Ethical advice needed for a new grad... - page 8

What would YOU do? Say, hypothetically, that you are a new graduate RN at your first job. During morning med pass at a SNF, you witness another RN entering incorrect times for med administration... Read More

  1. Visit  Spidey's mom profile page
    0
    Quote from candyimage16
    To answer your last question, Heck Yes i feel comfortable charting a 0900 administration time if I gave it anywhere between the +/- one hour scheduled time. Unless it's a pain med/PRN med, then I always chart correct time (+/- 5 min).
    Quote from Deidra47
    It has always been you have an hour before and an hour after the "due" time to get your meds. out.

    That isn't the issue. Of course if your policy is that you have an hour (or 30 minutes) before and after scheduled time and you do it then you are ok. Usually in that case the med sheets don't have an exact time that you have to initial though. From what I've seen it is QAM or BID or TID or QHS.



    Say, hypothetically, that you are a new graduate RN at your first job. During morning med pass at a SNF, you witness another RN entering incorrect times for med administration on multiple patients in order to seem like everyone received their medication within the designated time frame. When you asked this nurse about the times, she states that she "guesses every nurse has to make a judgement call on how to chart."
    Would you take it further? Would you ignore it?
    My understanding of the above highlight part is that the nurse was putting in exact numbers (8:00 a.m.) when the med was actually given after that one hour designated time frame.

    That is a different question.
  2. Visit  Spidey's mom profile page
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    Quote from newkidnurse
    tl;dr; I've done a little reading on this and other similar issues related to med admin....

    The Institute of Safe Medicine Practices (ISMP) released this document which you all may find pretty interesting: Acute Care Guidelines for Timely Administration of Scheduled Medications. Basically, this set of recommendations came in response to the realization that the 30 Minute Rule was causing way more harm than good (for example, see this article).

    Even though my hospital hasn't made any changes to our '30 Minute Rule', the ISMP guidelines has allowed me to feel much better (in my head...) about giving Patient A her scheduled 0800 Colace at 0845 because I decided I needed to prioritize giving Patient B her 0800 IV antibiotics and Patient C her 0800 seizure meds.
    Good info, thanks. Personally 30 minutes (30 minutes before and after scheduled time) is all I've ever heard. Not the hour (one hour after and one hour before) that some folks have mentioned.
  3. Visit  TheCommuter profile page
    0
    Quote from Spidey's mom
    Personally 30 minutes (30 minutes before and after scheduled time) is all I've ever heard. Not the hour (one hour after and one hour before) that some folks have mentioned.
    In the nursing homes here in Texas, the TX Dept. of Aging and Disability Services (DADS) legally allows medications to be administered one hour before or one hour after the scheduled time. This regulatory agency will cite a medication error for any prescribed drug not taken within one hour before or one hour after the arbitrary time (refusals do not count).
  4. Visit  Spidey's mom profile page
    0
    Quote from TheCommuter
    In the nursing homes here in Texas, the TX Dept. of Aging and Disability Services (DADS) legally allows medications to be administered one hour before or one hour after the scheduled time. This regulatory agency will cite a medication error for any prescribed drug not taken within one hour before or one hour after the arbitrary time (refusals do not count).
    Thanks. I'm going to check when I go see our hospice patient who is in LTC.

    It has been a long time since I've worked LTC . . . . .
  5. Visit  hope3456 profile page
    0
    Quote from TheCommuter
    In the nursing homes here in Texas, the TX Dept. of Aging and Disability Services (DADS) legally allows medications to be administered one hour before or one hour after the scheduled time. This regulatory agency will cite a medication error for any prescribed drug not taken within one hour before or one hour after the arbitrary time (refusals do not count).
    Do they enforce this? What happens when they ARE late? How are your meds scheduled - some at 8am some at 9 AM ect? Do you use scanners?
  6. Visit  TheCommuter profile page
    0
    Quote from hope3456
    Do they enforce this? What happens when they ARE late? How are your meds scheduled - some at 8am some at 9 AM ect? Do you use scanners?
    I have never worked at a nursing home that used scanners.

    Nothing happens if medications are administered late, unless management or the state surveyor dislikes the nurse for some reason. In that case, they'd make a huge example out of the nurse and possibly refer his/her license number to the state BON for medication errors. Then, the state BON would formally reprimand and/or issue fines and sanctions if the nurse cannot disprove the allegations made against him/her.
  7. Visit  chrisrn24 profile page
    0
    We have hour before and hour after. And I've never heard of any consequences from giving them late. I'm sure the EMAR records the times but to my knowledge no one has ever been confronted on giving meds late.
  8. Visit  MissyMichele profile page
    2
    I would certainly not bring this to anyone's attention unless you are absolutely certain that you are able to complete the med pass within the allotted time frame 100% of the time.
    ricksy and wooh like this.
  9. Visit  CountyRat profile page
    0
    Quote from TheCommuter
    I have never worked at a nursing home that used scanners.

    Nothing happens if medications are administered late, unless management or the state surveyor dislikes the nurse for some reason. In that case, they'd make a huge example out of the nurse and possibly refer his/her license number to the state BON for medication errors. Then, the state BON would formally reprimand and/or issue fines and sanctions if the nurse cannot disprove the allegations made against him/her.
    And, the reason nothing happens is that there is usually no clinical significance to being early or late (within reason, of course). Most meds (please note: I wrote MOST meds, not all) work as well given BID as they do given q 12 hours, as well given TID as q 8 hours, etc. Get your post-prandial insullin and pain meds on board on time, then pass your others. Again, there are exceptions, but you are smart and well educated. You know which meds are time critical and which are not, and if you do not, a pharmacist will know.

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