All medications to be given at least 4 hours before dialysis

[pinkiepieRN]

I work in a SNF/LTC but we have a fair amount of residents who receive hemodialysis. The corporate office was in our building recently and had us change medication administration times for all of our dialysis residents, but it doesn't quite make sense. We have a resident who receives his Coreg at 0200 and 1400. He normally has dialysis ~6am, but it's M-W-F. I feel silly waking a guy up for his BP medication at such a time! Also, we have residents on Renvela and/or Calcium acetate which I know is supposed to be given with meals who are receiving the medication at 1000, 1900 and 2400. Those are *NOT* when meals are given, so I worry about how effective these meds are when given without food. The rationale behind corporate's changes are that the medications are "washed out" if not given at least 4 hours before dialysis. Is this true and common practice? It just seems strange to me.

Thanks!

[Chisca, RN]

We have a resident who receives his Coreg at 0200 and 1400. He normally has dialysis ~6am, but it's M-W-F. I feel silly waking a guy up for his BP medication at such a time!

I would call the patients dialysis center and inquire as to how successful they are in meeting his UF goals. BP meds are not held because they are removed by dialysis but because they can limit water removal during the dialysis treatment. Every patient is different. You need more information on the patients BP during dialysis.

Also, we have residents on Renvela and/or Calcium acetate which I know is supposed to be given with meals who are receiving the medication at 1000, 1900 and 2400. Those are *NOT* when meals are given, so I worry about how effective these meds are when given without food.

100 % correct. Phosphorous binders are most effective when taken with meals. The times you describe would allow quite a bit of phosphorous to be absorbed unless you have patients on continuous tube feedings. Does pharmacy control these times or nursing?