pills left by bedside when patient is in the bathroom

SmilingBluEyes · Sep 9, 2005

You don't want to get into that habit. Pills should be swallowed/witnessed before we mark it off on our MAR---particularly narcotic meds. If the patient is in the bathroom, I wait til she is done before I administer the meds. Yea, it's a pain, but it's the right way to give meds. Also, you can't be sure someone else won't take them---or of the time, if you don't see the patient take them yourself.

pricklypear · Sep 9, 2005

I absolutely second SmilingBluEyes comments. Leaving meds at the bedside is a really bad habit to get into. I know it gets tough when you have several patients to pass meds to, as well as all sorts of other things going on, but doing that can come back and bite you some day. You leave yourself open to too many things. It's amazing how many bad habits we fall into these days when we are all so pressed for time. Good question, Krisssy!!

rn/writer, RN · Sep 9, 2005

Never, never, did I say never? leave any controlled substance anywhere unatttended. Think about the possibilities. Someone else--and this could be anyone from the patient's visitor to ancillary staff to someone passing by in the hall to the patient's doc to a curious child wandering from the next room over--could help themselves for reasons ranging from substance abuse problems to curiosity to concern for you to pure devilment. The patient herself could be forgetful and, after having taken them, say she doesn't remember you giving them to her--and, in a way, she'd be right. Or she could have substance abuse problems and try to score another dose. Or she could accidently knock the med cup off the tray table and the meds could go rolling. You get the picture. This is in invitation to Trouble with a capital "T."

It isn't even a good idea to do this with so-called innocuous meds--Benadryl, Tylenol, cardiac meds, etc. You can have the very same problems listed above and get in only slightly less trouble because they are not narcs.

Train yourself to keep your meds with you till you watch the patient take them. This is a good opportunity, if appropriate, to do med teaching and say things like here is the lisinopril for your blood pressure and the lipitor for your cholesterol.

Having said all that, here is a personal side note. On the postpartum unit where I recently started working, I would never (there's that word again) leave either of our two main controlled meds (Percocet and Darvocet) on a tray table, but we do give moms a self-med pack containing Ibuprofen and a stool softener (and an anti-flatulent for section moms). They are given a med sheet to mark the time and dosage (up to three Ibu. at a time) and instructed about how often to take them and then, unless they have some cognitive or other impairment, we let them manage this part of their care themselves. This has been a highly successful protocol that has freed nursing staff from a lot of extra running, but BOY was it hard to retool my thinking. Here we are, leaving not only a med or two but a whole dadgum bottle of Ibuprofen and other OTC meds besides. They are in containers in a re-sealable plastic bag instead of sitting exposed in a pill cup, but it still took me a while before I could turn off the ingrained alarm system.

SmilingBluEyes · Sep 9, 2005

We did away w/bedside packs of motrin, tylenol, etc. per JCAHO recommendations about 3 years ago.

If you think about it, it's potentially dangerous. What if the patient's other child or someone else gets hold of them? What if the patient takes tylenol and then asks for Percoset, yet forgets the tylenol she took 2 hours ago and forgot to tell you about it? It's a real risk management issue, not to mention safety aspects.

Even if they have these meds in their control you are held liable for them in the hospital.

So based on that, it was decided these packs were a bad idea by our management/admin, based on these potential problems, after all. It's a pain, but we get them their motrin, tylenol and stool softeners whenever they ask for them if they are due, and then document it on the MAR.

rn/writer, RN · Sep 9, 2005

We did away w/bedside packs of motrin, tylenol, etc. per JCAHO recommendations about 3 years ago.
If you think about it, it's potentially dangerous. What if the patient's other child or someone else gets hold of them? What if the patient takes tylenol and then asks for Percoset, yet forgets the tylenol she took 2 hours ago and forgot to tell you about it? It's a real risk management issue, not to mention safety aspects.
Even if they have these meds in their control you are held liable for them in the hospital.
So based on that, it was decided these packs were a bad idea by our management/admin, based on these potential problems, after all. It's a pain, but we get them their motrin, tylenol and stool softeners whenever they ask for them if they are due, and then document it on the MAR.

I see your point, but I'm hoping we don't go back to the old way. I don't know if there have been any run-ins with JCAHO about this at my facility. Probably not, if we're still doing it.

stidget99 · Sep 9, 2005

:yeahthat:

UM Review RN, ASN, RN · Sep 9, 2005

When I was being mentored in med surg, I noticed that my mentor left the patients pills in a cup on her bedside table. She yelled into the bathroom that the patient's pills were there when she was ready. Is this commonly done and how do you feel about it?

Never do that.

You could lose your license; your patient could potentially miss the dose or take it so close to the next dose that it'd count closer to a double-dose.

I won't tell you the number of times I found controlled substances on bedside tables leftover from evening shift, but suffice to say that if it was a patient safety issue, I'm following you on the next shift, and I will report that.

'Nuff said.

SmilingBluEyes · Sep 9, 2005

I have a stupid question. Why is it ok to have self-med packs, yet never leave other meds at the bedside?

Tylenol and Motrin, if misused or misappropriated, have the potential for a lot of damage, too.

No they are not digoxin or a narc, but still potential for harm and liability are great when you use these.

UM Review RN, ASN, RN · Sep 9, 2005

Oh, we can have other meds at the bedside for self-medication. We just have to get a Dr's order for patient to self-medicate and the name, dose, and times of the particular med.

rn/writer, RN · Sep 9, 2005

I have a stupid question. Why is it ok to have self-med packs, yet never leave other meds at the bedside?
Tylenol and Motrin, if misused or misappropriated, have the potential for a lot of damage, too.
No they are not digoxin or a narc, but still potential for harm and liability are great when you use these.

Not sure of the official rationale (or rationalization). In my mind, the self-med packs are in child-resistant containers in a re-sealable plastic bag so they aren't just laying around exposed. We are, for the most part, dealing with basically well adult women who are responsible enough to care for newborn infants. If we have doubts--very young mom or someone who is impaired in some capacity, we administer the meds ourselves.

Even though I have never seen a problem occur with the self-med packs, I do think that I will add a caveat from now on for moms--and dads--to make sure that they keep the meds away from their other offspring. Actually, this is a good opportunity to do a little teaching for when they go home. But then, isn't everything?

SmilingBluEyes · Sep 9, 2005

I have seen problems, that is why I ask. I was really loathe to hand them out to some patients, for just that reason.