Question, med admin times?

Nurses General Nursing

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Specializes in ER/Trauma.

If a med is not given because it was overlooked, what would your process be? Say, it is 3 hours past the time it was to be given? Oh yes, and lets say it was something critical, like a cardiac med.

I have thoughts on this, but want to see what the vets here say.

Thanks!

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Specializes in CVICU, MICU, CCRN-CSC.

Well, at my hospital a certain "time" schedule is set per the pharmacy. Example: BID equal 9a, 9p. Period. No matter how many times you try to get it changed. Even if the order is written at 1300, the first dose will show to be scheduled at 0900 that morning. So, you use your discrection. If the patients b/p was 180/100 with a HR of 120 and the med was Lopressor 50mg PO, yes I would give it and "full document the reason it was "late" and the time the actual order was written. If it was PO K q 6 hours written at 1400 for instance and the pt's K was low say 3.8 (that is "low" for our CABG pts), I would probably give both doses and with in an equal time frame of the like the first dose as soon as available from pharmacy and the next at the schduled time of 1800. I would also look at the pt kidney function/IVF's, etc. Ofcourse you have to look at the entire picture of the patient. We also have started to document in our nurse when it takes FOREVER for our pharmacy to get us a med. Or we document, pharmacy problem and "full document" when the order was wirtten, howmany times called, when actually recieved on floor. Our pharmacy is a disaster. We no longer have certain medications in our override meds in accudose (BiCarb, ATROPINE, EPI,demerol for post op shivering, amoung a ton of others) IN OUR ICU. Yes, that has been a bit of a problem...but that is another thread...

So, in a nutshell, depends on the pt, the med and the order.

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I would check the pt, and if okay give the med, note on the MAR the actual time given, and then write a note in the chart explaining that med was late , pt stable etc and med given at such and such time. Then I would adjust the next dose accordingly.

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3 hours late? Is it a q so many hours med, or a QD/BID/TID/QID sort of med. Because if it's supposed to be twice a day, 3 hours isn't going to make that much of a difference. If it's a q 6 hours med, then it makes a little more of a difference. Just because a med is put on the MAR to be given at 0800, doesn't mean that medically it has to be given between 0730 and 0830 or huge problems will result.

I would: Assess the patient, give the med if warranted, retime the next dosages, go on with life.

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Specializes in NICU, PICU, educator.

It depends on your hospital policy. Where I work, if it isn't given within 30minutes for an IV med or within 1 hours for an oral, that is a med error and has to be documented as such and retimed accordingly. Even if it is pharmacy's fault, we still write it up....they have an hour to get us our meds. CICV...oh how I can empathize with you! We have our peds satellite open until 8pm and after that it is horrid. It was much easier when we were allowed to mix our own drips and meds, that is for sure!

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Specializes in ICU-Stepdown.

can't argue with any of the responses here. Our facility allows for an hour before and an hour after, anything over that, it just depends -treat the patient. If the reason it was 'late' is because of the pharmacy, then document accordingly. Our med dispensing machine allows us a pretty good discretion on overrides, and if the machine doesn't, a quick note to the pharmacy may get you the med in a uh, 'timely' manner :)

In any case, documentation, and treat according to the patients' needs.

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Specializes in CVICU, MICU, CCRN-CSC.
It depends on your hospital policy. Where I work, if it isn't given within 30minutes for an IV med or within 1 hours for an oral, that is a med error and has to be documented as such and retimed accordingly. Even if it is pharmacy's fault, we still write it up....they have an hour to get us our meds. CICV...oh how I can empathize with you! We have our peds satellite open until 8pm and after that it is horrid. It was much easier when we were allowed to mix our own drips and meds, that is for sure!

We actually can get levo and regitine out and mix ourselves in an emergent case (and god help us for the questioning we have to go though from management). However, we can't get atropine out. You can't even go to "custom inventory" anymore (a way we used to get around to it).Got to have a HR to have a BP.....Luckily, we have 6 code carts and 2 OMG "heart carts" (cracking a chest) becasue one afternoon we went through the meds in THREE code carts before the pharmacy got us some emergency meds we need. We have a doc that thinks Bicarb solves all problems :uhoh3: :uhoh3: Then, our manager was actually SURPRISED we had started documenting how long it took for pharmacy to get our meds. Then we got an email about how that was "not appropriate" from the pharmacy. :angryfire Well, I'll be the one in court expaining my inablitity to get the med(or why I did not give it in a timely matter). Oh, and we still document the time it takes. CYA, CYA, CYA.:smiley_ab :smackingf

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I once documented that a standing order PRN was given because we didn't have the prescribed med. Did the DON rip me a new one! Apparently, we didn't document the truth there, but what wouldn't get us cited by the state.

Oy.

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