Open Forum

Hello

Would like to see what the current standards are for patients bringing in the own medications to be administered in the clinic. Does your organization allows it? If so, are their certain guidelines that must be followed prior to administering? If not, what would be the concern?

Thank you in advance

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Kristyl McCray MSN RN-BC
RN Clinical Director, Education & Prof. Practice
PIH Health Physicians
Whittier CA
(562)698-0811
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We do allow this practice for certain medications in our non TJC clinics. We have a policy in place that outlines when it is acceptable, when a med can be administered by the staff and when it needs to be administered by the patient or caregiver. Included in the policy is a "Consent to Administer Medication from Home" form that is signed by the family basically acknowledging that the clinic is not responsible for improper storage or any errors that could have been made by the outside pharmacy. For our TJC clinics, there is a bit stricter guideline calling out that this must be a med that is unavailable anywhere in the system and has to be inspected by a pharmacist prior to administration.

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Brandy Williamson BSN RN CPN
Ambulatory Nursing Manager
Children's Healthcare-Atlanta
Atlanta GA
(404)785-8978
brandy.williamson@choa.org
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Hi Brandy. Thank you for the feedback. Would you mind sharing that policy and consent?

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Kristyl McCray MSN RN-BC
RN Clinical Director, Education & Prof. Practice
PIH Health Physicians
Whittier CA
(562)698-0811
------------------------------

Original Message:
Sent: 11-16-2022 12:28
From: Brandy Williamson
Subject: Patient Provided Medications

We do allow this practice for certain medications in our non TJC clinics. We have a policy in place that outlines when it is acceptable, when a med can be administered by the staff and when it needs to be administered by the patient or caregiver. Included in the policy is a "Consent to Administer Medication from Home" form that is signed by the family basically acknowledging that the clinic is not responsible for improper storage or any errors that could have been made by the outside pharmacy. For our TJC clinics, there is a bit stricter guideline calling out that this must be a med that is unavailable anywhere in the system and has to be inspected by a pharmacist prior to administration.

------------------------------
Brandy Williamson BSN RN CPN
Ambulatory Nursing Manager
Children's Healthcare-Atlanta
Atlanta GA
(404)785-8978
brandy.williamson@choa.org
------------------------------

Original Message:
Sent: 11/16/2022 12:28:00 PM
From: Brandy Williamson
Subject: RE: Patient Provided Medications

We do allow this practice for certain medications in our non TJC clinics. We have a policy in place that outlines when it is acceptable, when a med can be administered by the staff and when it needs to be administered by the patient or caregiver. Included in the policy is a "Consent to Administer Medication from Home" form that is signed by the family basically acknowledging that the clinic is not responsible for improper storage or any errors that could have been made by the outside pharmacy. For our TJC clinics, there is a bit stricter guideline calling out that this must be a med that is unavailable anywhere in the system and has to be inspected by a pharmacist prior to administration.

------------------------------
Brandy Williamson BSN RN CPN
Ambulatory Nursing Manager
Children's Healthcare-Atlanta
Atlanta GA
(404)785-8978
brandy.williamson@choa.org
------------------------------

So you do have some form of a policy. This makes sense because the medication is being controlled because it is purchased at one of your pharmacies. We no longer have a pharmacy but when we did, we were not required to take vitals before administration. We allowed the medication to be administered by either LPN or RN.
Nicole

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Original Message:
Sent: 11/17/2022 8:53:00 AM
From: Melissa Roffers
Subject: RE: Patient Provided Medications

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I am interested in seeing your policy and consent as well. Does anyone have special considerations before administering injections? Vital signs before and after, etc.? Who do you allow to give the injection? LPN or RN?

 

Thank you!

 

Melissa Roffers BSN, RN

Primary Care Nurse Educator

BMG Admin

Cell 920-366-5404

Melissa.roffers@bellin.org

 

 

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Nicole, you are correct, our patients home medications come from our pharmacy. However, I would still need a doctor’s order to administer it in clinic.

Melissa, LVN’s can give injections at our clinic but they cannot teach patients how to self inject. Teaching is an RN role. You cannot delegate what you EAT to an LVN: evaluate/assess/teach.

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Original Message:
Sent: 11/20/2022 4:52:00 PM
From: Nicole Napier-Scott
Subject: RE: Patient Provided Medications

So you do have some form of a policy. This makes sense because the medication is being controlled because it is purchased at one of your pharmacies. We no longer have a pharmacy but when we did, we were not required to take vitals before administration. We allowed the medication to be administered by either LPN or RN.
Nicole

Sent from my iPhone



Original Message:
Sent: 11/17/2022 8:53:00 AM
From: Melissa Roffers
Subject: RE: Patient Provided Medications

This message was sent securely using Zix®

I am interested in seeing your policy and consent as well. Does anyone have special considerations before administering injections? Vital signs before and after, etc.? Who do you allow to give the injection? LPN or RN?

 

Thank you!

 

Melissa Roffers BSN, RN

Primary Care Nurse Educator

BMG Admin

Cell 920-366-5404

Melissa.roffers@bellin.org

 

 

This email and any files transmitted with it are intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material.

 

This message was secured by Zix^®.

So we do not allow patients to bring on their own medication for administration. The issue is that we cannot verify the conditions in which they were stored. We require that any injectable that we do not have in our inventory, must be sent directly to us via a pharmacy. We must also check the FDA website to confirm there is no recall on the medication before administering.

Nicole

Sent from my iPhone

If a patient brings medication to clinic for me to administer I will inform the patient that I will need a doctors order since these medications are ordered for self administration at home. However, if the provider places an order for patient teaching how to self administer the medication, I will document the encounter as a patient education note. If there is any question about the storage, safety, or expirationI wouldn’t give it, but I have not encountered this issue yet. Providers should not prescribe medications without ensuring that patients have to proper education for administration at home because this would not be safe for the patient.


Original Message:
Sent: 11/17/2022 5:28:00 AM
From: Nicole Napier-Scott
Subject: RE: Patient Provided Medications

So we do not allow patients to bring on their own medication for administration. The issue is that we cannot verify the conditions in which they were stored. We require that any injectable that we do not have in our inventory, must be sent directly to us via a pharmacy. We must also check the FDA website to confirm there is no recall on the medication before administering.

Nicole

Sent from my iPhone

This is called “brown-bagging” and is usually against policy due to risk/liability issues. I would check with your institution’s policy/risk department about this prior to administering any patient provided medications.

Amy

Sent from my iPhone


Original Message:
Sent: 11/18/2022 8:11:00 PM
From: Myra Thomas
Subject: RE: Patient Provided Medications

If a patient brings medication to clinic for me to administer I will inform the patient that I will need a doctors order since these medications are ordered for self administration at home. However, if the provider places an order for patient teaching how to self administer the medication, I will document the encounter as a patient education note. If there is any question about the storage, safety, or expirationI wouldn’t give it, but I have not encountered this issue yet. Providers should not prescribe medications without ensuring that patients have to proper education for administration at home because this would not be safe for the patient.

Correct. I thought I could administer with an order from the ordering provider and found out that it is not allowed at our organization. Many nurses said they were also unaware that we could not administer them unless they are delivered to our side. So yes, be sure to check.

Nicole

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Original Message:
Sent: 11/19/2022 8:36:00 AM
From: Amy Cadoret
Subject: RE: Patient Provided Medications

This is called “brown-bagging” and is usually against policy due to risk/liability issues. I would check with your institution’s policy/risk department about this prior to administering any patient provided medications.

Amy

Sent from my iPhone



Original Message:
Sent: 11/18/2022 8:11:00 PM
From: Myra Thomas
Subject: RE: Patient Provided Medications

If a patient brings medication to clinic for me to administer I will inform the patient that I will need a doctors order since these medications are ordered for self administration at home. However, if the provider places an order for patient teaching how to self administer the medication, I will document the encounter as a patient education note. If there is any question about the storage, safety, or expirationI wouldn’t give it, but I have not encountered this issue yet. Providers should not prescribe medications without ensuring that patients have to proper education for administration at home because this would not be safe for the patient.

Original Message:
Sent: 11/19/2022 8:36:00 AM
From: Amy Cadoret
Subject: RE: Patient Provided Medications

This is called “brown-bagging” and is usually against policy due to risk/liability issues. I would check with your institution’s policy/risk department about this prior to administering any patient provided medications.

Amy

Sent from my iPhone



Original Message:
Sent: 11/18/2022 8:11:00 PM
From: Myra Thomas
Subject: RE: Patient Provided Medications

If a patient brings medication to clinic for me to administer I will inform the patient that I will need a doctors order since these medications are ordered for self administration at home. However, if the provider places an order for patient teaching how to self administer the medication, I will document the encounter as a patient education note. If there is any question about the storage, safety, or expirationI wouldn’t give it, but I have not encountered this issue yet. Providers should not prescribe medications without ensuring that patients have to proper education for administration at home because this would not be safe for the patient.

Our office does have a policy in place allowing patients to bring in medication for our staff to administer - this primarily is used for testosterone injections as the majority of our clinic sites do not stock this medication. Our policy requires the medication to be ordered by a provider in our health system and the patient must purchase the medication at our clinic affiliated pharmacy immediately prior to their nurse visit as our pharmacy will put the medication in a tamper-proof package. The patient has to present the pharmacy receipt to our nurses as proof of when it was purchased and the nurse verifies the packaging has not been tampered with before administering the medication.

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Melissa Ropella
Clinic Triage Nurse
Fairview Medical Group
Burnsville MN
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Thank you all for your feedback. Your input will assist me as I make my final determination to accept such processes in my clinics.

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Kristyl McCray MSN RN-BC
RN Clinical Director, Education & Prof. Practice
PIH Health Physicians
Whittier CA
(562)698-0811
------------------------------

We currently have a White and Brown Bag Medication policy that covers this for injections and infusions. I also found an older policy that covers other medications as well. I will attach both below. Hope this helps.

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Tomika Green MSN,RN,AMB-BC
Nurse Clinician
VCU Medical Center
Henrico VA
(804)647-0199
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Thank you Tomika. I really appreciate the resources you've shared.

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Kristyl McCray MSN RN-BC
RN Clinical Director, Education & Prof. Practice
PIH Health Physicians
Whittier CA
(562)698-0811
------------------------------

Original Message:
Sent: 11-22-2022 16:28
From: Tomika Green
Subject: Patient Provided Medications

We currently have a White and Brown Bag Medication policy that covers this for injections and infusions. I also found an older policy that covers other medications as well. I will attach both below. Hope this helps.

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Tomika Green MSN,RN,AMB-BC
Nurse Clinician
VCU Medical Center
Henrico VA
(804)647-0199
------------------------------