Scope of Practice and medications?

Nurses Safety Nursing Q/A

Specializes in Psychiatric.
Scope of Practice and medications?

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. 

46 Answers

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.

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.

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.

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.

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.

7 hours ago, amoLucia said:

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.

I didn't make the rules I'm just reporting them since people seem to act like they don't exist. They do. There are cases where nurses were told to do this and were fired because the facility didn't put it in writing and wouldn't back up the nurse because they knew it was, in fact, against the rules.

5 hours ago, Catedi said:

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. 

No. It pertains to all medications. You missed the part about prescribed meds are treated as controlled meds?  I even linked two separate articles to further explain this. Glad you understand it's not standard practice because that's what I am trying to relay.

Specializes in Critical Care.

What the OP is describing is not a violation of any law, practice act, or scope of practice.  

In situations where the nurse is assisting someone in taking medications they already own, typically in ALF or ECF settings, it is true that you can't take from one patients medications to give to another patient.

But what the OP is describing is administering medications from the facility's stock, not medications already owned by the patient.

Facilities often manage on-hand stock based on whether there is a patient who needs that medication, but that doesn't mean if that medication is stocked that it is only for that patient.  

For instance, if 12.5 mg Coreg is not commonly administered in a particular facility or unit so it is not regularly stocked there, then a patient is admitted for whom that medication is ordered, the unit supply would be stocked with that medication.  If that patient is then discharged and another patient is admitted for whom 12.5 mg coreg is also ordered, there is no requirement to throw away the doses stocked on the unit and replace them with the same medication, obviously that would be silly.

In terms of nursing practice, not utilizing the facility stock on hand and instead delaying the medication for a new stock of the same medication (for no reason) could be argued to be a failure of the nurse to meet their professional standards.

Specializes in M/S, LTC, home care, corrections and psych.

In the correctional facilities that I have worked in there was stock medications available to cover new medication orders until the patient specific supply was delivered from the out of town pharmacy. This question is a good one to ask your BON, BOPh and/or your health services administrator. If the policies of your facility are not consistent with state law you should know sooner rather than later. 

Specializes in Addictions, Psych.

I did a brief stint in corrections. We were trained that we could not administer medications to a patient that were dispensed under the name of a different patient. Did it happen anyway? Sure.

If the medication was not floor stock, the patient had to wait until it was delivered. Most vital medications were stocked, so it was rare that something critically important was unavailable. If the medication are unavailable, I would double-check with the prescriber as to the indication for the drug and if they would put in an order for a temporary substitution -- hydroxyzine isn't necessarily a critical med. 

The issue comes if there's ever a medical record or pharmacy audit. If your charting indicates that the medication was administered, but the pharmacy record indicates that it wasn't dispensed and delivered until 2 days later, is "I borrowed it from a med card that was supposed to be destroyed" going to be valid to your administrator?


Specializes in Critical Care.
On 5/27/2021 at 8:37 AM, NurseBlaq said:

No, it is not stock. OP clearly said it was to be returned from another patient and there are no stock meds. The whole damn thread, including replies, are talking about borrowing meds from other patients and here you come with the know-it-all condescension. What's your problem? You always have this opposition view to people trying to be in the right all the time, even to the point of intentionally not comprehending what's being said and even clarified in the thread just to be an antagonist. It's a common theme with you in these AN threads and has been going on for quite some time. Narcissistic behavior on full blast. It's a clear pattern.

I don't see where the OP stated "there are no stock meds", and actually the OP described their practice as administering meds from a stock supply.  

In correctional settings patients aren't typically allowed to self-administer medications from a patient-owned supply, medications are typically administered by staff.  The OP also said the medications in question were about to be returned to the pharmacy, typically pharmacies don't accept returned meds that have been dispensed for someone to self-administer, but they do take back medications delivered to a facility to be kept under the control of facility as their stock supply.

It's pretty common, particularly in settings that aren't administering large volumes of medications, to only keep enough common medications in stock to last until an additional supply arrives when a medication has been ordered for a particular patient (or inmate).  When this additional supply arrives from pharmacy it will typically be labelled with the name of the patient (or inmate) that it was ordered for, but that doesn't make it a patient-owned medication dispensed to them, that just makes it easier for staff to find the medication. 

I think nurses in a number of settings mistakenly assume that when a facility only keep on hand the medications they need to administer for currently active orders that these medications are specific to that patient (that they are patient-owned medications), which isn't the case if they are being administered to patients, as opposed to being self-administered.

The OP's question was what is required for a nurse to appropriately administer a medication per practice acts, regulations, etc.  The components of appropriate medication administration are the correct medication and dose (ie metoprolol tartrate 25mg) the right frequency, route, and to confirm that you have the right patient that the order is written for.  The history of how that 25mg of metoprolol came to be in the facility's possession does not factor into the requirements of appropriate medication administration.

I'm not sure why you feel the need to respond to my views with aggressive bullying behavior, I'd welcome any examples of where I've been disrespectful or mean but I'm honestly not clear when that occurred.  

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.

Except for controlled substances, theft, or fraud, Muno is correct that there is no LAW regarding the practice of borrowing from Peter to pay Paul and repaying Peter when Paul’s blister pack finally shows up. The word “illegal “ has a particular meaning in law, LOL. 

What we’re talking about is a policy, not a law. If the OP is concerned, then a written missive cc’d widely to the institution and the state regulatory board is in order to obtain clarity AND to suggest better policy language to protect patients and nurses. If the response is, well, not responsive, do it again until somebody wakes up and pays attention. This is probably going to be the only way to fix her dilemma (which is likely shared by others).

Specializes in oncology.
Hannahbanana said:

What we're talking about is a policy, not a law.

Thank you for pointing out what is in the patient's need (and best interest for the entire facility) When the count comes up accurate, we have done our job...not "nursing" the pharmacy counts...but nursing out patients.

This is off the subject but shows how crap  goes:

We had a correctional facility patient (who came every few weeks)  came in ( as usual) for his chemotherapy the next day. The orders were not taken he had no food (dinner or breakfast,) no orders processed for chemo. And he never asked for food. ( And This is the only time in 45 years that I complained that his orders should have been caught in the midnight audit,) ( I worked that floor for years and we always checked  orders that weren't  racked before the RN knew about them. ) Made dash for pharmacy to make his chemo,and put the pre-meds in the system.  I knew the patient well,  he was kind to students, tolerating the protocol of his pre-chemo med well with at least 3 students have a part in it.. 

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