landing on a gown?

Very contaminated? Had the patient just vomited on his gown? Did the patient have a bowel movement and use his gown to clean it up?

Sorry, I don't see how she can say that the gown is "very contaminated"... any germs that are on his gown are likely on his hands too... so why is it any worse for a pill to land on a gown before going in his mouth than for it to land in his hands? Or does this instructor also expect that you require patients to Purell their hands prior to being handed medication?

I would absolutely give a pill that fell on a patient's gown and do... on a regular basis. If I got a new pill every time a pill landed on a patient's gown, or blanket or in the sheets, I'd spend my entire shift getting new meds. That, and it easily takes 2 hours for a med to come from the pharmacy after you send a request for a missing dose. If it hits the floor, I'd get a new one... 5 second rule does not apply in hospitals... but gowns, t-shirts, beds, bedside tables, whatever.

Perpetual Student · Mar 11, 2012

Whatever the gown was "contaminated" with is routinely ingested by the patient when eating. What a load of silliness. I would've given it without a second thought (and have). It's no different than dropping a potato chip on your shirt and eating it. I would love to hear the instructor's rationale for why your actions were unclean or dangerous, though I recommend you just let it go to keep from riling her up and causing yourself trouble.

The other day a patient missed her mouth and the pill fell IN her gown. I told her to hold still and got the closest female staff member to help her locate it (I had a sneaking suspicion that it was under her breast and I didn't want to go rooting around for it). She then took it without a second thought.

I'd wager the average patient's hands are dirtier than the front of her gown.

Lynx25, LPN · Mar 11, 2012

That's silly. I work in LTC and between my Parkinson's people and my blind-as-a-bats, and my dementia people who like to party with their meds before they take them, pills are dropped ALL the time. If it's on your clean sheet, or your shirt, yep, I'm scooping it right back up and it's going in your mouth.

Hands are grosser than gowns anyway. I don't know how this could be a med error.

sharpeimom · Mar 11, 2012

i was a psych nurse. i just can't imagine trying to explain to the majority of my patients why they can't take the pill that fell into their shirt pocket or down their t-shirt front! if they weren't agitated before they will be after i take the "contaminated" pill away... :eek:

~PedsRN~, BSN, RN · Mar 14, 2012

This is the perfect example of how nursing school is nothing like real life floor nursing. LOL!

allnurses Guide · Mar 14, 2012

This is the perfect example of how nursing school is nothing like real life floor nursing. LOL!

That's the main point here - in nursing school, you get a new pill.

But yes, it is not a med error.

I'd try to give the pills in a way that made sure this didn't happen. But there is no guarantee.

As to the question about the pill on the floor - YES, I toss that one and get a new one.

(But not at home - I've dropped my own pills on the floor more than once and I take it).

nursegirl75 · Mar 14, 2012

Its nursing school. Just do whatever makes the clinical instructor happy. YOur clinical instructor just said it was a 'med error' to cover her own butt. So just nod, smile, and agree to what she/he says. In the real world, most patients want the pill in their hands or on their gown. I bet even your clinical instructor would not even get new pills.

Do-over, ASN, RN · Mar 20, 2012

I had a patient with Parkinson's that actually wanted me to put the pills in a little valley of the bed sheet - that way the patient was able to pick up the pills with very shaky hands - the pills didn't roll around.

PS - yes, I do get a new pill if it goes on the floor. Table, gown or bed? Nope. Unless it falls in a pile of poo. Hopefully, I would have cleaned that up before passing meds though... I have a preference for cleanliness in my rooms.

AndyB · Mar 20, 2012

A gown or bed is safe. The human mouth probably has more harmful bacteria then a hospital floor but a pill on the floor is a no-no.

nurseprnRN, BSN, RN · Mar 20, 2012

if i drop one of my own pills in the bathroom, i'll pick it up and take it unless the cat licks it first. otherwise... down the hatch if it hits the reasonably clean patient gown or bedding. that's not a med error, that's gravity. and it's the law.