Can an RN legally refuse to carry out a doctor’s medication order for an opiate?

By | 2022-02-14T18:08:09-05:00 October 19th, 2011|1 Comment

Question:

Dear Nancy,

Can an RN legally refuse to carry out a doctor’s medication order for an opiate (Methadone) if a patient presents as very sedated, lethargic or physically ill — even if the physician saw the patient and he does not agree.

Ginger

Nancy Brent replies:

Dear Ginger,

Your question raises the very important role of the RN in medication administration: That is, the nurse is the health professional who is the last line of defense against a foreseeable and unreasonable risk of harm or death to a patient.

Medication administration is not just administering an order given by another healthcare provider authorized to prescribe medications. Rather, the RN must follow the Five Rights of Medication Administration and assess the patient’s overall condition, the medication to be given and its effects on the patient’s current condition. As an example, giving a blood pressure medication to a patient whose blood pressure is well below acceptable levels, who complains of dizziness and general malaise and speaks of “being weak,” would not be acceptable and may cause injury or death to the patient.

In any situation where a medication order is questioned by the nurse who has done a thorough assessment of the patient’s condition, he or she can contact the ordering physician or other healthcare provider, document the notification of the healthcare provider pursuant to facility policy, hold the medication (documenting this as well), notify the nurse manager or other nurse administrator in charge (documenting this as well) and wait for further instructions. If the ordering healthcare provider insists the medication be given and it is still the nurse’s professional judgment that this is not in the best interest of the patient, the healthcare provider should be informed and the notification should be documented. Again hold the medication and ask for help from the nurse manager and others identified in the facility policy for conflicts concerning patient care.

Remember that as a nurse licensee, you are accountable and responsible for your care. If you administer the medication and the patient is injured or dies, you will be held responsible under the state nurse practice act and possibly in a lawsuit filed by the patient or his family.

If the ordering healthcare professional sees the need to administer a particular medication in view of a nurse’s thorough assessment and judgment not to do so, he or she can administer the medication.

Regards,
Nancy

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    Sherry L March 9, 2019 at 6:07 pm - Reply

    I recently had a patient with an order to administer insulin Novolog 40 units one-half hour prior to meals. The patient’s glucose was 63 prior to eating. I withheld the insulin, checked the patient after dinner and her glucose was only 95. I called the on-call doctor who instructed me to administer the medication. I said “I’m NOT doing it”! She then stated to D/C (discontinue) the insulin order at dinner. If I would have administered 40 units of insulin to that woman, she’d be dead. (My Supervisor couldn’t believe the doctor instructed me to still give the insulin.) So, nurses beware! My advice is: 1) Always carry your own medical malpractice insurance; 2) If in doubt about a medication order, check with a supervisor, etc. and if you are still in doubt, DON’T give the med. Tell the supervisor to do it. Then, see how they react. I’d rather be written up for a med error, rather than kill someone. This advice is from a nurse who is both in the legal and medical professions. It will be your butt on the line, even if the doctor prescribed the medication!!

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