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- by thisnurse Apr 8, '02i thought it meant three times a day.
i had a patient the other night with a small wet to wet dressing change ordered TID.he had debridment of a small infected wound. surgery had come to the floor near 11pm and changed the dressing. after report i did my rounds and this patient was fast asleep so i did not wake him to change his dressing. he slept thru the night.
next morning the nurse i was reporting off to said TID means once each shift.
i think if the doctor intended for us to wake him up to change his dressing he would have written qshift. although i took a verbal lashing for not doing the dressing change, i stand by my decision.
ill not do it again the same way tonight if hes still there.
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- Apr 8, '02 by hapeewendyTID means three times a day
every 8 hours
but can be turned into q shift
*in terms of 8 hr shifts*
usually we tend to do drsgs on the medsurg floor I work on BID,or OD but when TID comes up we usually
do it early in the dayshift, afternoon and night
I have seen orders written for TID being 0600-1400 -2200 hrs but usually we improvise that to 10-18-22-2300hrs
one of the wound/infection control MD's put it brilliantly in that she said as long as the wound is being dressed properly and visualized and noted on each drsg change then the times are figurative
if an emergency happens are you gonna say
"hang on mr brown, I cant do cpr right now I need to clean out this decub ulcer"
my rationale for drsg changes is to follow the orders as best I can , but I will not wake a person up at 6am, if they are up at midnight I will do it then, if they are up at some point thru the night I will do it when they are awake
if the orders however are strict, I will follow them
I'm lucky to work with great (and practical) plastics drs who take our input and revise their plans accordingly
ps- for every decision you make in nursing there is gonna be someone who questions it, I always make sure I have a good reasonable explanation for things, as you seem to have !
- Apr 8, '02 by AgnusThree times a day. Check your facilities policy as they may specify certain times of day to do a TID med or procedure.
I personally would not wake a patient in the middle of the night to do a dressing change without a very good reason. Patients need to sleep undisturbed through the night more than they need dressing changes at a specific time. Since the dressing was changed at 11 pm , I would try to change it around 6-7 am (I'm assuming that is about the lenght of your shift. ) That would give him 7 hrs of uninteruped sleep.
We do 24 hour nursing not 8 or 12 hour. So it is not inappropriate for the next shift to do the dressing change at 7 or 8 am and then anohter around 3 or 4. The fact is you are not going to always get everything done on your shift.
It seems to me you were putting the patient's need for sleep first over the next shift's staff's needs. Oh for shame.
Q8H would be three times a day around the clock. But TID does not mean nor imply around the clock.
Perhaps You might get the MD to clarify the order further to read TID during hours pt. is awake. The doc might be ticked but if you explain your reason at least it won' t be you he is ticked at.Last edit by Agnus on Apr 8, '02
- Apr 8, '02 by ratchitQS = Q Shift, which gets confusing when some people do 12's and some do 8's. TID = three times a day, which means different things depending on action. A PO diuretic or BP med won't be taken Q8 at home, no point in having the patient up all night peeing in the hospital either. Might as well see how they will do on their home routine.
As for dressing changes, in most cases it would be useless to do one at 6am. If the doc comes in at 8 and takes it down, the wound has been traumatized twice. Not to mention the patient was exposed unneccessarily and the added cost of supplies for changing a dressing too frequently.
It sounds like there might be a shift war at your hospital- days wants nights to do 2 out of 3 tid things and vice versa. But 6am is just too busy a time to be doing dressing changes and the patient does deserve some sleep.
I try to get the timing of the changes as evenly separated as I can. But there are things more important than a dressing being done at exact 8 hour intervals. You did the right thing.
- Apr 8, '02 by NannaNurseHi, TID is, as the others here have stated, Three times a day. If the drsg was to be changed as the other nurse stated, it should have read 'q shift'. I also agree that I would not wake a patient up just to change a drsg. If it is c/d/i/, I would wait until the very latest time to change.
If I were a patient and I was woke up in the middle of the night ( I have been there as a patient and was woke up to be given medication to sleep ), I would be upset.
I would let 'whoever' know (the one doing the 'lashing') that they should get a clarifying order whether it is 'TID' or QS. I personally would not stand by for a lashing. I think this was unprofessional and like another stated, a power thing.
Hang in there and get the order clarified from the MD who wrote it. I just had 3 P.O's changed today. 'Hold medication/tx if patient is sleeping.
- May 18, '02 by AJACKT33Ztid is up for day nurse interpretation---at my workplace--I do not get a say in it. I also want to quit---but going to find a good place that makes sense of dr's orders. I think tid w/o specification is 9-1-5.
- May 18, '02 by mother/babyRNPerhaps the person who complained didn't want to have to do it twice on their shift? Three times a day works for me, and unless times are specified or the order is written to do it q shift, I wouldn't have a problem with letting the person sleep, although, if I was assessing the pt anyway, such as with vs, breath and bowel sounds and the overall deal, I would have changed the dressing too for my own peace of mind. Still, think you were in the right as long as there was no drainage on the dressing and you visualized the actual incision/wound....
- May 18, '02 by fedupnurseTID where I work is defined as 9a 1p 5p. BID is either 9a 5p or 9a 9p. If a doc wants it q shift he should write q8 or q shift.
- May 18, '02 by PhantomRNTID is as the others have described three times a day.
What we would do is 6-7 am, 1 pm and 7-8 pm
- May 18, '02 by KaraLeaHere, TID is 0800, 1300, 2000