setting up medications

[kcrnsue]

I have only been doing home health for a few months now, and for the most part, I like it. At some times, however, I am confused as to what exactly I should be doing for a patient. When doing a soc assessment for a therapy only patient, I ask the patient what medications they are taking. They usually show me the bottles, and I write it all down. Some have the little medi-sets. If the patient or the cg seems to be capable, I leave it at that. Another nurse I know will set up patients with sn just to monitor their medication, and she goes every week or so and opens up the medisets and counts the pills or whatever. Am I not being diligent enough, or is she doing overkill?

[renerian, BSN, RN]

If a client knows what their meds are for, their side effects, and how to take them I did not go back. Sometimes they needed disease process teaching. I never set up meds for a capable person as all that does is make them dependent on someone else rather than making them independent for things they can do. Does that help?

renerian

[hoolahan, ASN, RN]

Exactly like renerian.

When I do a new, I take all the med bottles, and one by one give them to the pt and ask them to tell me what they take this pill for and how they take it.

Sometimes they give me a strange look, and I say, I know what they are for, but I am testing you. They either get it or don't at that moment. If they know them, they start to tell me how they take it, I write it down. When we get to the new meds, I give them instructions and be sure they know the s/e.

If Rx has not been filled yet, but they know their old meds, I instruct them to take as directed and be sure to read the insert/info that comes from the pharm and if any questions call their pharmacist or doctor. (Because that is who they should call after discharge, you are teaching independence and giving them the correct resources)

If I go in and bottles have very old dates, I question them. Some people will dump new refills into old bottles.

You can get a LOT of info from looking at the bottles. Sometimes I get the best info from the pharmacist. I make them get me the bottles, and not just a list. You can see the dates and count the remainders and know if they have been compliant, and you can find out if they are treating w multiple doctors. I recently had a pt who was taking Diovan and Lisinopril, each a diff type of ace-inhibitor, and she had renal failure (new), hhhhmmm wonder how she ended up in renal failure?? Two diff docs prescibed these meds. No one told her to stop the other one when they gave her a new one.

I never assume anything, but I do not set-up medipalnners or count pills on a regular basis, only in cases of suspected non-compliance. And usually it will take a visit or two to determine this. I give people the benefit of the doubt.

Every once in while people will not want to bother getting thier bottles of meds, and insist on just going over the list. In that case I won't push it, but I do document that they would not show bottles to SN.

Hope that helps. But ITA w renerian, that starting w medi-planner only makes a pt dependent. Your colleague should be giving them a diary and teaching them to fill their own planner. Besides some people really hate medi-planners, and I have seen some pushy and overbearing nurses who try to force people to use a medi-planner. This only creates dissention. The med plan has to work for the pt. And a HH nurse has to be flexible enough to try alternatives. I would bet there are a few people who describe your colleague as "that nosy nurse" and no doubt resent her "interference" and then again I am sure some think she is great.

[renerian, BSN, RN]

Wonderful post hoolahan!

renerian

[kcrnsue]

Thanks!

That does help. I don't want to be the nurse that only does the bare minimum, on the other hand, I dont want to waste time on people who really dont need that kind of help.