Late Meds.

  1. There are lots and lots of meds to be given to lots of patients but when theres the added factors like,someone gets sick,someone falls,IVs to start or re start, some one with chest pain,someone has a vagal response or just what ever,then I really feel pressured. I use Maslows hierarchy of needs and focus on the ABC's first and move up the hierarchy. Usually this means that the scheduled meds dont get out on time.

    Correct me if Im wrong,but if the meds dont get out on time,then viewed in the scheme of things its not a big deal that they dont get out on time.

    Just wondering if any one out there takes issue with my view of late meds.
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  2. 7 Comments

  3. by   thisnurse
    i agree with you. if our meds are late we just change the schedule. there are times when it is impossible to pass meds when scheduled.
    we have the hour before and the hour after window.
    i can usually get them out in that time frame but not always.
    i remember this new resident. one of my patients had ecoli and was on iv antibiotics. it was scheduled at 2 and was q12. this patient was a pain in the ass. if his meds were not given exactly on time he started calling me and complaining. the first day his line infiltrated and had to be restarted so his antibiotic was late. the resident raised hell about it because the patient was mad. tough. he got it at 3.
    the next day at 2:30 i was in another patients room trying to get this huge uncooperative woman in a wheelchair. she was dead weight. it took more than one try and it was damn hard.
    this resident walks into the room and says he needs to see me. i told him i was kinda busy at the moment and asked him what he wanted (i already knew). in the meantime my assistant and i are struggling to get mrs.icantwalkmovedonuthin in that chair. the doc wants to know why those antibiotics arent hanging. it was 2:30, i was well within my window and thats what i told him. i was nice about it. i told him that just as soon as we got this patient in the chair i was going to hang the iv. i just didnt like his attitude. this doc knew his patient was being a pain in the ass and he could have explained to him that it wasnt going to make a difference if his iv was hung at 2 or 3.
    we got mrs.icantwalkmovedonuthin in her chair and i went after the doc. i asked him if i was being yelled at. he was confused. i told him i just needed to know in case mr.painintheass asked me if the doctor yelled at me. he laughed and said no.
    so i go to the room and am hanging the iv. i explain to mr.painintheass about it not making a difference if the iv was hung at 2 or 3, just so long as he got it. i also explained that i had a very heavy patient load (big mistake..ill never do that again) and this was the soonest i could get to it.
    he was really pissed.
    i went to the station and started charting his iv when he comes out. pump beeping.
    he screams at me in broken english (chinese)

    YOU FIX THIS NOW!
    i looked at him with no reaction and got up to fix it.
    he continued to scream at me...by now we had a captive audience. he was still mad that his iv wasnt hung at 2 and he didnt care about my other patients. he went on to say that i wasnt nice. lol
    he screams...
    I NICE. I ALWAYS NICE. WHY YOU NOT NICE.
    i asked him if he was being nice right then. i asked him if screaming was nice.
    there was air in the line and i had to prime the line again. some of the antibiotic ran out on the counter. maybe 1 cc....maybe. well this sends him in a tizzy. he is screaming at me again.
    THAT SUPPOSED TO BE IN MY BODY. IT ON THE COUNTER.
    WHY YOU DO THAT? I NOT GETTING MY MEDICINE.
    i tried to explain to him that the iv bags have extra in them so we can prime them. i asked him to estimate how much was on the counter...how much would you say that is mr. painintheass? maybe 1cc? ill have the pharmacy call you and explain this to you if you like.
    no, he didnt want that.
    I CALL ATTORNEY RIGHT NOW. I TELL HIM THIS HOSPITAL IS BAD.

    with that he stomped off into his room. he was discharged about an hour later.
    we laughed about that all day.

    thats my late med story.
  4. by   ohbet
    What a story,Thanks you. After all , s... happens right?
  5. by   Teshiee
    Noone takes into account that you are have many tasks to do and unfortunately your meds can't get out when they are suppose to. I understand you have about an hour before and after? or 30 minutes. Sometimes when I have lots of med I give them early so when I anticipate crap at least they got their med. There is no sure proof of getting meds out on time all the time. That patient was a true *******. Too bad the med couldn't be given IM hahahahah
  6. by   LTC-LPN
    Getting the meds out on time at my LTC facility is a challenge to say the least. I generally have 36 to 40 residents. I work pms and right after report, I run! I try to start the meds at the stroke of 3 pm, so I can be finished by 5 pm. I usually have 5 or 6 blood sugars to do, insulins and checking up on anyone sick. I pray the whole time that no one falls, has chest pain, starts bleeding anywhere and especially that the aides do what they are supposed to be doing so I don't have to chase them down for help. I have been out of compliance several times and have reported this to the DON, whose response is "just do your best." It wouldn't be so bad if the residents took their meds nicely, but so many of them have dementia and if approached incorrectly, I wear the meds. It is a hard job anymore.
  7. by   night owl
    ohbet,

    You took the words right out of my fingers! Sh** does happen and there's nothing you can do about it.

    At my facility, it seems that we can go all night with it being nice and quiet...The minute we roll out those med carts, BOOM! someone decides to have an MI, someone falls and needs sutures, someones foley is blocked, or someone is unresponsive. Happens EVERY time, and I'm not kidding. It gets to the point that when I roll the cart out the medroom door I'm thinking, "What sh** is going to happen now???" Never fails...When the window comes up and says,"This med is 65 minutes overdue!" and the space is provided for an explaination, I always type...We had an unforseen emergency situation...No questions ever asked. Although I'd love to type in, "Hey, sh** happens!"
  8. by   thisnurse
    and where i work when its med time, all the assistants go on break and EVERYONE on the unit gets together and has synchronized bowel movements...lol

    seems like that sometimes
  9. by   deespoohbear
    One of the big problems we have at our facility is with the pharmacy getting us our meds in a timely fashion. Our pharmacy closes at 7 pm during the week and at 2 pm on the weekends. We have a Documed machine that is suppose to have our most frequently prescribed meds in it. With JCAHO not wanting non-pharmacy personnel accessing the pharmacy when it is closed it can leave us in a bind sometimes. The Documed is out of what we need frequently. So, the float nurse will go to pharmacy and get the essential meds "antibiotics, cardiac meds, diabetic meds" etc. The pharmacy opens at 7 am, but it is not unusual for the meds not to arrive until after 12 pm for an admit the night before. Anymore, I call the pharmacy once. If I don't have my meds in 2 hours from the pharmacy opening up, I make out an incident report. I mark the pt's MARS "unavailable" and put a note in the nurses notes that the med was unavailable for administration at that time. Our pharmacy is terribly understaffed and we are trying to prove to the admininstration that the pharmacy needs to be open longer and have more staff. Our floor manager told me that the pharmacy manager is getting frustrated about all the incident reports (I am not the only one who has started filling out incident reports). Our manager told her were are not trying to pick a bone with the pharmacy, just trying to prove they need more help. Maybe if the state board of health or JCAHO notices all these meds are not being passed in a timely fashion action might be taken sooner.

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