In dispensing meds upon discharge of a patient from a mental health unit where I work, the physician puts pills in a cup and tapes it to the discharge papers for the patient to take at home. It is up to the RNs to give the papers and meds in the cup to the patient when they are being discharged. There are no instructions as to when to take the med or name of med written anywhere. The doctor tells the patient this is for their safety. Is the nurse liable in any way?
Dear Nancy replies:
The practice you describe when patients are discharged from your mental health facility is not consistent with standards of practice for medication preparation upon discharge. It is also pretty certain that this practice is not consistent with the unit’s policies of dispensing medications for discharged patients. Initially, there is no labeling of the medication (What is it?) or when and how the patient is to take the medication in the cup. What has the patient been told about the medications? What if they are lost in transit from the facility to the patients home? How is this procedure for the safety of the patient?
As a nurse, you have a legal and ethical duty to advocate for the patient. Sharing this procedure with the CNO, the chief medical officer, the psychiatrist who is the head of the unit, as well as the administrator, should stop this procedure in its tracks. Not only does a healthcare facility have legal and ethical duties when a patient is an in-patient of the facility, its obligations concerning discharge instructions, medications prescribed and sent home with the patient, and the continued well-being of the patient for follow-up care and other issues continue to exist.
Nursing staff should not participate in this type of procedure. Doing so simply supports uncaring, unethical standards of practice, places patients at risk, and violates the rules of the dispensing of medications to discharged patients, both in the facility and state and federal dispensing requirements. If you and your fellow nursing staff’s concerns about this procedure go unheeded within the institution, you may want to consider reporting this physician/psychiatrist to the state medical board for an investigation into his conduct. If you take this route, be certain to explain that you shared your concerns to the administration and those concerns were not acted upon.