The dispensing of naloxone is an exception in response to a public health issue. In this instance, the nurse may be dispensing to a person who is not their client or their client's delegate but who may encounter another person outside of a hospital setting who is experiencing a suspected opioid overdose.
Nurses dispensing naloxone to a person who is not their client must teach that person how to respond appropriately to an opioid overdose. They must also follow applicable organizational policies and processes. In these instances, nurses would not be expected to fully meet principles 1-5 of the Dispensing Medications practice standard. These required activities are intended for the recipient of the naloxone. Examples of dispensing naloxone to an individual who is not a client may include:
When a pharmacist has already reviewed a medication’s suitability and dispensed it for the client, nurses take steps to ensure its proper use. Examples of dispensing with a pharmacist’s involvement may include:
Sandy checks the clock and realizes Mr. Habib will be leaving on his afternoon pass soon. She’s already checked the medication administration record (MAR) and knows he has medications due at 1600. Both need to be given as close to the scheduled time as possible—she’ll need to get them ready for Mr. Habib to take with him.
Sandy remembers that packaging medications for pass is now considered dispensing and that the unit has a new policy to follow. She pulls the policy up and reviews it. She confirms that, because the medication has already been dispensed by pharmacy, she’s responsible for taking steps to ensure proper use. This includes packaging and labelling the medications and providing Mr. Habib with the information he needs to safely take the medication.
Sandy reviews Mr. Habib’s chart, considers information from this morning’s report, her last assessment and the MAR. Mr. Habib has been on both medications for a week and they have been effective. Neither medication require any assessment prior to administration.
Sandy locates the containers and dispensing labels with the agency information. Copying from the MAR, she labels each container with Mr. Habib’s name, the date, medication name, dose, directions for use and number dispensed. Using the MAR, she selects the medications, carefully double-checking as she puts each in the appropriate container. She initials the labels, indicating she is the dispensing RN.
After checking the medications against Mr. Habib's ID band, Sandy hands him the medications. She explains what each medication is for, how and when to take them and asks if he has any questions. She tells him he can call if he has any concerns or questions and points out the phone number on the label.
After Mr. Habib leaves, Sandy documents the dispensed medication in his chart, including the instructions for use and other information she provided.
When a pharmacist has not reviewed the medication’s suitability (or it’s unclear if this was done), nurses take steps to ensure the medication’s pharmaceutical and therapeutic suitability for the client, as well as its proper use. Examples of dispensing without a pharmacist’s involvement may include:
It’s 0230 and Simon’s client, Mr. Roy, has just been discharged from the Emergency Department. Mr. Roy is a 55 year old with renal colic, admitted at 2300. Over the last 3 hours, he’s received IV fluids, morphine 12mg IV and dimenhydrinate 50 mg IV. His pain is now 2/10. The physician has written a prescription for hydromorphone and an order to dispense hydromorphone 2 mg tablets q4h po prn x 4 doses.
Simon knows the pharmacy is closed so he’ll need to dispense the medication. He reviews the order to make sure it’s complete. He hasn’t done much dispensing in Emergency so he also checks the agency policy and the list of medications RNs can dispense. When he finds hydromorphone on the list, he knows he’ll find it already packaged by pharmacy. His next steps will be making sure the medication is suitable for Mr. Roy.
Simon takes a quick look at the chart. Mr. Roy has no allergies and is not on any medications except an occasional non-prescription analgesic. Simon takes a few minutes to double check with Mr. Roy and asks about alcohol or drug use, and any other health issues. He learns he is a non-drinker and has never taken a narcotic before. Checking his PharmaNet profile shows no current medications. Simon systematically runs through the information he’s gathered: no allergies, past adverse reactions or contraindications, no therapeutic duplications or potential drug interactions. Simon accesses the online medication database and makes sure he hasn’t missed anything. He also prints the patient information sheet he’ll give to Mr. Roy.
Simon selects the prepackaged hydromorphone. The container is labeled with the agency information and
Hydromorphone 2mg x 4 tabs—he carefully checks this against the order. Deciding the container is appropriate for Mr. Roy, he adds
Take I tab by mouth, every 4 hours as needed. He checks the order a final time and adds the client name, date and his initials as the dispensing RN. Simon’s certain he’s covered all the steps but does a last check with a colleague.
Simon takes the medication and information sheet to Mr. Roy. After checking the medication label against his ID band, he hands him both. Realizing Mr. Roy is still drowsy from the narcotic he received, Simon includes his wife as he reviews the information sheet. Simon explains the medication’s purpose, expected side effects, and how often Mr. Roy can take it. Simon cautions against taking other analgesics or driving. He points out the rare, but serious side effects, discusses when and how to seek medical attention and answers their questions.
After Mr. Roy leaves, Simon documents the dispensed medication in his chart, including instructions, cautions and written information provided.
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