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

BacktoBasics · Jun 20, 2013

First recognize 9:30-12 is 2.5 hours....

At my hospital 1.5 isn't a big deal as it can take pharmacy up to 30 min to approve and 45-1 hour to receive on the floor.... but 2.5 is long.

I would try to recall what the delay was from and just be honest about it.

KelRN215, BSN, RN · Jun 20, 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.

When I worked in the hospital, it would be highly unlikely that a manager level person would even notice this. 9:30-12 is 2 1/2 hours not 1 1/2 though.

Why was the medication given so late? Did the doctor call you when he put in the order? I know there were times when I worked in the hospital that if I wasn't advised "I just put in this stat order", I might not see it for several hours if it was a busy day. Not to mention, though pharmacy's turnaround time for stat meds was supposedly fifteen minutes, an hour and a half was more likely.

You won't necessarily be in any trouble.

treeye · Jun 21, 2013

I figured one hour is appropriate turn around time for NOW medication, so 10:30 is on time and 11 is 30min late. Anyway, I don't deal with this type of order often since our floor is not considered acute care. I got carried away when it became busy. Hopefully I won't get in trouble, and hopefully I learn my lesson this time. thanks

KelRN215, BSN, RN · Jun 21, 2013

I figured one hour is appropriate turn around time for NOW medication, so 10:30 is on time and 11 is 30min late. Anyway, I don't deal with this type of order often since our floor is not considered acute care. I got carried away when it became busy. Hopefully I won't get in trouble, and hopefully I learn my lesson this time. thanks

Does your floor have a protocol for these type of situations? When I worked in the hospital, pharmacy was required to physically hand a stat medication to a nurse, so that it couldn't be overlooked.

LadyFree28, BSN, LPN, RN · Jun 21, 2013

It will depend in protocol as others stated...One facility I worked for, a STAT had to be given no later than 30 mins, a NOW order no later than 90 mins. At this place, a pharmacy was on site, and a policy was in place.

VANurse2010 · Jun 21, 2013

I highly doubt anyone will notice or care. Do better next time and let it go.

evolvingrn, BSN, RN · Jun 23, 2013

would never be noticed where i work.

SwansonRN · Jun 23, 2013

Not too big of a deal. The patient had been hanging out in a fib for a few weeks and 100 is not that high. Plus I am having trouble thinking of a scenario where a PO med is urgent enough to be ordered stat. If the patients HR was 130s with a low blood pressure and the order was for 10 of dilt IVP then that's a different story. I don't think you will get in any trouble for this, just don't make it into a habit :)

NurseOnAMotorcycle, ASN, RN · Jun 23, 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.

It's a medication error and needs to be reported as policy requires. I doubt you'll hear about it again other than the required "Don't do that again" talk from the NM.

However, I think that brushing it off as "merely 1.5 hours late cuz I don't count the first hour" is not ok. The MD ordered it now for a reason.

ClearBlueOctoberSky · Jun 23, 2013

I think what concerns me more is the disregard that you appear to have in giving a medication late. You are more concerned about how much trouble you will get in for giving a medication late, rather than WHY it was given late, and WAS there POTENTIAL HARM that could have happened to the patient due to the late administration and what the rationale for the NOW order was.

Just because the patient has been hanging in the 100's in AFIB for two weeks, doesn't mean she couldn't have had an acute episode that made the NOW order necessary. To me, even though she has a heart rate in the 100's and without knowing the rest of her history and VS, doesn't mean that she isn't stable. The fact that the MD did do a NOW order tells me maybe he saw something that you didn't see. Maybe she is starting to have an intolerance to the HR.

Do you know what his rationale was for the order?

dirtyhippiegirl, BSN, RN · Jun 23, 2013

Um...is this the same unit that wrote you up (per one of your last posts) for many similar "small" infractions, including giving multiple NOW meds several hours late?

The big problem here isn't whether you'll get in trouble or not -- it seems like you're not learning from your mistakes.