Is giving meds early common??

[Bonnie86]

I just finished my 2nd week off orientation as a new grad and feel that all I'm doing is running around giving meds ALL DAY. I work 7a/7p and have been staying until 9:30 to do charting. I don't have time to look at labs, orders, do dressing changes...nothing.

Last night a slightly more experienced nurse told me she gives ALL her morning meds at ONE time (as long as it's safe). She even gives antibiotics early (due at 10 given at 8). I do full assessments and she told me she does focused assessments only. She said she used to stay that late catching up, but was griped at for OT so she had to do something.

Is this common and acceptable??? Last night I had a new admission which took me forever right before shift change and I missed two antibiotics, dressing change, and my 6 p.m. feeding to unconcious PEG tube pt. I did them all, but was there until 10 p.m.

Everyone says things will get better with experience, but by experience do they mean you learn you HAVE TO cut corners in order to get everything done in 12 hours????

[kevx]

Once I had a pt with meds scheduled for every hour. I clustered all the medications into groups. ie: 0800, 0900, 1000 and 1100, 1200, 1300 etc. A vast majority of our patients are on q8 heparin sq and one dose is always due at 1am. I hated waking up patients for their heparin injection.

[K+MgSO4, BSN]

It depends on the reason that a pt is fasting. If they have a bowel obstruction there is NO point in giving them meds PO as they will not be absorbed & simply sit in the gut until the obstruction is resolved and then they may be days of meds absorbed

(seen it happen another ward was giving my SBO PO endone as he was in severe pain for 2 days as we had no beds. He arrived up to the ward and 2 days later he was unresponive as he was truly narc'd from absorbong approx 60mg of endone.)

If they are going for surgery it depends on the surgery vascular pt often need to have their their anti platlets where as other surgeries the pt needs to be off their anti platlet (asprin, clopridgril) to reduce the risk of bleeding

We give anti hypertensives and analgesics as we are told by our anaesthetic docs that it is easier to raise BP than drop it.

[HappyApple]

Our floor has a policy where we give anti hypertensives, psyche meds, & pain meds while NPO. We also give 1/2 or all of long acting insulin if NPO dependent upon if they are DMTI or DMTII. For organization I have a list down the side of my brain for each pt's tasks: T O M A S CP FP GP N. This refers to my task list, orders, meds, assessments, screens (fall & pressure ulcer), care plans, fall precautions (I.e. bracelet, socks, fall POC & fall stickers on chart, & fall sign on door), green paper (has to do with RBC), & note. I have been a med/surg nurse for 3 yrs now & was an extreme ball of anxiety the first yr. hang in there...it will get better. I am very confident & for the most part comfortable in my abilities as a nurse. I do still have days that make me feel like a complete ass though. Good luck!

[classicdame, MSN, EdD]

In our acute care hospital we have specific times and nurses are allowed to administer 30 minutes prior to or after that time. Other than that, the nurse needs an order from the MD

[veronica butterfly, ADN, RN]

I've been Med/Surg for 6 years and change my plan of attack daily and depending on the patients. Every day on Med/Surg is so different and I really rely on my intuition. This last weekend I had two heavy pts and two "easy" pts. I knew the nursing assistants were with the heavy pts a lot early on (getting them up to chair for breakfast, toileting, turning) so I knew they were being tended to and started with my two easiest pts, did their assessments, gave the meds, and actually charted everything. Then by 9 am I knew I had the rest of the morning with the tough ones. Sometimes you get an assignment where you've got one pt that needs a lot of watching from the get-go and you spend your time with them, and your other 3-4 you end up ignoring.

Many of my pts I do a "mini-assessment" on. If it's a young person in their 40's in with a rule out MI, I listen to their heart, take their vitals, and make sure everything is in place to go to their stress test. Bye-bye--the folks they're going to see in the next couple of hours (resp therapists, nuc med techs, cardiologists) are a lot smarter than me and that's what the pt is there for. I don't spend time looking for pressure sores, etc. Get r done... If someone is in with abd pain, I focus on the abd... If they've got cellulitis and they're diabetic, I focus on their wounds, edema, and blood sugars. Old folks with chf, a broken hip, kidney disease.... them I do a super thorough assessment on.

I usually don't do my dressing changes til later in the morning or early afternoon. If it's an ortho pt, they can eat, poop, do PT and then when they're back to bed by noon, I can do their daily dressing change then. There's no hurry with the daily dressing change.

You just eventually get a feel for what needs to be done asap and what can wait. Sometimes I group my meds together, but usually if they're spaced apart an hour or two, it's for a reason. Flomax needs to be given after a meal, Synthroid before... Antibiotics need to be given at a regular interval so they kill the germs... I had a c-diff pt with a lactobacillus capsule that directions on the MAR stated specifically should be given 2 hours apart from any ORAL antibiotic. Guess what, no one was following that direction. If it was you or your loved one, wouldn't you want the directions followed?

Our pts waiting for surgery are NPO but they have to have their beta blockers, so I give them with a very small sip of water. Any other questions, I call the doc and ask (and chart the answer!).

Med/Surg can be brutal, follow your gut and do your best...

[JGmomof2]

It is almost impossible to medicate your patient at 8, come back at nine,and then 10 kust for meds. Sure you'll be giving bedside care in there somewhere but I find that it is much easier to make a checklist and follow a plan (let that include grouping meds)

Not only does it help your day go more smoothly be grouping together meds timed within an hour or two that can be safely given together, but discussing this plan often has favorable responses from patients since they are included in this decision and feel more involved in their care. I find that many patients prefer to follow their home routine which does not tend to fall in lne with our pharmacy scheduled times. I simply make a notation where required (MAC shows that it is being given too early or too late) stating that this is the patients preference, and leave note for MD if there is a two hour diff or more. Remember that I said that WHEN meds can be given together safely.

Everyone finds the routine that works for them, have faith and dont sweat the small stuff!

[tcvnurse, BSN, RN]

Heck yes! I give my 8 9 and 10 o'clock mess at the same time unless it's contraindicated. I get there early and check vitals and look over the chart. I do quick assessments on everyone and then MEDS. Seriously, sometimes you have to practice defensive nursing.