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Why wouldn't you chart this??

Posted

We had a discussion at the hospital about a nurse that refused to hang meds b/c they were expired (expired that day). When asked how we would handle the situation - I said that I would double check with the pharmacist and if he/she gave me the ok, I would give meds and then document it in the chart. I was told that that should not be documented in the chart? confused...:confused:

racing-mom4, BSN, RN

Specializes in ICU/ER.

Interesting scenario. I agree, if the pharmacy says OK, then I would simply hang the med and not chart anything about the med being expired that day. As I have never documented the expiration date on any other med before.

KaroSnowQueen, RN

Specializes in Telemetry, Case Management. Has 30 years experience.

Personally, if it were me, :twocents:I would:

A.get another nurse to witness that the meds were expired,

B.write an incident report, send copies of the incident report to both the nursing and phar mgrs,

C. return the expired meds and make pharmacy give me good ones, THEN

D. return to the floor, give the good meds and chart I gave those.

None of this however, needs to go into the individual patient's chart, other than signing out the meds on the MAR when you finally get to give them.

Jolie, BSN

Specializes in Maternal - Child Health. Has 35 years experience.

I support the nurse for refusing to hang expired meds. Some (such as Ampicillin) have a very narrow window of safety and effectiveness, so the fact that the meds were "only" outdated by one day does not guarantee their safety or effect. Why subject a patient to the possible risks and side effects of a med that may not be effective?

If pharmacy OK's the drug, then let them either re-label it with a new expiration date, or administer it themselves. Otherwise all that the patient and family will see and know is that Nancy Nurse hung an outdated med and Granny had a bad reaction to it.

If a medication can't be administered on time, it needs to be noted in the chart. I would make the following entry: "Ampicillin unavailable at this time. Pharmacy and physician notified. No new orders received." An incident report then needs to be written detailing the reasons for not administering the medication, as this is inappropriate to document in the chart.

BTW, why couldn't pharmact simply provide a new dose?

bklynborn

Specializes in GERIATRICS, DEMENTIA CARE, MED-SURG. Has 10 years experience.

Would be interesting to know what the medication was....if it was an antibiotic then the pt missed a dose. Not a good thing.

Most medications in the hospital are timed and expire after the hour the dose is due.

The pharmacist if consulted will usually tell you to hang the med and then retime the next dose to provide adequate coverage.

Would like to hear more info on this.

PsychNurseWannaBe, BSN, RN

Specializes in LTC, Nursing Management, WCC. Has 13 years experience.

So are the meds that expire...expire at the start of the day or at the end of the day. I ask because insulin is good for 28 days after opening...so they write the 28th day as the date of expiration. Is it still good for the 28th?

bklynborn

Specializes in GERIATRICS, DEMENTIA CARE, MED-SURG. Has 10 years experience.

Use it on the 28th day and then discard

TexasPediRN

Specializes in Pediatrics Only.

Poopsie-

If a med expired that day, I'd still give it.

As for the question of why you shouldnt document that in the chart, its for legal reasons.

Say you documented ' meds expired but per pharmacist ok to give '

Then later on pt becomes septic and dies.

Family decides to sue (as they always do) for who knows what reason.

Now the lawyers get to see the chart. They see the line you have charted above. Ah HAH! They have all of the ammunition that they need.You gave an expired med. Pt didnt get the right concentration of meds b/c you hung an expired med. Now hes dead. Lawsuit won! Your license on the line.

As other posters said, you'd do an incident report. You would never ever document in the chart that you filled out an incident report, because they the lawyers could track it down and find our exactly what happened.

Does that help explain things a little more clearly?

PsychNurseWannaBe, BSN, RN

Specializes in LTC, Nursing Management, WCC. Has 13 years experience.

You never chart that you filled out an incident report. Incident reports are for in house use only. Once you chart that you filled it out...it becomes a part of the chart and subject to discovery.

PsychNurseWannaBe, BSN, RN

Specializes in LTC, Nursing Management, WCC. Has 13 years experience.

Use it on the 28th day and then discard

So does this rule apply with other drugs such as what the original poster is talking about?

bklynborn

Specializes in GERIATRICS, DEMENTIA CARE, MED-SURG. Has 10 years experience.

In our hospital meds are delivered to the units by techs just before routine doses are scheduled. As I said before they expire on the same day or shortly after the routine dose is scheduled to be given. This does not mean the med itself has expired..........the question about the insulin was about the medication itself.

OC_An Khe

Specializes in Critical Care,Recovery, ED. Has 40 years experience.

You must clarify with pharmacy the exact definition of the term expired on.

Does expire on 1/1/08 mean it must be used before 1/2/08 or does it mean must be used prior to 1/1/08.

In the original posters questions pharmacy stated it was OK to use. To me that means it wasn't expired. On the whole question of charting an incident reports is moot.

bagladyrn, RN

Specializes in OB.

I won't hang or administer any med which indicates that it is expired on the label or package. I would obtain a new dose from the pharmacy. If the pharmacist states that the med is safe to give, then he can take it back and relabel it and sign the label to indicate this.

If you administer any med that says "expired" on it, no matter what the reason, you will most certainly be held responsible for any untoward occurance that happens to the patient afterwards, whether or not it was truly related to the med. "The pharmacist said it was okay" is not going to be a valid defense and if confronted with a patient with a major bad outcome, do you really think the pharmacist is going to admit to having told you that? Not likely with his license and malpractice on the line as well!

You must clarify with pharmacy the exact definition of the term expired on.

Does expire on 1/1/08 mean it must be used before 1/2/08 or does it mean must be used prior to 1/1/08.

In the original posters questions pharmacy stated it was OK to use. To me that means it wasn't expired. On the whole question of charting an incident reports is moot.

I don't think that med was expired. I think you need to check with what your pharmacy says, but as long as it's not BEYOND the date on the med, you'd be okay. I'm pretty sure if it was an IV med that it would have month, day, and year (rather than month/year which would be a different argument). But at least where I work, I think that's how it is - good till 23:59 on the date on the bag. If it said 4/21/08, I would use it today. If it said 4/20/08, I wouldn't. There are some meds that are much more time sensitive, like chemo. Those would say "exp: 4/21/08 2130" and if it's going to be hanging beyond that time, we have to call pharmacy. They can come up and extend the date if it's okay for the med, but we can't hang it if they don't.

Again, can't say it enough - NEVER chart that you filed an incident report! You're covering your own toosh that way! Incident reports are for internal review, meaning that the institution uses them to make improvements and look at safety issues, etc. That information is not necessary in a pt's chart. True that you are supposed to chart what you do, but if pharmacy said it was okay to hang the med, hang it. If not, tell them you need a new dose. But don't write in the chart "pt abx dose expired, not given". Like someone said before, that is just ASKING for a lawsuit. Even if you feel like that was the right thing to do, you have to consider the other side of the coin. The pt missed an abx dose. Not good. If that pt later sued, they would ask you why you didn't get them a new dose, etc. Not good! You chart what you did for the pt, not the hoops you had to jump through to do it!

RN1982

Specializes in ICU/Critical Care.

We had a discussion at the hospital about a nurse that refused to hang meds b/c they were expired (expired that day). When asked how we would handle the situation - I said that I would double check with the pharmacist and if he/she gave me the ok, I would give meds and then document it in the chart. I was told that that should not be documented in the chart? confused...:confused:

The only reason I would not have documented that in the chart is because it's hearsay. The pharmacist isn't going to document in the chart that he said it was ok to give expired meds.

txspadequeenRN, BSN, RN

Specializes in ICU, PICC Nurse, Nursing Supervisor. Has 20 years experience.

i don't even know why this is a issue. if the drug is expired don't give it... get another dose from the pharmacy. i would never chart i gave a expired dose of medication that is setting your self up for lawsuit. i would alert my nurse manager and if she agrees with the pharmacist then she can give it and sign the mar....

txspadequeenRN, BSN, RN

Specializes in ICU, PICC Nurse, Nursing Supervisor. Has 20 years experience.

this is the whole deal right here..that pharmacist will be sitting on a beach in tahiti while you are defending your nursing practice in court....it is hearsay and that wont do you any good in court....

the only reason i would not have documented that in the chart is because it's hearsay. the pharmacist isn't going to document in the chart that he said it was ok to give expired meds.

I was taught that you never chart anything that will bring attention to your actions or that point out errors as errors. That is asking for it when lawsuit time comes around. You don't chart incident reports. If, for instance, you do discover a mistake, you are supposed to chart objectively what occurred and the actions that happened afterwards without using the words "mistake" or "medication error" etc. In this case, simply don't give a questionable med. If the pharmacist oks the med, then give the med. If you have any doubts, just don't give the med. Don't give it, then chart statements in the chart indicating that the med was expired or that anything else was wrong about the med. That is not very wise. If I were someone looking for info for a lawsuit, I would jump on statements like this being in the chart. You would be handing ammunition to me on a platter. If you ever have questions about charting something, it is always a good idea to check with your supervisor about it before you write in the chart.

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