OTC at work: OK at some sites, banned at others

NSAIDs, antacids among medications at issue

After going back and forth over the question of whether to provide employees certain over-the-counter (OTC) medications for everyday complaints such as headaches, muscle strains, and upset stomachs, Community Memorial Hospital in Menomonee Falls, WI, has opted to not stock OTC medications for its employees.

Shirley P. Rosien, RN, COHN-S, director of occupational health and wellness at Community Memorial, says the decision boiled down largely to record-keeping and documentation requirements set forth by the Joint Commission on Accreditation of Healthcare Organizations.

"Being a hospital-based occupational health department, the regulations may be different than industry-based occ-health departments, but most of our issues relate to Joint Commission requirements," explains Rosien.

As an alternative, the hospital's outpatient pharmacy keeps a stock of commonly used OTC medications that employees can obtain.

No standard, but plenty of questions

At any time, a third or more of your worker population is likely to be taking OTC medication for a whole array of minor complaints, including cold symptoms, allergies, headache, muscle pain, or indigestion, surveys have shown. While company clinics at one time might have freely dispensed aspirin for headaches, employee health providers are taking a more careful look at what the risks might be to handing out medications on demand.

"There is no standard for administering meds at work," according to Susan A. Randolph, MSN, RN, COHN-S, FAAOHN, clinical instructor in occupational health nursing at the University of North Carolina at Chapel Hill and current president of AAOHN. An occupational health nurse planning a system to dispense OTC medications should carefully consider a number of concerns, including what state regulations might govern the plan, what medications to make available, and how they should be administered. (See table below for steps for setting up an OTC program.)

Administering OTC medication at work

1. The occupational health nurse should evaluate which OTC medications are currently offered and available at the work site. Ask the following questions:
  • Are all of them necessary?
  • Why are they offered?
  • What are their ingredients?
Many OTC medications contain compounds that induce drowsiness, impair performance, and can contribute to work-related injuries. Some warn against operating machinery or driving. Some medications contain alcohol, caffeine, sugar, salt, or antihistamines.

2. Decide which medications are needed based on the types of worker complaints (e.g., headache, etc.), which medication(s) workers prefer, and what the possible cost of the medicine might be.
The nurse or person in charge of the program needs to know if a standing order for the medication is required. The Board of Nursing in each state would be able to provide guidance regarding the need for standing orders.

3. Explore the effects of the medication on the employee's job.

4. Consider the interaction of the medication with other medicines the worker may be taking. This may be other OTCs, vitamins, and prescription drugs for any number of ailments, such as hypertension, glaucoma, heart disease, diabetes, etc.

5. Consider effects of other variables:
• If the worker drinks alcohol, what effect might it have on the medication?
• What about herbal compounds or remedies?
Certain foods may interact with medicines. This could potentially make them less effective or could cause side effects.

6. Teach workers how to read labels on medications. Include where to find important information such as active ingredients, side effects, precautions, dosage, and indications for use. This education can save lives, decrease medication interactions, and promote self-care.

7. Written directions are helpful to guide workers' decisions, especially in light of diversity of workers and language differences.

Source: Susan A. Randolph, MSN, RN, COHN-S, FAAOHN

Among the concerns voiced by occupational health providers about administering OTC medications at work include misuse by employees and potential interactions or side effects that could create safety risks for the employees taking the medication or their co-workers.

On one hand, if a company dispenses OTC medications, it knows what the employees are taking, and the employee's complaint is relieved, letting him or her continue to work and saving the company money. On the other, if the employee is taking prescription medications or OTC medications other than those dispensed at work, potential risks exist.

Occ-health nurses who dispense medications are responsible for the effects they have on the person taking them, so it's crucial that the nurse know what the condition is that the medication is for, and what other drugs the employee might be taking at the same time.

Dispensing OTC medication not without risk

Some hospitals in the United States have stopped dispensing OTC medications to employees who request them for headaches, out of fear that the employee's diagnosis might be wrong. Anecdotes abound of employees with headaches being found to have subarachnoid bleeds; "dry eye" turning out to be contagious conjunctivitis; and "indigestion" actually signaling a myocardial infarction.

Other worksite occupational health offices limit their involvement by providing one-time-only doses of OTC non-aspirin pain relievers, antacids, or anti-emetics.

Consumer Reports on Health in 2001 listed five hazards associated with use of OTC medications:

  • Incorrect self diagnosis and subsequent treatment with an OTC medication that either alleviates symptoms and masks a more serious problem, or delays necessary treatment;
  • Overdose resulting from increasing the dose past recommended parameters in an attempt to alleviate symptoms that do not respond to standard, non-prescription doses;
  • Overuse caused by frequent and repeated use of some OTC medications can cause dependency. Rebound effect refers to when the drug wears off and the symptoms may be worse than those originally felt when the medication was initiated, creating a cycle of increasing drug use associated with worsening symptoms.
  • Overuse can lead to dependency or damage of major body organs, especially for individuals with histories of ulcers, gastrointestinal bleeding, hypertension, heart arrhythmias, kidney disease, or liver disease;
  • Drug interactions can be mild, moderate, severe, or life threatening, and can occur with other OTC medications, prescription medications, herbal preparations, alcohol consumption, or illicit drug use; and
  • Drug allergy may occur at any time, with any medication and can be life-threatening.

[For more information, contact:

Shirley P. Rosien, RN, COHN-S, director, occupational health and wellness services, Community Memorial Hospital, Menomonee Falls, WI. E-mail: SROSIEN@communitymemorial.com.

Susan A. Randolph, MSN, RN, COHN-S, FAAOHN, clinical instructor, occupational health nursing, University of North Carolina at Chapel Hill. E-mail: susan.randolph@unc.edu.]