MDS Alert

Question: Our nursing staff has found numerous occasions where residents are taking their own over-the-counter or herbal remedies which their families bring them. Sometimes we've found residents taking herbal remedies that could interfere with their medications. Last week, a resident's family member brought in a tea for incontinence that the family member had ordered off the Internet, although she did ask us if we'd give it to the resident. How should we go about managing these issues? Does the facility have a right to require residents/families to inform us of any OTC or herbal/vitamin remedy they bring in before giving it to the resident? Can we forbid residents from taking such things or is that a resident rights violation?

Answer: The facility and its healthcare professionals have a duty to meet the standard of care. And that involves doing a comprehensive history on the patient, including a medication history where you ask about traditional OTC medications, as well as herbal and nontraditional medications, says Mardy Chizek, RN, FNP, BSN, MBA, AAS, CLNC, a legal nurse specialist in Westmont, Ill.

Also ask the right questions, she advises, such as "Do you take anything that you or someone buys at a health food store?" or "Do you take over-the-counter medications that you buy at the drugstore or anything that anyone else gets for you?" "The facility staff also has to research or consult with someone to determine the side effects and drug interactions that the OTC or herbal remedies might cause," adds Chizek.

The facility itself cannot prohibit the resident from taking an OTC med or supplement, says Joseph Bianculli, an attorney in private practice in Arlington, Va. "But make sure that the MD and/or pharmacist counsels the resident/representative about any contraindicated medication or substance. The MD or pharmacist should also document the counseling."

Also: The facility "absolutely" should have a policy requiring families to inform staff of any over-the-counter medication or supplement they are bringing the residents, adds Bianculli.