Time allowed for medication administration changing. - page 2

An e-mail went out today from the Pharmacy head stating that a (hospital) corporate wide change went into effect today. Until today, a medication could be given up to 1 hour before or as much as 1... Read More

  1. Visit  morte profile page
    0
    Quote from Indy
    I don't see changing the times as practicing medicine without a license. Changing the frequency would be an order change, but what times? Unless the doc writes for a specific time, and there are few who do, we time the meds for when it is reasonable and appropriate to give them.

    Example: admission arrives at 0100 with orders for some BID meds. Now the patient is awake, no problem. I will consider what those meds are that possibly he missed the evening dose, before giving them, because we're about 6-7 hours away from the morning dose. There are things that although they might be BID, I don't want to give that closely together. And I don't control admission times so I am not responsible for the fact that he was ordered meds at 2100 in the admit orders and arrived on my floor well after midnight. This is just an example mind you.

    The admits always do give me problems. If they arrive dinnertime or later, whether or not they got their meds that day, I am not going to attempt to give a whole day's meds just in the evening/overnight. With my patients it just sets them up for low heart rates, bottomed out blood pressures, etc. either in the middle of the night or the next AM after the normal dose is given around 0800/0900. So, no thanks.

    And what about those "Q 6 hour" and "Q 8 hour" dosed meds? eh? So if your patient's lopressor is due and you hold it for a heart rate of 44, would you give it the next time he's up and about with a decent heart rate, or wait 6-8 hours until it's due again and then check HR/BP to see if you can give it? The docs I work with didn't sit down and write exactly what time we had to give the meds, and it exasperates the cardiologists if a nurse holds the meds all the time because they only check the VS when it says the meds are due on a sheet of paper... I really hope you don't call that bit of nursing judgement and time management, practicing medicine without a license. Good grief. If that's what it is, omygosh, better call the state board 'cause we're all in trouble!

    Edit: Ok I found the flaw in your statement. "If the institution has a prescribed time" is the flaw. The institution does not "prescribe" medications, the doctor does. The pharmacy prints times that they think are reasonable for administration based on mealtimes and when people are likely to be awake. That has absolutely ZIP to do with the act of prescribing a drug. Adjusting what time to give a med is well within the boundaries of nursing practice.
    ok, if you want a semantics arguement, perhaps the term prescribed was less than accurate....the concept remains accurate....IF your institution has SET, agreed upon times for the order of BID,TID, Q12...etc, it is not within your scope to change that without a doc's order.....if the doc is unhappy about being called, (s)he needs to learn to write the orders correctly.....
    Last edit by morte on Apr 5, '07 : Reason: spelling
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  3. Visit  flashpoint profile page
    0
    When I worked in the hospital, the policy was that we had 30 minutes before and 30 minutes after, but 1 hour before and 1 hour after would not be considered an error. In LTC, I have always seen 1 hour before and after. There is no way in a busy LTC that a med pass could be completed in only an hour.
  4. Visit  Elvish profile page
    0
    In our hospital we have 30min before and after, so for a 2100 med we have from 2030 until 2129 to give it. In a hospital where I worked prior, we would have had from 2000 until 2159.
  5. Visit  Lorie P. profile page
    0
    one hour before or one hour after, which means I can give a 1000 med at 0900, 1000 or 1100. can come in pretty handy on a busy med/surg floor taking care of 7-9 pts. Also when those cute little elderly pt want to take one pill at a time and you have to give them 8+
  6. Visit  veegeern profile page
    0
    Thanks to all who have already responded. I see that there a those who have either always been held to the 1 hour standard, or have gone to the 1 hour standard.

    As an entire floor, it is a challenge to give our medications within the 2 hour time frame, so I guess I'm also looking for ways that we can do things differently and comply with a 1 hour med pass.

    Any suggestions/strategies for speeding up a med pass? This is a busy (who isn't busy ) M/S floor. Right now it seems like I do a lot of my patient teaching r/t medications as I'm giving them. I usually have at least 1 patient/caregiver that states she didn't know xyz about that medication, and many times she's been on the med for years. Do you find it's better to give out the "quicker" ones first, and then move on to the more time consuming patients? Quicker being the patients that can swallow easily or don't have IV push meds that take several minutes. How are you handling dressing changes that have medications recorded on the EMAR or MAR and are due at the same time as your other meds? Have you found anything that works to minimize interruptions during a med pass?
  7. Visit  veegeern profile page
    0
    Quote from nurse hobbit
    one hour before or one hour after, which means I can give a 1000 med at 0900, 1000 or 1100. can come in pretty handy on a busy med/surg floor taking care of 7-9 pts. Also when those cute little elderly pt want to take one pill at a time and you have to give them 8+
    :yeahthat:
    Most of ours have multiple tablets, and many take them 1 at a time. A couple of our nurses will crush meds for these to save time, but I really hate to do this if the patient can swallow. :smackingf
  8. Visit  morte profile page
    0
    Quote from veegeern
    :yeahthat:
    Most of ours have multiple tablets, and many take them 1 at a time. A couple of our nurses will crush meds for these to save time, but I really hate to do this if the patient can swallow. :smackingf
    check with your p+p, you may need an order to crush meds...as well as there are many that cant be crushed....i think some "spreading out" is going to be nec, which will require either getting a doc order for every change, or some policy change, this would come under "you need to consider the unintended sequelae of one's actions" (refering to the ones instituting the change)......perhaps all the "once" a days could be changed from the AM to noon? it will take some work, and complaints, to get this resolved..
  9. Visit  Ayvah profile page
    0
    Quote from morte
    check with your p+p, you may need an order to crush meds...
    Why would you need to get an order to crush meds? If crushing isn't contraindicated, i.e. SR meds, you are still giving it PO like the order says.
  10. Visit  Ayvah profile page
    0
    For us, its an hour before and an hour after. When you have multiple patients all having meds due at the same time, and some of those needing preparation, and sometimes you don't get out of report till 8:30 and you have 8:00 meds to give, it just doesn't seem feasible to have it be only a half hour +/-.
  11. Visit  morte profile page
    0
    Quote from Ayvah
    Why would you need to get an order to crush meds? If crushing isn't contraindicated, i.e. SR meds, you are still giving it PO like the order says.
    i am more familiar with long term care.....and we need an order to crush......that is why i said to check your p+p, maybe you do, maybe you dont....CYA
  12. Visit  Ayvah profile page
    0
    Quote from morte
    i am more familiar with long term care.....and we need an order to crush......that is why i said to check your p+p, maybe you do, maybe you dont....CYA
    What is the rationale for needing an order to crush meds (that are not contraindicated to being crushed)?
  13. Visit  morte profile page
    0
    Quote from Ayvah
    What is the rationale for needing an order to crush meds (that are not contraindicated to being crushed)?
    what the rationale for the REGULATION that expects i am not sure, though partly to ensure that patients know what they are getting, ie that nothing is being "snuck" in.....my suggestion wasnt to critisize or chastize, but for you to CYA!
  14. Visit  INtoFL_RN profile page
    0
    Quote from veegeern
    Thanks to all who have already responded. I see that there a those who have either always been held to the 1 hour standard, or have gone to the 1 hour standard.

    As an entire floor, it is a challenge to give our medications within the 2 hour time frame, so I guess I'm also looking for ways that we can do things differently and comply with a 1 hour med pass.

    Any suggestions/strategies for speeding up a med pass? This is a busy (who isn't busy ) M/S floor. Right now it seems like I do a lot of my patient teaching r/t medications as I'm giving them. I usually have at least 1 patient/caregiver that states she didn't know xyz about that medication, and many times she's been on the med for years. Do you find it's better to give out the "quicker" ones first, and then move on to the more time consuming patients? Quicker being the patients that can swallow easily or don't have IV push meds that take several minutes. How are you handling dressing changes that have medications recorded on the EMAR or MAR and are due at the same time as your other meds? Have you found anything that works to minimize interruptions during a med pass?
    One of my strategies is to get to the Pyxis early in the morning and get all my meds out that I will need for the "0900 med rush". This may or may not work for you, depending on how your unit is set up. All of our pts have their own med drawers inside the locked med room, so it is perfectly kosher for me to get the meds out ahead of time (except for narcs, of course). I do my initial med/route/dose/etc. check, then put the meds in a ziplock bag inside the pt's drawer. When it's time to pass the meds, I bring in the MAR with the meds to the pt's room and go over what meds they are getting with them. If I need to draw up any IVPs, I draw it up in the med room first, and write the med&dose on the syringe.

    As for meds that go with dressing changes (like polysporin for sternal wounds), I wait to give that until it's a prudent time to change the dressing. For instance, I'm not going to change it at 0800, when the pt is going to shower at 1000. Things like this, you can use your "nursing judgment" on, I think. Always best to check policies, of course .


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