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Scope of Practice and medications?

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Specializes in Psychiatric. Has 10 years experience.

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My question is: If a physician writes a valid order for a non-controlled medication in a prison setting and the medication (Hydroxyzine) has not yet arrived, is it beyond the nurse's scope of practice to provide the inmate with an available dose of the medication not specifically RX’d to him, from a sealed and sterile blister-pack that was scheduled to be returned to pharmacy services, if this action is safe and appropriate to perform for the patient at the time, and it is verified by a second RN that the medication is unexpired, the Right Medication, the Right Time, the Right Dose, and the Right Route?

I could not find any nursing or pharmacy laws or policy to prohibit such an action, as provided in the Ohio RN and LPN Decision Making Model. This act is also not prohibited in my facility's current policy. 

No, it is not alright as the medication was not prescribed to that patient. They will have to wait until their prescription arrives. Any medications awaiting return to the pharmacy, be it because the patient expired, med dc'd, or whatever, must be sent back to the pharmacy. You can't sub one patient's drugs with another patient's drugs just because they're available. That's for any setting, including at home.

Catedi

Specializes in Psychiatric. Has 10 years experience.

Is this your opinion or is your answer based on law or do you have any indication that this violates a standard that I can't find? I'm not being snarky here, I just want to know for sure. This is a prison setting and there are also many drugs we keep around that aren't necessarily specifically RX's for anyone that we give if there is an order and the inmate needs it - such as anti-biotics or Inderal, until the pharmacy sends their medicine. The inmate has episodes of self-harm and violent acts against other inmates and staff. Given his agitated state, I thought it appropriate to give him his first dose so he could go to sleep, for his safety and the safety of others. But, of course, I don't want to do so again given that it may be a violation of the law. It was a one-time situation where I thought I made the right call in the best interest of my patient. 

Does not matter which setting it is, that is the law. There are standards starting with 'right patient'. That medication is not prescribed for that patient and therefore you're already in violation of the 5 rights of medication administration. Also, I'm disturbed by the fact you keep saying it's a prison setting as if prisoners are void of nursing standards because they've been incarcerated. Maybe call the pharmacy and request a special drop. Are there no stat meds in a locked cabinet somewhere?

If you've already done it, what's the point of asking? It was wrong, it is wrong, please don't do it again. Yes, it's a violation.

Catedi

Specializes in Psychiatric. Has 10 years experience.

I did not mean that prisoners were void of nursing standards, I just meant it is a residential type facility and where there is an off-site pharmacy and the client would have gone without his medication for maybe a few days. 

Thank you for your feedback. 

amoLucia

Specializes in retired LTC.

You have to be VERY VERY careful about setting special precedents within a corrections setting. Shouldn't be any special circumstances to circumvent regular SOP. Makes you look like you're 'playing favorites' (never acceptable in corrections).

I doubt there's any law anywhere; just good standard of practice.

Also no pt should be having to go 'for maybe a few days' without an ordered med as you say. The pharmacy contract addresses 'timely deliveries'. And that for emerg backup. If that's unworkable, then it needs to be corrected.

Your intentions were well-meaning, but not correct. Also think about another scenario - if you were in a hosp/NH, you would NEVER have done that action in a DOH supervised med pass.

CommunityRNBSN, BSN, RN

Specializes in Community health. Has 3 years experience.

I am interested in this too. I don’t work in a similar setting (I don’t even give meds at my job!) but I think it’s an interesting question. If anyone has a link to real info (a law, as the OP asked, or P&P from a similar setting, or a BON document), I’d like to read it. 

Do not know of any law or such, but wanted to say it was done at the LTC facilities where I worked and not a second thought occurred. We received pharmacy deliveries late at night so I don’t think that was an excuse.

When a resident’s medication is permanently discontinued, per the 2014 Drug Enforcement Agency’s (DEA) Disposal of Controlled Substances Final Rule, it must be properly disposed of within three business days.

https://www.deadiversion.usdoj.gov/fed_regs/rules/2014/2014-20926.pdf

You still can't use medication prescribed to another person just because you have a similar prescription. You all should know this as nurses.

What are the legal ramifications in borrowing patient medications for another patient’s use?
This practice is not an acceptable standard of care in any setting, and bypasses the checks and balances provided by the pharmacy.
Use for another patient constitutes fraud, as the medications have been charged to the patient for which it was prescribed and must be credited back to that same patient.
Governing bodies such as the Joint Commission set standards prohibiting such practice, and facilities tolerating such behavior risk losing their license, and fines.

https://www.medical-legalnews.com/hot-topics-in-the-legal-arena-borrowing-meds-from-one-patient-to-give-to-another/

amoLucia

Specializes in retired LTC.

2 hours ago, NurseBlaq said:

 .....  Use for another patient constitutes fraud, as the medications have been charged to the patient for which it was prescribed and must be credited back to that same patient.
Governing bodies such as the Joint Commission set standards prohibiting such practice, and facilities tolerating such behavior risk losing their license, and fines.

https://www.medical-legalnews.com/hot-topics-in-the-legal-arena-borrowing-meds-from-one-patient-to-give-to-another/

Honestly, I really don't think that the crediting of returned medications is in anyway shape or form a realistic possibility. Just the sheer quantity of meds t be returned from all types of facilities across this country is mind-boggling (at the least!). Gotta be gazillions! Does anyone here REALLY TRULY believe that ret'd meds are credited?!?!!?? (Big Pharm racket, but that's another thread!)

But for this post, it's the rule that meds should not be borrowed. End of sentence. Personally, I have mixed thoughts about this, and to be honest, I have borrowed in the past, REGULARLY. But I made the effort to remedy the situation that forced me into borrowing.

Catedi

Specializes in Psychiatric. Has 10 years experience.

4 hours ago, NurseBlaq said:

When a resident’s medication is permanently discontinued, per the 2014 Drug Enforcement Agency’s (DEA) Disposal of Controlled Substances Final Rule, it must be properly disposed of within three business days.

https://www.deadiversion.usdoj.gov/fed_regs/rules/2014/2014-20926.pdf

You still can't use medication prescribed to another person just because you have a similar prescription. You all should know this as nurses.

No offence, but this rule only pertains to controlled medications. Hydroxyzine is a non-controlled medication. There is no DEA oversite of non-controlled medications. Although I get your point - it is not standard nursing practice.