Apparently, it is common in many corners of the Known World for Chirurgeons to act as if they don’t know that they are providing OTC meds. Scenarios described go something like this:
“Good Chirurgeon, dost thou have an aspirin for a headache?”This gives the impression that the Chirurgeon is doing something shady and less than legal. Let’s see what the Society Chirurgeon’s Handbook (Jan 2004) has to say about medications:
“M’Lord, I cannot give out medications. However, I think there is something in yon box marked ‘lost-and-found’ that you might find interesting. Please excuse me whilst I examine this tent seam.”
III.8. MedicationsWe can’t ‘administer’ medications. This means we cannot give pills, shots, poultices, enemas, or aromatherapy massages. Anything above and beyond letting a gentle choose the medicine and dosage on their own is beyond the scope of practice for the Chirurgeon. In a related vein, we cannot give advice on which medications and what dosages to take. This is prescribing and therefore practicing medicine. This is a no-no. The section continues:
No medications of any kind will be administered by any Chirurgeon.
If anyone requests an over-the-counter medication from a Chirurgeon, the Chirurgeon may provider the container of that medication to the requester and advise the requester to follow the label directions for taking that medication. The requester should dispense the medication themselves. Under no circumstances will a Chirurgeon recommend or dispense a medicaion or recommend a dosage.This gives us a mechanism to provide a supply of OTC medications – the patient does all the selecting and procuring of the medication with no input from the Chirurgeon on what specific medicine or how much to take.
The rules do allow you to hand them a specifically requested bottle of a specific medication, but you need to be extremely careful about this route. If someone asks for a Tylenol, don’t hand them a bottle of aspirin. I prefer to keep a box with all my meds available, and when asked for something, I just hand them the box and say “Help yourself. Make sure you read and follow the directions on the label.”
The medication rule concludes:
If a Chirurgeon can dispense medication under his or her medical certification or license, such an action does not have the sanction of the SCA and Section III.4 wholly applies.This part says that just because you are a pill-pusher in your mundane job, you cannot push pills in the SCA as a Chirurgeon. If you do so, you are practicing strictly under your mundane license.
We are allowed to maintain a supply for the use of guests at events. There is no reason to hide medications or pretend you don’t see a person taking meds. Doing so can only give the impression that Chirurgeons are being less than on the level with those we serve.
The best way to give out individual doses of medications is to have unit-dose packaging. This is commonly used in hospitals because unused medication can be returned to the pharmacy. Loose, unpackaged pills are consider non-returnable. The downside is the extra packaging costs more money. They are also not as easily obtainable as the el-cheapo bottles of generics from the corner discount store. (Yes, generics are just as good as the brand name when it comes to common OTC meds.)
The proper way to hygienically dispense loose pills from a bulk bottle is to gently shake some pills into the bottle lid. You can then pour back any extra without ever touching a pill. Since we can’t do this for the patient, the ideal would be to teach them all how to properly dispense meds. Unfortunately, this is the real world. If someone dumps out a handful, I usually ask them to give me the extras and toss them. Wasteful? Yes, but much cleaner (and safer).
2. Keep meds away from environmental extremes: Too
hot, too cold,
too moist, or too dry can all be bad. Direct sunlight can damage some
medications.
A cooler (even without ice) in the shade can be a good place to keep
meds.
3. Check the expiration dates before events, and before anyone takes a
bottle to get meds. I usually write the expiration date in large
numbers
on the label with a Sharpie marker.
4. Look at the meds before the event. I’ve seen
bottles of pills that
have turned to mush or a solid rock.
5. Always keep the medications in their original containers.
Don’t mix
bottles, even if they are the same med.
6. Use bottles with child-proof caps when available. Make sure
you keep
a child handy to open them for you. (Just kidding!!!). If someone has
difficulty
opening a bottle, you can open it for them, then hand them the bottle
back
to dispense the med.
7. Avoid liquid meds. They are messy, harder to measure out in the
field,
and less stable in heat and light. Most liquid medications are
available
in pill or gelcap forms.
Pain and fever meds:
Ibuprofen
Acetaminophen (Tylenol)
Aspirin
Children’s
Acetaminophen (chewable tabs) Avoid
children's aspirin
Cold and Allergy meds:
Pseudoephedrine (decongestant)
Diphenhydramine (Benadryl)
Guaifenisen (Robiutussin
Gelcaps – almost always
has a decongestant mixed in)
Stomach meds:
Antacid tablets
Anti-diarrheal (Immodium AD
tablets)
Topicals
1% Hydrocortisone cream
Diphenhydramine (Benadryl) cream
Antibiotic ointment
Calamine lotion
Sunscreen (not really a med, but something commonly asked for and can prevent the need for coming back to see you later with a nasty burn). Use at least SPF30, UVA and UVB blocker, PABA-free.
DEET (bug repellant) – cream is better than sprays.
Saline (without thimerasol) for contacts and eye-wash.
© 2000 and 2004 Galen of Ockham, MC, OP (MKA Keith E. Brandt, M.D.) May be used in SCA pubications as long as content is not modified and proper credit given. For all other uses, please contact the author at galen@chirurgeon.org.
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