Meds:Initial Dose LTC - page 2

I work a medicare/LTC unit. We do not have an in house pharmacy, nor a Pyxis. Many times, our admits come in after 1500.. We get the orders, transcribe and fax to pharmacy. The pharmacy delivers... Read More

  1. by   LPN1974
    Quote from webblarsk
    Easy does it. OP already got written up at work. Isn't there a nicer way to state opinion?

    Sorry...I didn't mean to sound as if coming on so strong.
    It's just I've always been taught to start something as soon as the med arrived, within a reasonable time after it arrived.
    I am only thinking if it were me, or someone in my family.
    I would want myself or family member to get prompt treatment, and IMO almost 12 hours to wait is unreasonable.
    A technicality like 30 minutes past the facility's scheduled time frame of 1900-2100 is a little bit ridiculous, due to the fact it wasn't anyone's fault, nurse, or whomever, that it arrived late.
  2. by   leslie :-D
    the med was probably acidophilus, which we used to give our pts with c-diff or hx of c-diff- it restores the normal flora in your gut, except we gave it tid for active c-diff then bid for those w/a hx.

    but yes, i would have given it also.

    leslie
  3. by   ktwlpn
    Quote from LPN1974
    Sorry...I didn't mean to sound as if coming on so strong.
    It's just I've always been taught to start something as soon as the med arrived, within a reasonable time after it arrived.
    I am only thinking if it were me, or someone in my family.
    I would want myself or family member to get prompt treatment, and IMO almost 12 hours to wait is unreasonable.
    A technicality like 30 minutes past the facility's scheduled time frame of 1900-2100 is a little bit ridiculous, due to the fact it wasn't anyone's fault, nurse, or whomever, that it arrived late.
    We have P and P in place at our facility to cover this type of occurence.I would review the policies with the DON-if this scenario is not covered I would insist it be.I would try to get the written warning thrown out and get a verbal is there is no policy in place.......We have emergency boxes and we do order meds for stat delivery but we must be mindful of cost...a routine med such as this or a freaking vitamin would have been started the next day...As I am sure many of us have done at home-can you honestly say you never ran out of a med at home? Did you go to the store in the middle of the night for your kid's Flintstones vitamins? I doubt it.... I would NOT have awakened this resident for this med either-In LTC you want to try to administer meds during waking hours as much as possible....(excepting the obvious-) Our policy states we start an antibiotic right away -common sense should prevail.If you have a resident with a whopping high b/p of course you'll give the med...We routinely write to start this type of med the next day to take into consideration pharmacy turn around time-that insures this type of thing won't happen...
  4. by   jaimemds
    My personal "policy" for meds that are not in the e-box, is to wait until the med is delivered and then write the times for the med. Works well for me.
  5. by   joyflnoyz
    I really DO appreciate all the input from everyone.

    Patient had already been on Flagyl...this is a "supplement" to that course.
    Meds were delivered at 2130..by the time they're all separated for the patients it's closer to 2230.
    I'm not "excusing" my actions: I made a judgement call based upon what I was taught in nursing school.(The five "rights") Same call made by every nurse, dozens of times in this same facility. ABT we have in the "E Kit" and are started ASAP.

    Instead of being hammered over the head (esp for a "first offense")
    I truly believe this should have been handled differently, as a verbal education experience. I've been at this place 16 months, and I'm not a job hopper. I'm looking for a place to work for the next 15-20 years.

    perhaps I'm a bit anal ...err..concientious ...about wanting to do things the right way.. usually saves a lot of trouble. I just want to do it correctly.
    I KNOW the DON is within a few inches of losing her job (new HC admin, and DON has been slacking for about a year. . Has had to make up for it with marathon "inservice" sessions, has been rude and nasty to just about everyone, wrote up another nurse on heresay.. many other stresses there, so there IS a lot going on.)

    All in all, I'm just trying to understand.
  6. by   LPN1974
    Well, personally, joy, I would have given the medication, if the patient had a DX of C-Diff,
    I would have done so. C-diff, is a pretty bad thing, they can have nausea, vomiting, along with diarrhea, which, your may patient may or may not have been having it that severely, but I just would have given it. If it'd been ordered, to help clear that up, just seems to me it would need to get started. The DON felt it should be given.
    You posted alot more information, in your second post, tho, than the first, so I see now where you might have thought it would be okay to let it start next morning.
    However, a write up with your employer is not as bad as the BON breathing down your neck, so if she didn't report it I sure wouldn't go volunteering any information to them, myself. That's why I said I'd just take the writeup and leave the BON alone.
    Anyway, hope things work out for you on your job. Does sound like alot of unecessary stuff going on.
  7. by   CoffeeRTC
    [QUOTE=ktwlpn]We have P and P in place at our facility to cover this type of occurence.I would review the policies with the DON-if this scenario is not covered I would insist it be.I would try to get the written warning thrown out and get a verbal is there is no policy in place.......We have emergency boxes and we do order meds for stat delivery but we must be mindful of cost...a routine med such as this or a freaking vitamin would have been started the next day...As I am sure many of us have done at home-can you honestly say you never ran out of a med at home? Did you go to the store in the middle of the night for your kid's Flintstones vitamins? I doubt it.... I would NOT have awakened this resident for this med either-In LTC you want to try to administer meds during waking hours as much as possible....(excepting the obvious-) Our policy states we start an antibiotic right away -common sense should prevail.If you have a resident with a whopping high b/p of course you'll give the med...We routinely write to start this type of med the next day to take into consideration pharmacy turn around time-that insures this type of thing won't happen...[/QUO


    Couldn't have said it better.

    It wasn't fagyl...it was an OTC....I still disagree with the write up.
  8. by   nicolel1182
    i agree- you have to give the ID once it comes in...especially if the next dose isnt for another 6 hours or so.. you would write on the MAR ID @ whatever time and then chart it...

    i dont agree with the write up - this is a learning experience...but hey just live and learn and move on
  9. by   Nurse Hatchett
    Quote from joyflnoyz
    I work a medicare/LTC unit. We do not have an in house pharmacy, nor a Pyxis. Many times, our admits come in after 1500.. We get the orders, transcribe and fax to pharmacy. The pharmacy delivers tid..approx 1000, 1500 and 2100. The DON wrote orders last week for a homeopathic <what ever>OTC for C-Diff, to be given bid. As I transcribed, I put 0800 and 2000 for times (standard on my hall..adjoining hall woulda been 0900 and 2100)
    OTC didn't come in until 2130, so I began the med the next AM.

    Today I was "written up" because I didn't give the med. I have been taught from day one in nursing school that the "Right Time" is an hour before to an hour after, in this case 1900-2100 would be correct.
    I raised that to DON and she stated " But you give the initial dose anytime. You could give it at midnight, and it would still be the 2000 dose"

    Am I wrong on this one?? I anm pretty upset...doing what I was taught to do, and get slammed in the head for it...
    If she (DON) is correct..I think education and discussion instead of punishment was more appropriate .

    I think I'm going to write the BON and get a written opinion




    In my LTC facility, we have an EDK we obtain ATB's from when we get a new order. Our policy is we give the initial dose when we get the order, then set it up for certain times ie:9a,9p. Hope I am typing this correctly, this is my first input on anything

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