signing out medications

Nurses General Nursing


Hi, I'm graduating this May from an ADN program. Lately I have heard a lot of controversy over when nurses should sign their meds out. Some people think medications should be signed out before going and giving them and if the patient refuses coming back and circling the time. Others believe you should first attempt to give the medication to the patient and then sign it out. What is your opinion?

Thanks, Danielle


7 Posts

Hi. I was taught in nursing school that you should never sign out a med until it has been administered. However, certain hospitals have policies in place that you can sign out a med prior to it being given (i.e. immediately prior to your entering the patients room with the med) and then circle your initials if the patient refuses it or if certain parameters (i.e. hr/bp too low) preclude administration. You then document in your nurses note why the medication wasn't given. Always check your hospitals policy on medication administration first. The reason that certain hospitals have this policy in place is that by initialling the medex prior to administration it ensures that the med was put into the cup to be given to the pt. This is helpful when pts have multiple meds. If you wait until after your meds are given to sign off, you could have missed a certain med (it never got into the cup) yet not realize it, go back to your medex after medicating your pt, then just go down the list and sign off all the "open" spots. My hospital does not allow signing off prior to administration. Therefore, what I like to do is put a little check mark in each slot after I've put a med in the cup, then after admin, I go back and sign off. Believe me, it's very helpful. When I was in school I thought I'd never miss a med, but it happens, even to "very careful" nurses. I've gone back to the medex and not seen the check mark and then realized that for whatever reason my eyes just passed over that particular med, and I'm a nurse that triple checks everything! At that point, you just go back in and administer it and med error averted. Hope this helps.


36 Posts

I think the safest way is to get into the habit of first giving the med, then signing it off. There are just too many distractions that may cause you to forget to go back and to chart that the patient refused.

[This message has been edited by bshort (edited April 24, 2000).]


238 Posts

Specializes in Hospice and Palliative Care, Family NP.

I always initial my medications as I check them and add them to the medicine cup, they are then signed out, IF the patient refuses, I then go back and circle it. Also, I have made a habit of checking the MAR right before I walk off the floor at the end of the shift to make sure I have given all of them and not missed something, and make sure all refusals (if any) are circled. We just don't have time to run back and forth after giving meds to circle that they were given. Besides, it is easier on my poor aching feet to do it all at once! *G*

[This message has been edited by bshort (edited April 24, 2000).]

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