Self Administration

Here.I.Stand, BSN, RN · Sep 15, 2017

I just know that all the "right" processes are not happening that should be happening. Therefore the families etc will put the blame on the nurses is what it boils down to!

I'm not an expert, but if the physician has determined they are able to self-administer, couldn't the RN be considered acting out of scope for removing the meds? Or otherwise preventing self-administration?

Marija1 · Sep 15, 2017

I kinda agree but the error occurred so that's why, I am sure the dr would reassess at that point

allnurses Guide · Sep 16, 2017

Yes that's what happened am saying, most allow us to administer medications for them but the acfew say they can and want to do it!

In the assisted living that my mom was in there was a extra $500.00 charge to have the nursing staff administer her meds. Assisted living is expensive and some can't or wont pay extra for the service. The assisted living my mom was at was $4,500.00 a month - then she graduated to memory cary at it went up to $6,000.00 a month, now she is in a total care Alzheimer's facility at over $9,000.00 a month and not a dime of it is covered by Medicare thank goodness my mother is rich.

Hppy

brillohead, ADN, RN · Sep 16, 2017

How was it discovered that the patient took too many pills?

Was it a one-time occurrence, or were they supposed to take one a day and they were taking two a day for a whole month?

Why did the patient take too many pills, did they forget that they had already taken them and took a second dose, were they confused about how many to take or when, or was it an intentional mistake?

Is there any kind of process that can be put in place to reduce the chance of such a mistake happening again? I like the pill boxes where there are four compartments per day (morning, noon, dinner, bedtime) and a whole week's worth of slots in a set. This makes it easy to see if the day's pills have been taken yet, and they can be set up for the appropriate times. Can the resident or the resident's family set up the pills that way each week to prevent this from happening again? Blister packs work similarly... all pills put together based on when they are to be taken.

And finally, how many meds does the resident have available to them at any given time? If they have a 90-day supply, it could lead to a serious overdose if they double up on the dose and it's not discovered until 45 days later when the bottle is empty too soon. Likewise if the patient isn't taking the pills at all... after three months of no meds, it would finally get discovered when the bottle doesn't need to be replaced because it's not empty yet.

Marija1 · Sep 16, 2017

They have a blister pack and they also made errors with that and started antibiotics. Guess because they were not feeling well they took too many antibiotics from a bottle. I am pretty sure if we took his pills away at that point he may not have been happy but a family member did. The thing is once they are deemed capable then what more can we do?

brillohead, ADN, RN · Sep 16, 2017

They have a blister pack and they also made errors with that and started antibiotics. Guess because they were not feeling well they took too many antibiotics from a bottle. I am pretty sure if we took his pills away at that point he may not have been happy but a family member did. The thing is once they are deemed capable then what more can we do?

If deemed capable and errors are being made, the prescribing physician who gave the order for self-administration needs to be made aware of each and every administration error that is discovered. Maybe after getting a daily phone call or fax on the subject, he'll rewrite the order to discontinue self-administration.

At the very least, the prescriber needs to be made aware, just like with any med error. That puts the liability on him -- he gave permission for self-admin, he was notified of noncompliance with self-admin, so it's his license on the line if self-admin continues and errors continue as a result.

IMO, the only way this could come down on nursing's head is if the doctor wasn't notified of the errors. The doc can't be expected to rescind permission for self-admin if nobody ever tells him that there's a problem.