BITTER PILL? Can you be confident that the medication is what the patient says it is?

You walk by the waiting room and see a patient with a rolled up sleeve and a syringe, preparing to administer an injection. How should you handle the situation? Or maybe a patient insists on bringing his own bottle of pills from home, insisting that they're absolutely needed. What should you say?

It can be a sticky issue, says pharmacy and safe medication consultant Sheldon R. Sones, RPh, FASCP. There can be good reasons to allow it, as well as plenty of good reasons not to.

On the positive side, for example, since products like inhalers and insulin tend to be easily available, there's a good chance you don't keep them in stock. Patients may simply feel more comfortable if they're allowed to keep and use their own inhalers. Or patients may have been prescribed — and may be doing well with — unusual or unique medications that you also don't routinely stock.

But in many cases, you're bound to have some very legitimate concerns. How can you be sure the medication the patient brought into your facility isn't outdated or contaminated? How do know it is what the patient says or thinks it is, especially if it's in tablet, capsule or liquid form? Can you be sure the patient is competent enough to provide accurate information? Is it compatible with other medications you're administering to the patient? Do you have a therapeutic equivalent in stock?

It's important, says Mr. Sones, to have a clear policy to address these and other issues. He suggests letting patients bring their own medications "in extenuating circumstances, provided that the following procedures are followed":

1. In general, the practice should be discouraged.
2. Medications brought into the facility should only be administered if they include a valid and documented order from a licensed prescriber.
3. Medications should be identified by your facility, and their integrity should be validated to the greatest extent possible.
4. Medications should only be self-administered under observation by a nurse or physician.
5. Medications should be documented in the medical record.
6. The patient's competency to manage self-administered medications should be validated.
7. Medications should be permitted only when the facility does not routinely stock them.
8. Medications should only be used outside of the operatory.
9. The appropriate entry into the patient's reconciliation data should be completed.
10. By means of the reconciliation process, facilities should ensure that medications do not duplicate or infringe on the success of other drugs being administered.
11. No patient-controlled or non-FDA-approved drugs should be permitted within the facility.

Jim Burger