Will you give out a medication without the order yet?

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Just wanted to vent.....yesterday was a very busy day. The charge RN did an admission and apparently forgot to ask the dr. for a nicotine patch for a patient who was a heavy smoker when she asked for the admission orders of the patient. I gave out all the STAT orders and then the patient asked for the nicotine patch. I said, as soon as I get the order, I'll give it. Apparently, patient told charge nurse about it. Charge nurse barges in the medication room upset asking why I was making a big deal out of "just a nicotine patch" and also said that as an experienced nurse, she knows that it was not something to make a big deal of. I replied that I was uncomfortable giving something that was not ordered for legality's sake and it wasn't even an emergency! I don't care even if they say it's "just" Tylenol, Motrin, or a Nicotine patch-----if a patient gets a reaction and there's no doctor's order, I don't want to be in trouble. Because before, one patient told me that one of her allergies was a nicotine patch-----so it's possible to have an allergy from that. To the highly experienced nurses out there, was I out of line? What are your thoughts on this? How would you have reacted?

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Specializes in ER/Geriatrics.

don't ever give any medication without an order...that is just plain stupid...your charge nurse should be reported.

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Specializes in Peri-Op.

Not out of line. She was over reacting most likely becauseshe knows she messed up. She can give it herself without an order if she wants, I wouldn't.

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Specializes in L&D; GI; Fam Med; Home H; Case mgmt.

You did the right thing, period.

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Specializes in Trauma/Tele/Surgery/SICU.

I also agree with your actions. We are RN's, not Doc's. Giving a med without an order is prescribing....and way out of our scope of practice.

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You did the right thing...I am on so many different meds, from different md's, that one of my biggest fears is being admitted, and not being able to get orders for meds.....my docs are all well aware of what I take, I bring an update sheet to each visit, but that doesn't mean that pulmonary would be cofortablewriting neuro meds, htn writing pulmomonary, rheumatology, cfs, fibro...I totally understand not giving meds for which there are no orders...but, what would anyone suggest for this situation?

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Several of our docs will not give nicotine patches in certain situations, particularly with pts with CV or CNS issues or history. Anyone at risk for blood clots will not get a nicotine patch. I have several hospitalists I work with who prefer ativan over the nicotine patch. Nicotine IS a drug, and it has a dramatic physiological effect on the nervous and cardiovascular systems. You are not out of line, she was.

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Specializes in Critical Care.

A nicotine patch? Seriously? Hardly something that requires rushing to get done before an order.

Maybe ativan for an active seizure prior to having the doc call back or something...

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Specializes in ER, OR, PACU, TELE, CATH LAB, OPEN HEART.

Charge nurse was wrong. I agree with you and what others have posted.

That would never happen in my facility. An MD (attending, resident, PA) must place all orders in the EMR. Then the nurse AND pharmacy must verify the orders. Unless the patient is dying, coding, or in severe pain, the pyxis will not dispense any drug NOT VERIFIED by pharmacy.

YOU did the right thing. Never be bullied into doing what you know is not right or what is not in accordance with policy. No one can fault you for practicing according to the rules. They may yell and scream, but in the end you will always be right and the facility will have to back you.

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Specializes in CTICU.

Tell her to give it herself if it's not a big deal. Then watch her backpedal.

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Specializes in Geriatrics, Med- Surg.

You were absolutely right. I wouldn't give anything ever without the order first. She should not be in charge, can't imagine what other unsafe practices she performs.

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Specializes in ED/Psych.

Hi:

I agree with the others who have posted. Particularly as Bluegrass mentioned, some patients who smoke will be adamant about getting a nicotine patch but when it comes down to it, the doc will not order as the patient may have some underlying medical reason not to.

As others mentioned, if the charge nurse felt that she wanted to get a nicotine patch and give it to pt, then let her do it herself. It then becomes her problem and not yours. A nicotine patch is not an emergent need so worst case scenario, the patient has to wait a bit to get one.

Carla

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