Will you give out a medication without the order yet?

[rn4ever?]

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?

[elizabeth321]

I disagree....there is no situation that allows a nurse to administer ativan, narcan or any other medication without an order/standing order....O2 does not require an order in our hospital.....we can start a line....no meds. I don't claim to know when narcan or ativan would be the appropriate measure in all situations....I have been a nurse for over 20 years and I have never had a patient die because I could not get a doctor to give an order by phone or in person....why don't you guys go get your MD?

[urty]

Lucky patient who actually had an MD willing to prescribe a nicotine patch. Where I'm at the MDs rarely do that, it seems only if the nurse makes a fuss about it will it get ordered. Definitely not a life or death priority in their mind.

[Katie5]

She with the experience should know better. Don't let her intimidate you- if there's no doctor's order, pls do not give medication.

[NurseAdida]

Just found out that my facility has Nicotine patch protocol for patients who smoke and request Nicotine patch (am new to this facility). I always thought to call the doctor but I guess if the patient wants it I don't need to call as per hospital policy.

To the poster of the thread, yes you needed an order for a nicotine patch unless policy states otherwise. And I think your charge nurse was out of line!!!

[General E. Speaking, RN, RN]

In urgent situations where the patient's blood pressure is in the toilet or they are having a possible allergic reaction that is escalating and I have tried to get in touch with MD and I feel he is not calling back quick enough or the situation suddenly turns from urgent to emergent there is always a Rapid Response. Standing orders for meds, xrays, neb tx, etc...

Now, the house supervisor, pharmacist, ICU charge nurse and respiratory therapist that usaully respond to the Rapid Resopnse probably wouldn't appreciate it if they found out I was only in desperate need of a nicotine patch for my patient. By the way, we have a protocol (standing order) for nic patches. Pretty tight criteria to meet though. Usually we have to get the doc ok because our patients almost always have cardiac issues (which is a contraindication to giving unless ok w/ MD)

We have standing PCA order sheets that have Benadryl/Narcan on them. Urks me to no end when the MDs decide not to use the sheet and instead write what they want which doesn't mention anything in case of emergency...

[nursebenroc]

So, here is one for you: I've been at this agency for drug and alcohol patients for a few months now. One of the biggest problems my patients face is nicotine addiction. They are not allowed to smoke in this program understandably. However, since they are coming in from many different avenues, they many times aren't connected with a PCP. Nicotine gum came on the FoodLink truck the other day and was handed off to me. I was so excited because I could finally help them curb their appetites and help some of them not face negative consequences of smoking in the program: ie, going back to jail and drug court. I conferred with a few non medical team members. They said "sure, we used to buy it for them". Not thinking I just started giving it away. I did my duty in educating in nicotine overdose and making sure no one had allergies. You can already see how disappointed I am in my actions. Where (more in a legal sense here) did I step across the line? And please please since I already feel bad...and was trying to be HELPFUL for these men...be positive and supportive but constructive. I am open and eager to learn as always....as every nurse should be. Thanks for letting me speak.

[CFitzRN, ADN]

Is there an overseeing doctor? Can you ask him to write orders for this OTC med for the men? Are the men not able to choose to use OTC meds themselves while in the facility? I have to say, I am very rusty with this because I do case management and have for a long time, so I don't know the policies or regulations with OTC meds in a facility like that one. You sound like a kind and compassionate nurse though.

[PaellaMagi]

At my hospital (in Australia) RNs can initiate certain medications, including nicotine patches.

Would I ever give a medication that was NOT on the standing orders list? God no. You have to protect your registration at all costs, and definitely don't jeapordise it over a nicotine patch!