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He's not your client: can you dispense his meds?

Case study about professional responsibility & dispensing medications

 

Selena, an experienced critical care nurse, is new to rural practice. For the last three months she’s been working at a small community hospital. It’s early Saturday night and Selena’s covering Emergency while her RN colleague covers the inpatient unit.

While Selena is looking over lab results at the nursing station, she hears footsteps. She looks up to see an older man standing in the doorway, holding a piece of paper. After greeting him, Selena asks how she can help. He hands her the paper and says, “My doctor sent me to get this filled.” Selena realizes it’s an order sheet, with a medication order, from a local physician.

Selena asks him to take a seat and tells him she needs to do an assessment. He replies that he doesn’t have time for that, “I’ve already seen my doctor. Can’t you just give me the pills so I can go?”

Selena reads the order and considers her options. She knows the local pharmacy is closed and the hospital has the medication in stock. There isn’t a pharmacist on site but she knows RNs can dispense medications to clients with a physician’s order. She looks at the man, who appears a little uncomfortable. She wonders if the best option is to dispense the medication. ​

 If you were Selena, what would you do?

Dispense the medication

If Selena dispensed the medication, she would not be meeting the Dispensing Medications Practice Standard. While she does have an order for the medication, the man is not her client. Without knowing anything about him, she’s not able to determine if the order is appropriate for the man.

Not dispense the medication
Selena doesn’t think she should dispense the medication. The man is not her client and she can’t determine whether the medication order is appropriate. To be sure, she consults with her colleague. Together, they review the agency policy. Supported by this information, Selena decides to talk to the man and discuss the situation with the physician. 
​​Nurses dispense medications when it is in the best interest of the client and only for clients under their care. When nurses dispense medications, without a pharmacist’s involvement, they need to take steps to ensure not only its proper use, but the pharmaceutical and therapeutic suitability as well. For example:
  • Reviewing the order for completeness and appropriateness (e.g., dosage, route, frequency)
  • Reviewing the client’s medication history and other health information
  • Considering potential drug interactions, allergies, contraindications (e.g., adverse side effects)

The Dispensing Medications Practice Standard provides nurses with the information to dispense medications safely.

Next steps

Selena explains to the man that she cannot give him the medication without doing an assessment and consulting with his physician. She encourages him to stay, letting him know how long it’s likely to take.

She’ll also document this issue and discuss it with her manager to be sure everyone is aware of the agency policy and CRNBC practice standard on dispensing medications.

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