Question about self-administered meds at long-term residential rehabilitation policy?

[dekagirlsRN]

I'm hoping to talk with other nurses who work at a long-term residential rehab center for addiction. I am curious as to what your facility's policy is on self-administration of medication. Specifically, do you have monitors (who are not nurses) required to observe resident's self-administration of medication? If so, do these staff members have any special training with regard to the administration of medication? I greatly appreciate your input. Thank you so much.

[Davey Do]

dekagirlsRN:

You have a valid concern, allowing substance abusers to self-administer medications. Especially controlled substances. I had a similar experience, with similar concerns, in the past. I dealt with psychiatric patients/substance abusers in a residential setting self-administering medications.

Without going through the entire laborious process to fruition, this is how that particular medication program worked: An RN oversaw the program. Trained, non-licensed staff assisted the client in setting up meds in a weekly planner. The process was billed as "Med Training". These meds were kept in the residential office in a locked cabinet. The non-licensed staff documented the self-administration on an MAR. Any questions or concerns were directed to the RN.

Of course, the RN had multiple other duties: Dealing with medical issues, communication between clients and health professionals, lectures/groups, general case management, etc.

Let me know if I can be of any other assistance.

Regards,

Dave

[dekagirlsRN]

Thank you so much for responding Dave!! (there is very little activity here on the addiction forum unfortunately) You obviously know exactly the type of facility I'm working at.

I am very new to this area, the only nurse for a 12-bed residential rehab center. Finding information is very difficult. For over 10 years, our policy has been as you stated, but now one of our monitors is stating that she refuses to have anything to do with the meds because she isn't a nurse and isn't "certified to dispense meds" (her words). The policy I found on file doesn't specifically state how the unlicensed personnel is trained (I understood the RN is responsible for this training but can't find where that is stated).

I read another one of your posts and plan on purchasing the books you recommend. Thanks!!

[Davey Do]

The policy I found on file doesn't specifically state how the unlicensed personnel is trained (I understood the RN is responsible for this training but can't find where that is stated).

DekagirlsRN:

I understand your conundrum. When I did Home Health, I taught family members how to instill drugs directly into their loved one's veins. But, then again, when I worked at a Nursing Home, a CNA refused to apply skin protectant because it was "a medicine".

I use to keep a statement from the Illinois Nursing Licensure Board that stated something like, "An RN can delegate any duty to an unlicensed individual as long as that RN has had education and/or experience in that specific duty. The RN will assume any and all responsibility for that delegation."

I kept it on hand in case I ran up against what you are currently dealing with. Then, I thought, if the unlicensed individual continued to refuse, they would have to deal with the consequences of insubordination. But I don't have to deal with that scenerio, currently. Thank goodness.

Maybe you could get with appropriate administrative individuals and write up a policy and procedure yourself. That would work.

Well, thanks for the nice words and good luck in your endeavors. Keep on keeping on.

The best to you,

Dave