Giving meds late o.k.?

  1. Is it typically acceptable to give a medication after more than an hour has lapsed from the scheduled time?

    I ask this because last week during my clinicals (I am a nursing student) our clinical instructor was incredibly slow when passing meds with us. For whatever reason she requires that she be with us whenever we give any kind of med's (even PO) and as a result some of us have to wait till 9:30 or 10:00 to give 8:00 a.m. med's. We were always taught that you have an hour window before and after the scheduled time to give the med's. Our clinical instructor has us write down that we gave them at 08:00, even if we gave them at 10:00.

    Last week the charge nurse became aware of one student who was still holding her 0800 med's. By this time it was 0945 and the charge nurse took the med's and said she could no longer give them. Our clinical instructor was angry with the charge nurse and said, "yes I understand it is late, but these med's are not scheduled again until tomorrow morning.. so we might as well give them now."
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  2. 44 Comments

  3. by   RN BSN 2009
    General rule of thumb is 1 hr before or 1 hr after.

    How many students are in your clinical? There are 8 in mine, and one week 4 of us pass meds, and the next week the other 4 pass.

    This way the instructor has only 4 med passes at any given time, and it can be completed in that 2 hour window.

    So yes, that is a medication error.
  4. by   vashtee
    We have plus or minus 30 minutes, and our instructor will have our heads if we can't do it in that amount of time.
  5. by   MikeyJ
    Quote from iceyspots
    General rule of thumb is 1 hr before or 1 hr after.

    How many students are in your clinical? There are 8 in mine, and one week 4 of us pass meds, and the next week the other 4 pass.

    This way the instructor has only 4 med passes at any given time, and it can be completed in that 2 hour window.

    So yes, that is a medication error.
    There are 7 students in my clinical group and we each had one patient and we do total care on them, including all med's and treatments. This is the first time we have encountered a problem because our clinical instructors in the past allowed us give PO med's without them being present. They typically want to see you give the injections, but are sufficient with just walking in the room and watching you check the patient's arm band and then giving the med's without them being present.

    Next week our instructor is giving us 2 patients. A few students approached her last week about allowing us to give med's with the RN's, so hopefully she allws that.
  6. by   Bala Shark
    In the real world, nurses in nuring homes have to pass out medications to about 50 patients..And that is one nurse doing that..Say, you have 50 patients and all of them have 9 am medications..Sorry to say but it would be impossible to do..Some pateints will recieve their meds late if they are the last ones to recieve the medication..Some would be very late...

    You can go by NCLEX and their own rules about 30 minutes to 1 hour after or before in passing medication, but in the real world, it is quite different on what is acceptable..
    Last edit by Bala Shark on Sep 30, '07
  7. by   RN BSN 2009
    Quote from sistermike
    There are 7 students in my clinical group and we each had one patient and we do total care on them, including all med's and treatments. This is the first time we have encountered a problem because our clinical instructors in the past allowed us give PO med's without them being present. They typically want to see you give the injections, but are sufficient with just walking in the room and watching you check the patient's arm band and then giving the med's without them being present.

    Next week our instructor is giving us 2 patients. A few students approached her last week about allowing us to give med's with the RN's, so hopefully she allws that.

    Is there any reason why you would have to give meds every single week? I imagine if she is slow in helping you guys give meds then splitting you guys into 2 groups would be helpful. It's better if the instructor is there with you and asking you the correct questions & providing feedback.
  8. by   MikeyJ
    Quote from iceyspots
    Is there any reason why you would have to give meds every single week? I imagine if she is slow in helping you guys give meds then splitting you guys into 2 groups would be helpful. It's better if the instructor is there with you and asking you the correct questions & providing feedback.
    I don't understand why they have to be there to give med's in the first place. I understand IV pushes and perhaps injections. But it is really hard to screw up PO med's. And that is usually the bulk of the meds to give, especially considering this particular rotations is geriatrics. She should go over the MAR with us and quiz us quickly on the med's we need to give and make sure we understand the meds we need to take BP's first or heart rate first, etc. That is how our other clinical instructors have done it, and then let us go and administer the med's without their direct supervision.
  9. by   Faeriewand
    I've never heard of a nursing instructor not being with a student who is administering meds. The students in my clinical group would start getting ready an hour beforehand to give the instructor enough time to be with us all. And you had to be ready when she came. There were 10 in my clinical group. Then we (teacher and student) always wrote down the time we administered the med. Crossed out 9 and put 10 or whatever.
  10. by   MikeyJ
    Quote from Faeriewand
    I've never heard of a nursing instructor not being with a student who is administering meds. The students in my clinical group would start getting ready an hour beforehand to give the instructor enough time to be with us all. And you had to be ready when she came. There were 10 in my clinical group. Then we (teacher and student) always wrote down the time we administered the med. Crossed out 9 and put 10 or whatever.
    In the perfect clinical environment, we would start an hour early. However, every floor we do our clinicals on, the nurses are notorious of doing morning report until 7:30. And the RN's have to pull the meds for us... the clinical instructor is not able to pull the med's. Thus by the time the nurses finish morning report and finish chatting with each other, it is already 8:00 by the time they pull the meds. That gives the clinical instructor an hour to pass all of the meds.
  11. by   Hellllllo Nurse
    Quote from Bala Shark
    In the real world, nurses in nuring homes have to pass out medications to about 50 patients..And that is one nurse doing that..Say, you have 50 patients and all of them have 9 am medications..Sorry to say but it would be impossible to do..Some pateints will recieve their meds late if they are the last ones to recieve the medication..Some would be very late...

    You can go by NCLEX and their own rules about 30 minutes to 1 hour after or before in passing medication, but in the real world, it is quite different on what is acceptable..
    True.
  12. by   wooh
    Quote from sistermike
    I don't understand why they have to be there to give med's in the first place.
    Because you're giving them under her license and you can kill someone just as easily with a PO med as with an IV push.

    Personally, I'm of the belief that it doesn't really matter when you give QD meds. 0800 or 0900 is just a random time set by the facility to put on the MAR for QD meds. Which means the same QD colace that's ok to give an hour early at one facility at 0700 is ok to give an hour late at another facility at 1000. As long as they get it QD as ordered, it really in the big scheme of things doesn't matter if it gets given within some random time chosen by a pharmacist that has no idea what it's like to do a med pass. Their stool will get softened either way.
  13. by   suzy253
    Quote from wooh
    Because you're giving them under her license and you can kill someone just as easily with a PO med as with an IV push.
    exactly!
  14. by   smk1
    I can't imagine 6-10 students trying to give meds with the instructor in an LTC. Some should get to give morning and others get afternoon and switch off the next week. It is a med error, meds are supposed to be given 30-60 minutes before or after the assigned time.

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