SpeeDemonRN

I also deal with self administration of psych and medical medications on my outpatient assertive community treatment team. We are in the process of opening a new clinic and have had to change some of our practices and documentation so that we are exactly following regulations with the self administration part. In Arizona, there are a few definitions that are important for this topic. Dispensing or administering meds comes with responsibility and potential liability for the well being of the patient if they have an adverse reaction to the med, or get the wrong dose. Storing the med, handing the bottle to the patient, and providing supervision to make sure they take the med correctly is assistance with self administration, which is what I do. I am responsible for making sure that the patient is given the right med bottle and that they understand how to take the med. It sounds like you are not required to monitor them and make sure that they take the med correctly. If this is documented correctly it is possible to do without putting your license at risk. Several things need to be in place. 1) a policy that states that you are responsible for storing the meds and giving the bottles to the patient so that they can take the meds. 2) a prescriber order for each individual that states that the patient may administer their own meds. This puts the responsibility for evaluating safety on the doctor. You say that they are not under the care of a doctor but if they are getting rx's someone is prescribing them. Each prescriber needs to put this in writing. 3) in your documentation you need to have a sign out sheet that the patient signs and you cosign each time you hand the bottle to the patient. When they enter the program there needs to be a policy/waiver that the patient signs stating that they are responsible for correctly administering their own meds. 4) Since you store them it is your responsibility to CYA by making sure that the patients aren't taking too many meds. That can be done by reporting to the doctor if the patient runs out early. That is easily tracked by the last date filled- just check the number of days supplied against the date filled when you receive the med delivery and you will notice. If they are running out early notify the doctor and document it. 5) when you are documenting, if you write a note, specify that the bottle was provided to the patient for self administration, and leave it at that. I am assuming that none of these meds are controlled substances. There is a lot of liability involved with those, since you have to count them, which could be considered monitoring and not just storage. We have had to stop storing benzos for this reason. If you have all of these in place, you should be fine. You need to check the regulations to make sure that they are not different in your state, but I think that these definitions are pretty much universal.

I have always had insomnia, and worked overnights for almost a decade. The insomnia tends to be an issue that is not related to time of day. I have learned a few things, by trial and mostly error. UV light is my worst enemy. Blue light is next in line. Every time you look at a screen you are exposing yourself to blue light. It is recommended that you shut off all screens several hours before bedtime, but who the hell really does that? Recently I had an aha moment. I have had a problem with scorpions in my house. I live in AZ so this is not an unexpected problem. The only way to kill them directly is by hunting them down with a good UV light. I can't go to bed until I search the bedroom, and the parts of my yard that are closest to the house. I had several nights that I was up til 2 or 3am despite being sleepy before I turned on the black light. The best analogy- you know those anime cartoons, where everyone has giant round eyes. Mine felt like that. Took me a while to connect it to the UV light I was using to find scorpions. I read the reviews for the flashlight that I had been using and saw that they recommended protective glasses. They have ones that block blue light and are only slightly yellowish looking. My boyfriend didn't notice the yellow at all. I got mine on Amazon for under $20. I've started wearing them when I watch TV or read on my iPad a few hours before bed. My advice- get a pair of real blueblockers for when you are not in class, and then just get ones that are made for computer use for when you are in class. Search "blue light blocking glasses" on Amazon and you will have some reasonably priced choices. Good luck! It's hard to live with messed up circadian rhythms....

Be careful. Check out any place that you are considering with the state. A lot of people who live at these places are the chronically mentally ill. I'm a psych nurse and a lot of my most difficult clients live there. I have been to them. Those that have that population are usually dirty, bedbugs and all. If you are thinking about geriatrics only, like with memory care units etc, I recommend a Frontline episode about the assisted living situation in general in this country. It makes the whole thing sound pretty grim but there are some good ones. The episode would give you some pointers on how to evaluate a place when you go there, and the names of a few large companies that are bad news. You can find it on the PBS Frontline page.

I have worked inpatient and outpatient. The dress code varied on the inpatient units. Some street clothes only and others were scrubs only. The interesting part when I worked for a staffing registry full time- the darn company never knew which. If I couldn't find out ahead, I wore scrubs and kept some decent but washable street clothes in the car. Had to run out and change on more than one occasion.

The exact duties in a public mental health clinic setting probably have a lot to do with the state you practice in. If your state has the ability to court order outpatient treatment I'm guessing the population varies. My state does allow court ordered outpatient, and has a large system of outpatient clinics set up. There are also 2 urgent care type centers that can hold people for up to 24 hrs. I work on an ACT team, which is kind of a specialty within the specialty. We provide wrap around services- one stop shop type thing. There are usually around 10 case managers and they all have specialties- housing, transportation, rehab/employment, housing, substance abuse, etc. One doctor and me (RN). We do refer people out to day programs, and our voc rehab program, as well as intensive outpatient substance abuse programs. ACT started when they started opening the doors and dumping the chronic patients into the community with no support system. They kept ending up back inpatient, or in jail, homeless, etc. Someone started going into the community and teaching independent living skills IN the community. It worked. SAMHSA noticed. It seems to be very very popular recently- like, if you want a lot of funding, create ACT teams. I am thrilled that my experience doing a job that I love has made me so incredibly marketable. There is a future in it. I have worked on the traditional teams too, so can give you a run down of both. Non ACT RN's work with a team of case managers and a doc, but refer people out for services more. The case managers have to see each client in the community once every 3 months, and once a month overall. There are about 250-280 patients assigned to a team with about 10 case managers. The nurse has all 250ish, as does the doctor. The day consists of appointments. Labs, injections, the q 3 month appointments to check in, annual health assessments. Dealing with refill requests, team meetings, and of course, the very very mentally ill patients, who make it all so interesting. My day can be similar or drastically different depending on the needs of my team. I have about 75% of my time doing in clinic appts. I have 99 patients. I have to see them all monthly but most are on injections, clozaril, or come to fill their medisets once or twice weekly. The team overall has to deliver 50% of care in the community so the rest of my time is doing home visits, or jail and hospital visits. I met a girl last week at her GYN's office to provide moral support while she had an IUD inserted. I have testified in court to get a client a guardian when his health declined and he was too delusional to accept care (he had MRSA, but we hadn't ruled out TB). I went with a case manager to be in the room when a client was taken off life support. He had no one but his team, so it seemed like the right thing to do. It is a little weird, but I was proud that I had managed to bill for talking to someone who was brain dead. Almost forgot- in the end it's all about billing. It sucks but it's as much a part of the unpleasantness as bed bath's are to long term care RN's. I love that I get to drive around and give injections to people who are court ordered to have them but scared to go near a clinic. I don't like sitting in an office. I prefer to sit in a park and chart on my crappy but functional company laptop..... You need experience in inpatient psych for both, and in outpatient too for ACT, but it is a career that has growth potential. I love it.