Quote from manusko
How long does it take to do vitals. Say your floor does vitals every 4 hrs and you are giving meds at hr 2, what happens if your pt codes shortly after and dies? How does it look in court if you say, "well they were fine 2 hours ago and our floor doesn't check vitals before we give meds". You probably will being paying out. My philosophy has always been CYA. Why do the least amount to get by? I would do what you feel comfortable with and what can cause the least amount of problems for your professional life.
Actually, if you gave a narc and didn't check on your patient for 2 hours, you'd be answering first for not doing a focused assessment post-medication administration as well as for not adequately performing your regular checks on that patient. VS q4 hours vs q2 hours is irrelevant--it's still possible to check a patient's vitals and have them go down literally seconds after you leave the room. You can't be there 24/7.
There is nothing inherently wrong with taking VS beforehand. In fact, that was never indicated in my post. However, floor nursing is a busy experience. If your patient isn't symptomatic, they've been taking the narc often and don't have a hx of reactions to the drug, then VS aren't necessary.
I have never given a narc to a patient and then had them code as a result. There's CYA, and then there's over-vigilance that doesn't help anyone.
If pushing narcs is so risky, then PCAs should be restricted for patient safety because the nurse isn't there to monitor the patient for every dose of narcotic. And a basal rate! Don't even go there.