Over-The-Counter Medications (OTC) are those products which: are not subject to the prescribing and dispensing regulations of Maryland; readily available to the consumer without an authorized prescriber’s prescriptive orders; and, may be found in the Physicians’ Desk Reference For Non-prescription drugs. There have been a proliferation of products that affect the health and well-being of clients that are also not subject to prescribing and dispensing regulations. These products can be herbs, homeopathic remedies, vitamins, salves, nutritional supplements, etc.
Nurses increasingly are being asked by the consumer to be a resource in choosing and utilizing over-the-counter medications. Consistent with the Health Occupations Article Title 8, 8:101(f)(v) and (vi) the registered nurse may utilize his/her substantial nursing knowledge, judgement and skill to perform the independent nursing function of recommending the use of an over-the counter pharmaceutical product for an identified health-related need of a client as part of his/her nursing practice. This recommendation would be based upon the registered nurse having completed a comprehensive health assessment of the individual client; supporting the client to become an informed consumer ; and, the recommendation being congruent with the established policies of the system in which the registered nurse practices.
The registered nurse who makes such a recommendation is held accountable for having the appropriate knowledge of the recommended over-the-counter product and its interaction with other current medications (OTC and prescriptive), therapies and treatments for the specific individual client. Inherent in this independent nursing recommendation is the obligation of the registered nurse to educate the client to the use, effects, side effects, contraindications, potential drug interactions of the over-the-counter products, indicators to discontinue using the product and indicators prompting the client to notify his/her primary physician. Consistent with the policies of the agency in which the nurse practices and the client’s overall health related plan of care, the registered nurse must monitor the client, document the nursing action and communicate with the health care team.
Recommendations of an over-the-counter product does not encompass administration of the medication. Administration of the medication is governed by the policies and procedures of the practice setting.
It is not within the scope of practice of the licensed practical nurse to make independent nursing decisions and therefore he/she may not recommend the use of over-the-counter products as part of a health-related plan of care. However, the licensed practical nurse may participate in implementing an established plan of care consistent with Health Occupations Article, Title 8, 8:101(e)(i), of the Nurse Practice Act.
SUPPORTING THE CLIENT TO BECOME AN INFORMED CONSUMER
The client is the primary health care decision maker and may choose to whom, under what circumstances, and for what purpose he/she seeks health care. A licensed nurse, while providing care to a client, may be asked by the client, or discover inadvertently, that the client is either seeking to utilize, or currently utilizing, over-the-counter products or alternative / complementary / holistic / integrated therapies to supplement or to replace prescriptive medications, treatments and/or therapies. In this instance, the licensed nurse would encourage the client to: inform their primary health care provider of the client’s actions or intended actions; and, encourage the client to acquire accurate information regarding the over-the-counter product such as:
- Possible consequences of discontinuing the prescription medication(s);
- Description and components of the therapy;
- Safety factors/issues related to this therapy;
- Potential goals/benefits of this therapy;
- The potential for this therapy to interact in a non-therapeutic way with the treatment regime established by the primary health care provider;
- Expected frequency of therapy over what course of time;
- Expected course of therapy and its total cost; and,
- Third party reimbursement.
The licensed nurse would educate the consumer that health care decision-making begins with the client obtaining a complete medical evaluation including current health practices in order to: develop a therapeutic treatment plan which enhances the client’s health promotion and maintenance; reduces opportunity for untoward side effects or contraindications; and safeguard the client’s health.
