Withholding Medication

[Hachiko]

Hi all,

I am a new member, but, truth be told, I've been browsing the forums for years.

I am a 30-y/o career switcher who used to work in an overcrowded, understaffed, govt hospital.

I have gone private and was nursing an 87-y/o patient today who was straining very badly while clearing bowels.

I was there just for one day, covering the primary daytime nurse, who needed a break.

The doctor advised to pass the message that patient is to be given a fleet enema and dulcolax tomorrow, at the same time. This is due to patient's constipation.

As I was not familiar with this case, I did not realise that patient was prescribed charcoal TDS. The doctor was gone before I could request to r/v meds.

His number was nowhere to be found.

Patient previously had diarrhea, but, no longer.

It was not a PRN dose, but, I decided to withhold the charcoal in view of his straining. I wrote it down black and white in my report, not intending to hide it.

The night nurse saw it and I got a helluva verbal lashing from her.

I'll try to look past the verbal lashing...

Will I get into trouble for withholding a non-PRN medication?

[RN403, BSN, RN]

I would say it depends on your agency's policy. I would look into your policy and procedure manual which will guide you to the most appropriate answer.

[TheCommuter, BSN, RN]

Welcome! We are pleased you decided to join our online community.

Will I get into trouble for withholding a non-PRN medication?

It is definitely within a licensed nurse's scope of practice to withhold routine medications per our nursing judgment. However, since the routine medication has been ordered by a physician for a presumably valid reason, the licensed nurse who holds the medication needs to notify the ordering doctor to notify him/her that the med was held.

Charting that a routine, non-PRN medication was held is not satisfactory enough UNLESS the physician's order contains parameters or further directions to "hold medication if ___ happens." For instance, many antihypertensive medications are ordered with parameters to hold if the systolic blood pressure is below a certain number, and many laxatives are ordered with directives to hold if loose stools are noted.

If there were no physician's parameters for holding the charcoal or no directions to "hold charcoal if ___ happens," then you must call the ordering doctor to make notification that you held it and disclose why you held it. This covers you and shifts responsibility to the doctor, who will then tell you to either give the charcoal anyway or agree with your decision to hold it.

After notifying the ordering physician of your decision to hold this routine med/treatment, you document that you held it, as well as your notification including dates, times, and the doctor's response.

Also, company policy often has a policy for holding routine medications.

[mariebailey, MSN, RN]

It's really the clinician's discretion, not the nurses, to hold a med. I imagine that there is a very good reason why she's getting charcoal that likely makes the GI distress an acceptable side effect. Did she experience toxicity from a drug or OD on something?

[Hachiko]

I read through his medical notes, and, found out he was prescribed charcoal when he started having diarrhea. Nil drug toxicity/OD.

He no longer has diarrhea. He is straining and passing hard stools, bit-by-bit.

I could not find the physician's number. He doesn't visit everyday (according to the medical notes).

Anyway, I just hope I don't get my license suspended for this.

My agency doesn't have a policy for this sort of thing.

Feeling pretty despondent.

[TheCommuter, BSN, RN]

I could not find the physician's number. He doesn't visit everyday (according to the medical notes).

Since physicians have 24-hours a day/7 days a week liability over their patients, it is imperative that you have the doctor's number. Make it a priority to obtain the physician's number because, if a change in condition ever transpires, the patient's physician needs to be called.

[Hachiko]

I was just a stand-in for the primary day-time nurse. She wanted to take a day's break, so, I was called to nurse this patient for a day.

Didn't even know there was a doctor who was going to visit.

Fine. My fault.

[mariebailey, MSN, RN]

Anyway, I just hope I don't get my license suspended for this.

My agency doesn't have a policy for this sort of thing.

Feeling pretty despondent.

I'm sorry you're upset. Try not to stress out too much! We all make mistakes, & I'm sure your employer has seen much worse. You could seek clarification from the other nurse at work. Have a happy Saturday!