Med Admin. question

Do-over, ASN, RN · Aug 9, 2011

Wellll, I would check your facilities P&Ps and act accordingly.

That being said, I wouldn't pull and give that early simply out of convenience, but I would if patient condition warrants it. In the latter's case, the doc should probably be notified...

As for the BP meds - I have given early, but with the doc's OK - as in they have a really elevated BP and the meds aren't due for a few hours - "hello doctor, Mr Smith's BP is scary/too high and his lopressor is scheduled for the morning and I don't have anything to give PRN..."

Edited to add - just noticed this was the LTC forum, I don't really know anything about standard practice in LT.

CT Pixie, BSN, RN · Aug 9, 2011

My facility (and pretty much all around here)...ok to give scheduled meds an hour before scheduled time up to an hour after (with the exception of insulin of course). PRN's are to the hour, for example, APAP q6hrs PRN...I give it at 6pm, it cannot be given anytime before 12am.

If the MAR reads 5pm, I can give it anywhere between 4 and 6pm.

10pm meds given at 730? eeekk! Nope, can't do that. But it's best to refer to your facilities P&P..speak with DON/ADON for clarification etc.

Brea LPN · Aug 9, 2011

Its supposed to be one hour before and one hour after, but in LTC the med passes for 40 patients can't always but fit into the two hour window.

tyvin, BSN, RN · Aug 9, 2011

Anyone who has worked in LTC knows what the score is when it comes to med administration. You will see many things done differently in LTC. When she gave the bp med at 22:00 why didn't you ask for the rationale ... did she take the bp before giving it etc...? Waking up residents is unacceptable in my book unless it's an ABx or some other type of non-routine PRN. And why in the world does a person have a routine med a 22:00 in LTC?

The residents all go to sleep at different times and some will sleep at 19:00 and on. As soon as they finish their dinner the staff prepares them for bed. Perhaps this lady goes to sleep early and the nurse knows this. I would say many of the residents go to bed and are asleep by 19:00 so the HS and 21:00 scheduled meds need to be given before they fall asleep. Remember these are older people who need lots of sleep ... usually. Also they are being awakened at 07:00 to prepare them for breakfast so they do go to bed fairly early.

Perhaps a review of the meds by staff and then recommendations to change the 21:00 to 19:00 or 20:00 would be in order. The HS and AMs are given at the discretion of the nurse but I believe 17:00 would be a bit early for an HS unless it's how the resident usually takes it. Talk with the nurse and ask her the questions you posted here, then you will have your answer.

Also, if the meds or a med time needs to be changed, bring it to the attention of the charge. It doesn't take an act of God to change the time of a med.

systoly · Aug 9, 2011

In my state, each facility has to have a policy with regards to PM, BID, HS, etc. For instance, BID may be 0800 et 1700, HS may be 2000, so giving a BID Rx close to 1700 is perfectly alright and if to be spaced out needs to be ordered q12. Keep in mind, condition always supercedes time. If a Rx is ordered for HS and per facility policy to be given at 2000, you may overide the time for a resident who wants to go to bed early or late. As far as unsafe practice is concerned... a lot of med passes in LTC are unsafe because of the sheer number. Most LTCs in my area have med passes involving 50 pt.s ore more...you do the math.

honeykrown, MSN, NP · Aug 10, 2011

well part of the 5 patient rights says right time (and rule of thumb 1hr before and 1hr after) 2-3hrs b4 hmmmm...

agldragonRN · Aug 10, 2011

hi all,
i have a question regarding meds and working 3-11. i recently did an orientation for second shift and am a little unclear on timing of meds. the facility uses pm and hs, we also have 5pm and a few 10pm scheduled as well. the nurse i was orientating with gave pm and some hs meds between 3:30 and 5pm. i did have to wake a few residents up for the hs meds the other night. my question is is it safe to administer meds (specifically bp meds) that are scheduled bid to be given in the am and at 3:30-5pm times instead of am & pm. she also gave a med scheduled for 10pm (again bp) around 7:30. i was always taught 1 hour before and 1 after is allowable. is this unsafe practice?
thanks

i work 3-11 shift as well. your facility should have a policy regarding the times medications are given.

here's how it is in my facility:

daily = usually 9am

bid = 9am and 5pm

hs = 9pm

tid = 9am, 1pm, 5pm

qid = 9am, 1pm, 5pm, 9pm

q 6 hours = 12am, 6am, 12pm, 6pm

q 8 hours = 6am, 2pm, 10pm

q 12 hours = 9am, 9pm

in addition, you have to consider what medication you are giving. for example, when the md writes order as synthroid 100 mcg po daily, we put the time at 6:30am because it must be given on empty stomach. you should consult with your unit manager and ask her/him if there is a policy regarding this.

about the 1 hour before/after window, you will soon learn that it is very hard to be in compliance with this when you work ltc having so many patients and management knows this but chooses to look the other way.

good luck!

achot chavi · Aug 10, 2011

you can ask the doctor to change the med to the time that you give it, sometimes, there is a reason to justify giving a med early, but as a new nurse I urge you not to pick up the bad habits of other nurses. Stick to the P & P of your facility and all the good advice you got from the posters above me.