give NOW medication 1.5 hr late, what kind of trouble I am in

gcupid · Jun 24, 2013

I work on a rehab unit, pts come to us from med-surg floors. One of my pt had run A-fib around 100 for over two weeks and she is on Cardizem 240mg q day. Today the doctor put in a NOW order for 120mg additional at around 9:30am and I didn't give it till 12p. I did checked the pt's HR after one hour and it went down to 90, pt had no s/s throughout the shift.
Just wondering whether the DON will have a talk with me soon and what kind of trouble I will be in.

Just go by the nearest post office/ups/fed ex and overnight your license straight to the board of nursing :sarcastic: .

U will be fine.

MunoRN, RN · Jun 24, 2013

I would agree that it should be given as soon as possible, but still within reason and following the rules.

This isn't necessarily a med error, and at my facility giving it at the time it was ordered would be a med error. The first thing to remember is that "now" doesn't actually mean "now". Definitions vary slightly from one facility to another, but typically "Stat" means now, and "now" means it should be given after all the routine processes have occurred, which can take a couple of hours. In facilities with pharmacy support (hospitals), all non-emergent med orders are usually required to be pharmacy reviewed before giving, the goal at my facility is that this will happen in under 2 hours, although even then it's not always the case. You then have 1 hour from the time pharmacy reviews the order and enters it to give the med, although even then we need to be careful about how literally we take that rule. ISMP has made numerous statements on med timing parameters and that we too often prioritize a time parameter over safety. If you're running your tail off and the med isn't urgent, it's arguably safer to wait until you can give the med safely; the right med at the right dose given half an hour late is still safer than the wrong med or wrong dose given on time.

I can't say that this was the case in this situation, but these orders arent' unusual and aren't urgent, they usually come about after morning med pass when the MD's round and note that the patient is tolerating their current dose and has some room to titrate up, so they up the dose 'retroactively'. If the dose is needed to prevent imminent harm to the patient then it should be ordered "Stat".

LightMyFire · Jun 24, 2013

Depending on the med, that might be reasonable. If its something in our Accudose, there's no excuse. Otherwise it depends on when the pharmacy brings it.

NurseOnAMotorcycle, ASN, RN · Jun 24, 2013

.... The first thing to remember is that "now" doesn't actually mean "now". Definitions vary slightly from one facility to another but typically "Stat" means now, and "now" means it should be given after all the routine processes have occurred, which can take a couple of hours. [/quote']
It must be a facility thing then because "now" and "stat" are the same where I work.

MunoRN, RN · Jun 24, 2013

It must be a facility thing then because "now" and "stat" are the same where I work.

Maybe it's a regional thing since all three facilities I have worked at (in the same region) define 'now' as being different from 'stat'. Stat means it's ok to bypass the routine measures that take some time and to prioritize it as urgent, 'now' means to give it as soon as able but still following all the normal routines and to prioritize it as any other routine med.

What is the term where you work to indicate what we call "now" where I work?

dirtyhippiegirl, BSN, RN · Jun 24, 2013

^does it really matter when the OP has a long history of giving now meds several hours overdue?

Jory, MSN, APRN, CNM · Jun 24, 2013

What I find interesting is out of everyone that has posted....only ONE person wondered if the OP was even aware a new order had been written.

The physicians in my facility are responsible for either flagging the chart or telling the nurse that new orders have been written...they don't have to say anything but, "I've wrote new orders".

That's on night shift.

On day shift, the orders are written in the morning, mid-day and late afternoon, so you know to check the chart. Anything written outside of that, is brought to the nurse's attention.

So, no, I would not consider 2 hours 3 hours even 4 a long time, if nobody told you a new order was written. I have NO REASON to access the chart until a medication is due or I'm documenting something else...so therefore, unless the physician says something, I typically leave my crystal ball at home.

This is not a medication issue, it's a communication issue.

allnurses Guide · Jun 24, 2013

If there is a valid reason why it was late indicating a problem with communication and/or the workflow/system then it's likely not a huge deal.

If this is the third or fourth or fifth time with the same problem in isolation of a systems flaw, then it likely is a big deal.