Published Jun 29, 2005
I recently began work in a 10-bed ER in a rural area. The closest 24-hour pharmacy is close to an hour away, so it is common practice for our ER MD's to order a couple doses of meds (usually pain meds) sent "to go" with patients discharged after the local pharmacies close up shop (8 is the latest any of them stay open).
While I realize that this is done as a great convenience and is in the best interest of the patients, I and some of my co-workers are not entirely comfortable with the idea. For one thing, it could be construed as dispensing meds if a nurse gives the meds out...couldnt a nurse be cited for practice violation???
I guess my question to you all is, surely there are some of you out there who practice in a similar area where there is no 24-hr. pharmacy available. How does your institution handle it?
Altra, BSN, RN
We do this in the ER where I've worked as a tech as well, after hours. Never more than a dose or 2.
I have admittedly little experience, but as far as the concern about nurses dispensing ... when a nurse hands the med to the pt., it's accompanied by going over the d/c instructions written by the MD. Does this make a difference? Is there a difference between this and administering any med previously prescribed by an MD?
I work in an ER of similar size and also without 24-hr pharmacy availability. Our hospital pharmacy has pre-packaged medications that we dispense for take home. They are labeled and we keep a log of what is dispensed. We keep it to a minimum: for example a packet would contain 3 vicodin or one antibiotic. We also have a limited number of types of medications available. Anything that could be purchased at a 24-hr store, ie ibuprofen, benadryl is not dispensed. It works well for us and I have to believe it must meet the requirements of emergency dispensing since our pharmacists are knowlegable and conscientious.
I like the "pre-packaged" idea, Northernlights. Wish ours were that way. We have to get the meds from the cabinet, put them in a container and write out a label. Rather than keep a log, the MD writes a RX for meds "to go" that are filed in a special place for pharmacy to pick up.
I probably never would have thought twice about it except that my preceptor in the dept. will refuse to hand the meds to the pt - she makes the MD or PA do it...because she says otherwise she is "dispensing". But she seems to have no problem getting the meds out, putting them in the container and making the label. (to me, THAT is dispensing!)
I guess it's a question of semantics...what is the definition of "dispensing"?
If you get meds filled at a pharmacy the pharmacist packages the meds, labels them or at least oversees a tech do it. very seldom does an actual pharmacist hand you the meds.
My concern is that I don't at some point in the future find out that I am violating some sort of statute or practice guideline because of what I am required to do for my job. There is no way that the MD's would take the time to package the meds themselves and write the labels.
advice anyone??? am I making much ado about nothing?
We do not do it (I'm at a much bigger hospital though). I've had doctors who will give the patient the medicine and instruct them on home use, but we will not do it (nurses). -andrea
Oh my, I never thought about this. I work in an urban ED, there are plenty of 24-hour pharmacies around, and I will often give take home packs or one or two doses of meds to patients when ordered by the MD/PA/NP. It doesn't happen every day, but it is fairly common. I never even considered the ramifications.
CraigB-RN, MSN, RN
We have a set formulary were the providers are allowed to dispense medications. We use Unit Dose so here in KS at least the pharmacist doesn't have to repackage. We give enough to get them through till the pharmacy is open. The nearest 24 hour pharmacy to us is 3 hours away.
So since this is a 4 day weekend and if its after 6pm on friday we will give hem enough to get them to Tuesday morning. Out prob is that we can't charge for dispensing meds.
We have a set formulary were the providers are allowed to dispense medications. We use Unit Dose so here in KS at least the pharmacist doesn't have to repackage. We give enough to get them through till the pharmacy is open. The nearest 24 hour pharmacy to us is 3 hours away.So since this is a 4 day weekend and if its after 6pm on friday we will give hem enough to get them to Tuesday morning. Out prob is that we can't charge for dispensing meds.
It may vary state to state...where I work, you are allowed to dispense meds in the hospital, however if you send the med home with the patient it is supposed to have a label of some sort on it with prescribing info...does it happen that way...probably not like it should...
I have worked in settings in the past where this was a frequent practice (out of necessity, as you describe). Each state has its own rules/regs which define nursing practice and pharmacy practice, and, typically, the rules defining "dispensing" medications (pharmacy practice) allow wiggle room for nurses to hand out a small amount of medication (with a doc's order, of course!) without running afoul of the law -- a day or two worth of meds = ok; two weeks' worth = NO WAY! Also, as mommatrauma notes, there are typically requirements about the packaging/labelling.
You may want to check with your state board of nursing and/or pharmacy, just to make sure that you are kosher. Better safe than sorry.
You can't just give out a handfull of pills without a lable. Most of those regualations are federal. You can dispense but depending on the catagory of the hospital the quesion is wether you can charge for them or not.
I agree with checking with your state board of nursing- are you allowed to dispense or does this fall under pharmaceutical practice? (something to consider) Our hospital stopped this practice as they discovered that insurance companies would not cover this cost- lost $$$ to them. In our ED, (we have a pyxis), the ED physicians can get out what they want if they want to dispense. The exception to this are ear/eye drops and/or ointments- once used by a patient- they cannot be "re-used" for others so we dispense if needed. ( I'm talking about antibiotic drops-). They must be carefully labeled in layman terms including directions, storage concerns, names of pt/ prescribing physician, content amt., date, phone # of prescribing unit, etc. (This is where the pharmaceutical standards of practice come in to play-)
We also used to dispense the reconstituted PO antibiotics for children- but now our pyxis is stocked with more unit doses than it used to be-
Have a safe holiday weekend everyone!
I am a current Public Health Nurse (soon to be an ER nurse...in 1 month!), and I wish we could give medicines to go for our patients in the STD clinic....what I mean is, dispense additional medicines for the partners of the patients that have STD's.
I feel that if you are only treating one person, then you are not fully rectifying the situation...and there is no way to know if their partner will be tested and/or treated....as partner notification is not mandatory.
I am all for medicines to go...not only in this context, but others as well.
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