Is giving meds early common?? - Page 2

The dreaded med pass...ugh a blast from the past when patients got one or two meds. Now they get 19 or 20. We're changing our med times so the people can sleep in if they want so daily meds can be given between 6am and 1159am. If the doc still wants a specific time, we try to group everything we can at a few times so the med pass is not the be all and end all of the day.

You'll get the hang of it.

At my facility, we have medication scanning...and any time we try to scan a med that is more than an hour before the due time, we get a little alert. The only time I will do this is if the med needs to be given early, usually after talking the physician. I have had scheduled (as opposed to prn) pain meds that won't be due for another 2 hours but after speaking with the physician, they will tell me to go ahead and give it early. When I do, I make a little comment "Dr. so & so stated to go ahead and give med early" or something along those lines.

If a patient has meds due at 2000, 2100 and 2200 (I work nights), I will try to give them all at 2100 as long as it is safe. Most of the 2000 meds are antibiotics, however, and those should be given on time. Sometimes I'll cluster the 2000 and 2100 meds to save time. Meds due at 1930 should be given by the previous shift...those are usually antibiotics. Same with Synthroid doses that are due at 0730 - night shift is responsible for giving them, unless the patient is off the unit for a procedure/test or if the dose is not available in our Pyxis and has to be sent up from pharmacy, which we do not have on nights.

As others have said, try to cluster care.

You do have to cut corners in these days. With the med passes of today, I would take a very long time. I found a way. Give the medicine at the time they are ordered. This may seen a stupid answer but hear me out. Now this is only for 3-11 in long term care but I would give all of the 3's together then all of the 4's then thew 5's and so forth I found that after about a half year doing the 3-4 5-6, doing the meds when they were ordered gave me enough time for things like lunch, nd charting. Maybe this will work for you.

I dont know how it is in america but we generally try to put all our meds on the same time, so you can expect you give meds at 6, 12, 2, 6, 10 and during the night, of course there are always exceptions. As for giving meds early, ive seen nurses give meds 30 minutes before and 30 minutes too late...I try to be on the dot when giving meds, but i think our system is a bit easier, less multi tasking.

Our computer charting gives us a 1 hour window (my AM med pass goes from 8-10). It is a pain in the butt to give meds early because the program makes you explain why you are giving it early, so I usually stick with the window. Prioritize your important medications first, on our floor that would be IV abx and BP meds. I try and give the antibiotics as close to the due time as possible due to SCIP measures. I usually go to see all my patients first thing in the morning, sometimes before report if the last shift is busy (I won't wait around to do an assessment). By the time I am done with assessments it is 0800 and I can start meds. I figure out when meals are coming for each patient, and pass morning meds with insulin. When I am done with meds I will worry about dressing changes and other tasks. If it is a time consuming patient I do them last, it can be overwhelming to get stuck in a room for 30-45 minutes when you know you have countless little tasks to do. I prefer to finish the little tasks so I can feel free to focus on the big ones.

Our cardiac surgery patients have a protocol, we give them their beta blockers only, but hold all other pills. For other patients I might give some BP meds, I definatley give pain meds, and depending on the patient/medication I might give a psyche med. However, check with your providers! Some will change to iv BP/pain meds. The providers I work with don't bother, but everyone is different.

When I was working in a pediatric hospital, I always contacted the doctor with this question, and would have them write me an order if they wanted me to do anything other than holding all meds while NPO. Generally speaking, they wanted anti-convulsant meds given but most others could be held. If the pt's only scheduled meds were something that could very obviously be held with no problem, such as daily vitamins, I would hold them, but anything else I would ask the doctor.

Our rule of thumb on holding meds is if they're cardiac we give them, if not we hold them. Some docs specify, but usually that's what we do.

Nursing in a hospital is 24 hours, so if you missed the meds or feeding the next nurse can do it. Won't like it, but can do it. Look at facility policies regarding when meds can be administered. Remember Maslows---safety first (including meds) then worry about the rest. You will get faster as time goes on, but there is no such thing as dallying around