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I'm supposed to be taking my grandfather (who has dementia and Macular Degeneration) to his ophthalmologist in 2 days as he's part of a clinical trial in which he receives injections into his cornea to try to combat MD. In order to keep infection out, he's supposed to get a drop of Tobramycin in each eye for 4 days before and 4 days after his injections. I got a call from him today in which he stated that the nurse is refusing to give him the drops.

I drove over to the ALF to confirm if the nurse on staff is giving him the drops or not and it turns out that she isn't. We ended up getting in a huge argument over this and she stated that she refuses to give the drops as the prescription does not state when she's supposed to get them, so that the prescription is not valid.. I asked to see the prescription that she has on file and it stated 1gt 4D (one drop for 4 days). I tried to go above her head but it turns out that she's the charge nurse of the facility. I ended up having to run to CVS to get a refill prescription so that I could give him the drops myself as she refused to even give me the bottle as I'm not POA. I tried to go to the director of the ALF and he told me that this issue is between the staff nurse and myself / my doctor and that he has no control over the issue! My doctor is telling me(as well as I as a EMT-P) know that this is the correct writing of the prescription.... does anyone have any advice on how I should go about in getting the staff nurse to give him the eyedrops? As a paramedic I'm on shift for 24 hours so I can only get to him every other day to give it to him myself.

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Please note the original question was asked 4 years ago.

Great answers for those who today would need such information :)
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That prescription is written incorrectly, unfortunately. It doesn't designate which eye. It's ambiguous. I am a nurse, I would have just called the doctor if I could contact him or her. But until I clarified the order, I wouldn't do it either.
Yes as a nurse you can refuse to administer a medication until you clarify it - in this case I would have done just that, end of story.
There is two sides to every story...that nurse is not going to jeopardize their license over an order written incorrectly. Maybe she is the only nurse in the place ,or an agency nurse that doesn't know the patients very well. 
Take it to administration or have the doctor call to clarify the order. 
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Riley is correct no medications may be given without a prescription from a Dr. When an order is written PRN then the nurse can use her discretion. Deciding when someone is no longer capable of taking the correct drugs at the ordered time then there has to be an intervention whether at home or in residential care. There are a number of ways to achieve this. At home a caregiver can either administer each dose or fill a pill box if the loved on is still capable of taking them on time. In an institution the safest method is for staff to keep all medications in a locked area. This may involve an extra fee to have the medications given out and residents who are still capable can continue to keep their own meds. Some facilities require all precriptions be filled by a single pharmacy which has it's own difficulties.
If a loved one has hospice at home the patient usually may continue to use their own pharmacy. Medications are usually prescribed in two week supplies to avoid waste and patient or caregiver is responsible for administration.
Riley is probably an exception in her facility in that she is clearly competent to make her own decisions.
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I live in an assisted living facility and basically self-medicate myself. The staff keeps a few pills that they give me during the day. I take the very early morning pills as I do not want them to wake me up and I take them when I go to bed. However, if I want them to do anything with my medications, they will INSIST the doctor write specific instructions for that medication. They will not budge from what the original prescription says. It is a hassle but the only way you will get what you feel is proper is to have the doctor write a very specific order to do what you want.
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All nurses are required to follow doctor's orders. If they feel the prescription has been incorrectly written or they observe an adverse reaction, it is their duty to contact the doctor with their observations. There are nurses drug books where trade and generic names are listed along with correct dosing, adverse reactions and interactions with other drugs and foods For example if a patient is started on an antibiotic for a lung infection and after the first dose develops a rash, the nurse should with hold the next dose and immediately contact the doctor or his deputy to receive further instructions. All of this should/must be documented in the patients record. Any known drug allergies should also be in the patient's record
If you are having problems with nursing staff do not rely on oral communications write a note and include instructions for it to be included in the patient's record. Also write to the doctor and DON, naturally keep copies so you can prove your requests to the State board of Nursing when they investigate.
On the subject of involving elderly demented patients in clinical trails it would seem to be an excellent idea as long as the patient is caused no distress and there is potentially an improvement in quality of life. It is all about common sense which seems to be lacking in today's world.
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What you say is true, butterflygirl. You really can't judge them all by a few... or shouldn't, anyway. I give people a lot of rope :-) My mother came from a generation where they did think of them as nearly like Gods... what they said was what they believed, and they didn't go many steps, if any, beyond what doc said. Some of the other posts I've seen, today, talk about "quality of life" and that's why I feel, strongly, in family being proactive, to insure the best quality of life. I just can't say it enough.
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I meant I greatly respect most nurses. I greatly respect all 15 that I mentioned.
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Just as in many places in life, The actions of a few give the rest a bad reputation. There are 15 nurses right now that I could HUG and KISS. I love them and they are the kindest and most attentive to their jobs. I do not pretend to be able to do what they do and I greatly respect most of them. Just like firemen, they do no harm usually. I just feel that some get a little too drunk on power especially in this day of health insurance companies cutting costs every way they can think of. Seriously, my father has not seen a dr since he has been in the nursing home that he is in. He sees a Nurse practitioner. She is nice and works hard to help him. She consults with a Doctor but I have never met him.
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When my mother was in a nursing home/rehab type place, before she came home, it was true, they were not allowed to give anything that was brought in. If we had any 'scripts, they had to be turned over to the nursing staff, who then ordered the medication, themselves. That wasn't always a handy thing, either, because they had to be ordered from whatever program they were in, and the meds had to be curried in... which was not ever on the same day. That said, it's a shame the nurse wasn't kind enough, or efficient enough, to follow through in some kind of way, to remedy that situation. It would seem irresponsible to not at least let you know what needed to be done to make sure he gets the drops. I just wanna say, too, from my family's own experience, you do have to always continue being an advocate for your loved one. They probably all hated having to deal with us, but we knew our mother better than anyone, therefore we had to make requests, over and over again, in every place that she landed, in her recovery. We were always civil in our communications, although some of them were not, and often didn't listen. We almost lost her three times as a result of them not listening. Doctors and nurses are greatly needed, and we appreciate them, in many ways... but they are not Gods, only human beings. And there are sometimes things which they, in their busy tasks, are either not aware of, or perceptive of.
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You need medical POA for sure!
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I do not believe it is for anyone to comment on what is the best treatment for Newman's grandfather for the exception of the family and the doctor. I believe this because my mother is now in stage 7 Alzheimer and will die soon. The illness robbed me of my mother, but what would have been worse is if she would have been like my grandfather who lost most of his sight, hearing and speech before he died. He was so angry at the world that he struck out at everything including my grandmother. In the three years that my mother has dropped through stages 4 - 7 at least have been peaceful for my mother because she could see, hear and speak. Please focus on the real problem here in that the nurse is not doing what she should be doing not on what the family believes is best for their family member. You just really do not know those details.
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Nurses have to make judgment calls every day but it is only appropriate if it is concerning patient safety. The other decisions are NONE of our business. Even if asked, it isn't our place to offer suggestions about things that require far more personal knowledge than we could every be privy to (or want to be privy to!)

There ARE a lot of power-tripping nurses out there...I've worked for and with several. A lot of them, I noticed, oddly enough, were married to cops.

Sure, I have opinions. Everyone does. I just keep them to myself when they aren't directly related to me.

It seems to me that 'autonomy' was way high up on the list of what patients (and human beings in general) need to stay as healthy as possible, both in their body and mind. But then again, it has been over 20 years since I got out of nursing school so that might not be what they teach these days. Maybe they never did...it might be something I learned along the way in these past 2 decades.

Regardless, I know it is true. Minding one's own business ought to be one of the ten commandments, IMO.
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Most R. N.'s are not allowed to write prescriptions.. the excepions are of course, Nurse Practioners and P. A.'s under the direction of an M D.

I've nver been in favor of Clinical Trials. The exception ( and there are always exceptions) is a case in NH where a man with rather severe Parkinson's was helped quite a bit from a trial study where he received outstanding treatment for his disease, and is now off the trial and doing well.
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The bit about the nurse knowing this or that about a study is ridiculous. She has no say in that matter and should be able to get clarification from a dr. The only authority She maybe should have is if she thinks a treatment or medicine is harmful or counteracts with another. I agree with going to the board of nursing. Also, what's up with a facilitiy director acting as if they have to override a DON? They should be working as a team to treat their patient with whatever their dr prescribes. It seems to me that there really are too many chiefs in the nursing world. For instance, I had a nurse in our small hometown at a behavioral center tell me repeatedly that "you cannot force a person into a nursing home. Alot of people think you can just drop them off and that is a falsehood."
This caused me no undue amount of stress because my father's wife had died and he was wandering around in the yard at 3am and falling down. Someone called adult protective svcs who intervened and said that he could not be alone, had him evaluated by a dr at THE SAME facility and declared incompetent. They then told me that I was able to then make decisions for him. END of story. The same nurse said no more about it and helped me make the transition to NH. She obviously had interjected her own personal feelings into the situation and this caused me considerable, unnecessary heartache as no one was available to live with my father. My father also went to jail with his dementia from driving. I had a heated argument about getting him evaluated to go to the hospital by some state employed jail nurse who told me that "your father was under the influence and he would not be transported to the hospital because the rules of the jail dictated that prisoners don't get transported, etc. My dad doesn't even drink. He was driving erratically because of dementia. It's ridiculous that this staff nurse could make these calls. it seems to me like there are a lot of power tripping nurses out there.
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My, my "hadenough" you certainly got up on the wrong side of life today. After thinking about this question later, maybe the facility does not allow meds from outside their facility. I know a hospital once would not permit my husband to take an aspirin of his, they wanted to order it from their pharmacy. I certainly hope when the time comes that "hadenough" doesn't require tany health professionals and dies on the spot. You certainly are rude!
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A nurse can refuse to give medication but there has to be a follow up as to WHY she refused. By the way this has to be documented as to why the medication was not given. If the script was unclear you call the doctor. It is not the nurse's business if he is involved in a clinical trial. That is beside the point Ferris - the meat of the matter is the nurse not following the care plan that has been set up for the patient because of her own views. Please save us from the health professionals.
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I sure am learning a lot about assisted living -- and to be honest, I don't like what people say. This facility is your father's employee. He pays to be there. I find her attitude to be rude. I have had 7 surgeries, and I always had a Satan Nurse, and the rest were wonderful. The POA can have you as a co-POA if they choose. I hope you get this worked out. A nurse refusing to give medication is absolutely unacceptable. You may as well pay another person/facility.
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Sorry, but I have never seen a script written like that in my life! It does not even say one or both eyes and q (every) should have been written.
However, it IS the nurses job to understand the medicine given the correct way. (I see no reason she could not have called the doctor and got a correct script order.?) I did that almost on a daily basis to clarify.
Yes a Nurse can refuse to give a Medicine, but she/he usually has a good reason for doing so.
Something does not seem right about this problem? It should have been a simple clarification of a script. MO
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Find another facility for your father. I am a nurse and had worked in facilities and have seen it all. Unfortunately, we have to keep a close monitor on the services that our love ones receive while at most facilities. All the nurse had to do was to confirm with your father's Doctor for clarification. Did that many times. I don't know how old your father is but I agree with Ferris 1, is it really necessary to subject your father to this clinical trial?
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Oh, I forgot, any nurse can refuse to give a medication.
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As a nurse, I have more issue with him being enrolled in a clinical trial when he has dementia and therefore cannot sign their documents legally. Do you really think his macular degeneration will benefit him since he has dementia? Since you have no POA, and the drops are to prevent infection from the injection and to cover the asses of the clinical trial protocol requirements, drop the trial. It is not worth the hassle of giving or not giving the drops when the charge nurse will not do it and you cannot be there to do it. I have a problem with the instructions the doctor gave as to when to give the drops, and to give the drops four days post (after) injections. It is vague and I agree with the charge nurse. It sounds like she does not want to give the drops because she knows the clinical trial folks are taking advantage of your grandfather in his mental condition (only speculation). His eye sight is the least of his problems ahead and they will only get worse. So calm down and cancel the trial because, in my opinion, he should not have been enrolled in the first place.
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I agree with freelancewriter, really irresponsible that the Administrative Director chooses to not do his job
!
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Quick solution is to have the Dr. call-in an order to the DON specifying a time (morning...etc.) this way the nurse has no way out. Then, as stated above, take the issue to the Board of Nursing, and to the Facilities Board of Directors...imply you are considering having your father removed since their Administrator obviously has no administrative power of his staff.
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My mother was briefly in an AL whose Medical director was a nurse who insisted on scripts being written in a certain way. In the short term, have the doctor call the nurse and if necessary, have him/her re-write the script to the nurse's needs.
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Take it up with the State Board of Nursing in your state. You can find contact information for them on-line with a simple Google search.

It is not legal for her to just refuse to give a medicine if she has a question about dosage or time. It is her responsibility to contact the Dr. and get the details that she doesn't understand straightened out and on record (at the ALF). I know that each facility has its own policies and procedures for medication administration but if they have a licensed nurse on site to give medicines, then she should be giving them. And it is not the facility's policy that dictates her actions related to administering medications but the State Board of Nursing from whom she gets her authority and license to do so. Their rules trump all the other rules except for your father's right to refuse medication on his own.

Don't tell anyone there at the ALF what you are planning to do, if you do follow my suggestion. Just do it as soon as you can and let the State Board take care of it. They are the ones 'above her head' that you need to go to.


Oh yeah...and the prescription seems right to me, too...usually it might say 1gt QD (every day) 4D but that extra QD is implied in omission. Either the nurse is not really a nurse...or is somehow ignorant of things that all nurses should know...or she's got a nefarious reason for acting outside of her authority in regard to your dad.
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