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A doctor ordered chloral hydrate, 500 mg nightly, as a bedtime sedative for his patient. Each evening before ending her shift, the nurse brought the patient a capsule of chloral hydrate. Whenever the patient asked her to leave it on the nightstand so he could take it later, the nurse obliged.
After several days of hospitalization, the patient was sent to the X-ray department for studies. While the patient was off the floor, housekeeping personnel making his bed discovered eight capsules of chloral hydrate stuffed in a pillow. They reported their find to the head nurse. When the nurse asked the patient about the capsules, he admitted he'd been saving them for a suicide attempt.
To prevent any more such close calls, the hospital administration reinforced, in writing, its policy that nurses stay with patients while they take their medications.
Unfortunately, leaving oral medications on a patient's nightstand and not staying to see that he takes the drugs is too common a practice. Often the patient requests this ... or he's out of the room during medication administration rounds. Although this practice seems harmless, it definitely increases the risk of medication error.
When more than one patient is in the room, for example, a patient may mistakenly take his roommate's medication. Or, as this case illustrates, he may not take his medication at all. In any case, the patient may not receive what his doctor ordered.
Certain medications, however, such as antacids, nitroglycerin, and some topical preparations, can be given to a patient to selfadminister. And in some hospitals, certain patients participate in self-medication programs. But in either case, the hospital must have a policy stating the doctor writes the medication order.
If a patient asks you to leave his medication for him to take later, refuse, and try to convince him to take it right away. If he won't cooperate, say no to the request. For p.r.n. medications and bedtime sedatives, offer to come back later when the patient wants to take the dose. And above all, stay with the patient until you're sure he's swallowed the medication.