Time allowed for medication administration changing.

Nurses General Nursing

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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?

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!

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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 :lol2: ) 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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Specializes in vascular, med surg, home health , rehab,.

Don't you love it? As soon as corporate can tell me how I can be in 7 rooms and give a ton of meds safely, while answering questions about them, etc, etc, I am all in! I start my 10am meds at 9am and am almost always still doing a round at 11, sometimes later.

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Specializes in Telemetry, Nursery, Post-Partum.

We have an hour before and after. Quite handy! Also, we don't need an order to change a med admin time, but because we use a computer med charting system now, pharmacy has to be willing to change it. Otherwise, you do need to grab an order, which is a pain. And no need here to get an order to crush meds (those that are appropriate to crush, of course), that seems a little over the top to me.

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In my Gero clinical setting it was 60 min either way...In the Med Admin skill test it was 30 minutes....

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We use computer barcode medication administraion (BCMA) This covers the 1hr 59" period.

If you're early or trying to give the med later, it automatically asks for an explanation.

The joy of BCMA is, that IF it works correctly, you CAN'T make a med error.

Just recently heard, we have up to 2 hours before/after.....considering the shortage in some areas, this could be why......Med/Surg Floor with 6-8 patients..........Thats just nuts:uhoh3:

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Specializes in LDRP.

used to be 1 hr either way at old job. new job in same hospital system is 30 mins.

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Specializes in Med Surg/Tele/ER.

An hour before or after here.

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We have an hour before and after. Quite handy! Also, we don't need an order to change a med admin time, but because we use a computer med charting system now, pharmacy has to be willing to change it. Otherwise, you do need to grab an order, which is a pain. And no need here to get an order to crush meds (those that are appropriate to crush, of course), that seems a little over the top to me.

if that is how YOUR p+p reads, go for it, just be aware that in other practice arenas it may not be so......and make sure that it does, and not "everyone else does it so it must be ok".....

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Specializes in Nephrology.

In Pa we also have the 1hr. window, but as of last week our hospital policies have also changed to 30 minutes .

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Specializes in floor to ICU.

1 hr before/after here. I hope "they" don't decide to change it to 30 min. With the increasing comorbidities of some of the MS patient's, I'm not sure it would be doable.

Some of the elderly patients that have 4 or 5 consulting physician's have pages of meds. Dealing with that on top of the other urgent situations- low BPs, HRs, blood transfusions, K+ infusions, onset of chest pain, arrhythmias, lack of tech's to take everyone to the bathroom, family members, endless admits/discharges topped off by the never ending cycle of admitting and consulting docs changing/writing new orders all day....getting dizzy just thinking about it :uhoh3:

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Specializes in NICU.

haha! For a second I thought I wrote your post kriso!! Maybe if they gave us less patients we could get meds out on time!!

I always look over my meds for all my patients.. Decide which meds are most important to be on time and I give those patients their meds first. I think it is ok if the patient with the multivitamin, aspirin, and folic acid gets their meds a little late. Not that I want to give meds late. But when I have 7 high acuity med/surg patients and I'm dealing with all the things in Kriso's post as well.. Sometimes it just doesn't happen

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