1 hour window on med pass times...

[elimayrn]

I've read several posts describing the 1 hour window on the scheduled med pass time as being 1 hour before or one hour after. I believe this is wrong, it is 30 minutes before or 30 minutes after! Secondly, if Residents want (and are used to) getting their 20:00 meds at dinner, the nurse should send the physician a communication fax asking to change the scheduled time to 18:00. They will usually oblige this if the Resident wants them at that time and as long as it isn't a TID med which cant be given too close together anyway! These points will help keep you in compliance. Otherwise what in the world will you do if someone falls after having BP meds too early or when state is in house? :notgood:

[BostonFNP, APRN]

Without instruction? Our docs write "Lasix 20 mg by mouth daily". Daily is daily.

"Remeron 7.5mg by mouth daily at bedtime" is something I write all the time. I assume it's being given at bedtime..maybe I shouldn't assume...

[sharpeimom]

Speaking from a personal point of view, some meds should be given as close to when they're ordered as possible. I have had complex simple seizures since I was a year old and have been on Keppra and Neurontin for years. I take the Keppra at HS and I have to split the morning dose into a morning dose and a noon dose because the standard way makes me dizzy and Blecch! There is some carryover, but during allergy season, when I have a temp, or it's hot and humid, I need the pills by 1300 or I have a seizure. My seizures consist of vise grip strength contractions on the right upper quadrant of my face. No loss of consciousness, but still.

I've passed my share of meds and have been as far behind some shifts as anyone else and the only solution I've been able to come up with is to prepass meds like anticonvulsants when they're due, then start my regular meds pass.

[wooh, BSN, RN]

"Remeron 7.5mg by mouth daily at bedtime" is something I write all the time. I assume it's being given at bedtime..maybe I shouldn't assume...

Bedtime and daily are two different things.

Giving a med between 0600 and 1145 would be "daily." But it wouldn't be "bedtime." (Well, it would often be MY bedtime!)

[caliotter3]

There are daily meds I take in the morning and daily meds I take at bedtime. Unless there was some compelling reason to do otherwise, I would think the facility could follow their own policy while taking into consideration what works best for the resident. I know that I've seen those accommodations in the past.

[CapeCodMermaid, RN]

Daily is once a day. If the patient wants their daily med at 11 am fine. If they want it at 4pm we would write 'give daily at 4pm'. It's a shame that the med pass seems to be the be all and end all at most places. It's only medication...its not the person's whole day. Do the residents need all those meds at a specific time? Debatable.

[BostonFNP, APRN]

Do the residents need all those meds at a specific time? Debatable.

I guess we disagree on this issue.Many common medications have significantly increased efficacy and bioavailability when give at specific times. Many others have side effect profile that are improved by specific time of administration.

[CapeCodMermaid, RN]

Everything we do is a risk versus a benefit. We give synthoid at 6 on an empty stomach because it's absorbed better. We give most everything else whenever...the benefit to the resident of living a more normal, less medicalized life, far outweighs the small risk of giving a Lasix at 11 instead of 9.

[ktwlpn, LPN]

I guess we disagree on this issue.Many common medications have significantly increased efficacy and bioavailability when give at specific times. Many others have side effect profile that are improved by specific time of administration.

That is all taken into consideration but it does not trump the resident's quality of life in LTC.We also consider the resident's wishes and goals for care. If a dementia resident will not accept meds at 6am on an empty stomach as recommended by the pharmacy(like synthroid) we document their non-compliance and adjust the admin time to facilitate acceptance. Or ask the family and physician to consider discontinuing the med.