Time allowed for medication administration changing. - page 2

by veegeern

10,070 Views | 35 Comments

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... Read More


  1. 0
    We recently changed to 1 &59, to prevent errors of timing only. When you have 45 patients, and many are on multiple meds, and have pulses and bs to check, we needed more that the 1 hr window.
  2. 0
    Quote from Myxel67
    30 minutes before or after here too. As far as BID/TID. Different hospitals will set them differently. Ex. one hospital may use 0900 for QD, 0900 and 1700 for BID, and 0900, 1300, and 1700 for TID. QID 0900, 1300, 1700, & 2100. Ours uses hours 1 hr later than these.

    If a doc orders BID, Pharm will automatically use the standard BID times. It's up to the nurse to change it if times should be different. Ex: doc orders NPH insulin BID. It appears on MAR as 1000 and 1800. The nurse must change to 0800 (before breakfast) and 2200 (bedtime). Same thing if med should be given q12hrs and doc orders BID.
    you can change the times IF you want to be cited for practicing medicine without a license....if the institution has a prescribed time for BID, that is what you need to use....what you need to do is call the doc and get it ordered for appropriate times......i am sure in hospital, you do this all the time....but i dont think this will go over well with jacho (sp)
  3. 0
    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.
    Last edit by Indy on Apr 5, '07
  4. 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
  5. 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.
  6. 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.
  7. 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+
  8. 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?
  9. 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
  10. 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..


Top