Time allowed for medication administration changing.

[veegeern]

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 hour after the scheduled time without it being considered early or late. A 0900 medication could be given as early as 0800, or as late as 0959. Starting today, that 1 hour window was narrowed to 30 minutes. A 0900 medication could be given as early as 0830 or as late as 0929.

Now, take it for granted that as nurses we all want to give a 0900 dose at 0900.

This just got me to wondering...What kind of policies are out there? For how many patients are those nurses providing care? How many/what kinds of meds and accuities? Do the policies work?

Anyone care to comment?

[Indy, LPN, LVN]

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.

[morte, LPN, LVN]

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.....

[flashpoint]

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.

[Elvish, BSN, DNP, RN, NP]

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.

[Lorie P.]

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+

[veegeern, BSN, RN]

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?

[veegeern, BSN, RN]

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

[morte, LPN, LVN]

: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..

[Ayvah, RN]

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.

[Ayvah, RN]

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 +/-.

[morte, LPN, LVN]

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

[Ayvah, RN]

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)?