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By Nancy J. Brent, MS, JD, RN |
2020-11-23T12:36:15-05:00
December 16th, 2015 | 15 Comments
Our legal information columnist Nancy J. Brent, MS, JD, RN, concentrates her solo law practice in health law and legal representation, consultation, and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state.
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One reader asked about a nurse’s responsibilities when drawing up an injectible medication but not administering it, and specifically wanted to know about the documentation duties affiliated with the draw-up.
One of the first general principles in medication administration that a nurse must adhere to is to personally prepare any medications properly ordered for a patient and to personally administer those medications.
Although there may be instances in which more than one healthcare provider may be required to administer a single medication, such as in a code, it is not generally acceptable practice to prepare any type of medication for another person to administer. Nor is it acceptable practice to administer a medication that another has prepared.
The reasons for this strict rule are numerous. First and foremost, because preparation and administration are fraught with potential for error, relying on another nurse to prepare a medication that you administer is dangerous at best.
Did your nurse colleague correctly pull the right medication? Did your nurse colleague calculate the correct amount of an injectible drug for the patient? Did the nurse check the order and determine the medication was ordered for this patient?
If there is a patient injury or death because of an incorrect drug or an incorrect amount given, both you and your colleague will be named in a suit filed by that patient or the patient’s family. During the judicial process, the two of you most likely will be at odds with each other, as your colleague will steadfastly state he or she prepared the drug as ordered while you try to convince the jury otherwise.
In addition, since you administered a medication you did not personally prepare, you will need to overcome the testimony of a nurse expert that a general, cardinal rule in administering medications is that one never administers a drug not personally prepared.
A second reason this rule is important is the fact that along with personally preparing and administering a medication, the nurse doing so is also responsible for the proper, accurate and truthful documentation of the medication administered. This responsibility speaks to a nurse’s accountability when preparing, administering and documenting medications given.
Moreover, if you prepare a medication for someone else to administer, but you document the medication as given, you have just falsified that entry in the patient’s medical record. In contrast, if the nurse who administered the medication that you prepared documents the medication as given, your nurse colleague also has falsified the entry, since he or she did not prepare the medication.
Falsification of any record is a serious allegation that can result in an employee being fired or reported to the state board of nursing. And if a patient injury or death occurs because of the medication administered and its surrounding false documentation, a verdict against those involved in the professional negligence or wrongful death suit is very likely.
Following the basic rule coupled with the “ 8 rights of medication administration ” — right patient, right dose, right medication, right route, right time, right reason, right response and right documentation — can help you avoid medication administration errors.
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I need help in finding documentation to show my home care patient. He is a quadriplegic who receives 24 hour nursing care from RNs and LPNs. He recently had his mother buy him some over-the-counter Melatonin to take at HS. He wants us to give it to him but we have no doctor’s order. I tried to explain to him that if it is not on the POC we can’t give it…unless there is new written and signed order by the doctor. He is asking me to show him documentation regarding this law. I googled it but can’t seem to find the right document. Can you direct me to one?
The best source for the information you need would be the home care organization with which you work. If their policies are based on legislation, they would probably have that information on record.
I was working as a respite worker is it legal for me to give a disabled teenager her strong medication without any training or first aid? I ended up quitting cuz pay was $3.50 an hour and I had no qualifications to do to the job properly or could make a living off $3.50. But that seems strange I could hand out medicine to someone with no degree or training?
My home health care company requires me to sign the MAR of a patient I do not give medication to. I don’t like the possibility for fraud by someone entering my initials on the MAR. What can I do? My DON say’s it is company policy.
I work in a VA facility. They are asking that I pull medication from a pixis machine that will record it under my name and day shift will administer the medication. They ask night shift to pull medication for day shift. The pills are in a prepackaged bag and are scanned before given but how do I know those but pills were actually given? They are pulled under my name.
Hello and thank you for what you do. I understand in homecare environments certified medication technicians are able to administer medications to patients. Is there a federal or like law which states it is required for a nurse to administer a medication in a hospital setting, or are there alternate options such as a medication technician, an LPN, or other?
A nurse is working in a public health clinic. A 15-years old with no known allergies is diagnosed with syphilis and prescribed 1 dose of 2 million units of procaine penicillin G intramuscularly (IM).
1. Developmentally, why is this drug a good choice for this patient?
2. The patient asks why he cannot get medication in a pill. How should the nurse respond?
3. Describe the technique the nurse should use to administer this IM injection, including precautions to prevent administration complications.
4. The patient has denied an allergy to penicillin. why does the nurse need to be cautious about possible allergy?
5. What action/policies should the clinic have in place to prevent death from an anaphylatic reaction?
As the only private duty nurse for a complex and fragile client, the mother refuses to document in the MARs and TARs….she feels as the mother. she shouldn’t have to. I have requested this twice, stating I need to see the documentation, and as much information as possible to provide safe and appropriate care.
The mother is overwhelmed with the care hours, and resents having to provide care. yet she does an outstanding job.
What are my options and responsibilities to the client?
I have educated her and she remains resistive, yet she is paid as a personal support worker by the State. Does anyone have advice? Thank you.
I need to learn general pharmacology.I’m Somali Bantu man who is living in Kenya I’m a refugee. in Kenya turkana west I’m 23 yes old I have completed primary up to glass 8 , I’m very interest to learn this pharmacology, in side my email,because in Kenya I’m not able to learn because money,because we are refugee,I would like to learn general pharmacology in side email if it’s free in America,for this general pharmacology
my mother has dementia, is considered an incapacited individual. Her doctors have prescribed two pills a day, one to be given two times a day on Sunday only. She is staying with my sister and is being given eight different pills. We do not know what the other pills are. Her legal Guardian which is a company will not make any changes or take her for a second opinion. What are my legal rights and what can be done.
Ineed help in finding this question.
It is the responsibility of Ontario College of Pharmacist to administer the Ontario Drug Benefit Act.
I’m not sure if the Ontario College of Pharmacists “administers” the Ontario Drug Benefit Act, but at the very least they would be well-versed in the act and could probably answer specific questions you may have, as should the Ontario Ministry of Health ( https://www.health.gov.on.ca/en/public/programs/drugs/ ).
I work at an Outpatient Ambulatory Care Center. In the OR for pain patients, the circulating nurse is pulling the medication for the physician who is the one to retracts and administers the medication. Does the OR Circulating nurse need to document the medication the physician administers to the patient or is that the responsibility of the physician to document what he gave?
During this Covid cruise, non medical persons, ie, National Guard personnel, are drawing up the vaccines and then being administered by ambulance personnel, pharmacists, technicians and nurses. As a nurse, I feel most uncomfortable with this process. Is my Liability compromised or non existent under these emergency times?
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Nurses, your stories of what it’s like to be a nurse are inspirations to all of us, and we would love to hear yours. Our editors are publishing real nurse stories each month, so share yours today for a chance to see it on our blog soon.
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