Giving meds early/late

  1. I know the general rule is 30 min-1 hr, but When I was passing meds the other night a very experienced nurse told me to give 6 o'clock meds at 4. One was a BP med and the other was Nitropase. She said just get it done that way I don't have to go back. Then I asked others what they thought and they said that's too early and I could get in trouble, which is what I was thinking. But I did it because I'm new and that nurse was positive it was fine. I guess I should have used my own judgement. Obviously u wouldnt give antibiotics early or late, but what do you guys think about the others?
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  2. 20 Comments

  3. by   flutist
    You are right with the one hour time frame. Depending on how often the nitropaste is changed, it could throw off. If you give it 2 hours early and the next nurse gives it an hour late, that is a three hour time change.

    I'm guessing the experienced nurse was just trying to save time and is probably set in her way and does what is easier.
  4. by   Birdy2
    Well it's my butt if something goes wrong so I think I'll just stick with one hour
  5. by   MissM.RN
    Interesting question! Where I work, we technically have 1 hour and 59 minutes to give a scheduled med (ie, 0800 med can be given starting at 0701 up to 0859). I imagine this policy was drafted due to our high ratios and the fact that we have many patients scheduled for 3 antibiotics all at 0800

    Answering the question requires pharmacy knowledge, and I hope the veteran nurse looks things up before just doing it a certain way for your own convenience. for example, is it sustained release sinemet or metoprolol? I would pause. think about the order, the type of med, and remind yourself that timing is critical for a patient to get any benefit from it. When I was a new grad I was afraid of giving late meds for fear that my "late med statistics" would be bad. Now I'm not afraid at all. I give meds to the best of my ability within my patient ratio, and only when it makes sense based on the med itself - which I still look up in micromedex to this day. If I'm ever called into the office about late meds - you bet i will have a justification for each time. even yesterday, i gave an antibiotic late because it was incompatible with the IVFs, and the efficacy of the abx would be impacted. again, not giving meds early/late for convenience, but safety. good luck to you as you become a seasoned nurse yourself!
  6. by   Birdy2
    Thank you! I have talked to others since then and got yet another answer. This person said 1 h. They also mentioned that were really allowed to give prn pain meds 30 min early, which I didn't think was ok at all. I would worry about giving too much. Anyways, I think I've decided that I will only give antibiotics about 15 min early, BP meds same (maybe earlier if they're needing it right then), the rest I guess an hour just because that's what our policy is. I'm still confused about how late is ok. Like if antibiotics are due at 1900 and I don't get med from pharmacy until 2200....is it still ok to give it?? That's a little harder.
  7. by   wheeliesurfer
    I think it is better to give an ABX late than to skip a dose unless absolutely necessary. For a BID abx giving it a few hours late and then getting back on schedule would be appropriate. I think a few hours with a TID would be okay as well, but giving a QID abx a few hours late would be pushing it and I would likely skip the dose and get back on track with the next scheduled dose. Even home abx the pharmacist usually says if you forget a dose to take it as soon as you remember, but if you are close to another scheduled dose to skip the missed dose and resume at the next doses time. Use your nursing judgement and call the pharmacist for clarification/recommendation if there is doubt in your mind.
  8. by   ixchel
    Quote from Birdy2
    Thank you! I have talked to others since then and got yet another answer. This person said 1 h. They also mentioned that were really allowed to give prn pain meds 30 min early, which I didn't think was ok at all. I would worry about giving too much. Anyways, I think I've decided that I will only give antibiotics about 15 min early, BP meds same (maybe earlier if they're needing it right then), the rest I guess an hour just because that's what our policy is. I'm still confused about how late is ok. Like if antibiotics are due at 1900 and I don't get med from pharmacy until 2200....is it still ok to give it?? That's a little harder.
    The antibiotic should still be given and in my facility, that would warrant a call to pharmacy to possibly change the timing of future doses.
  9. by   Karou
    Quote from Birdy2
    Thank you! I have talked to others since then and got yet another answer. This person said 1 h. They also mentioned that were really allowed to give prn pain meds 30 min early, which I didn't think was ok at all. I would worry about giving too much. Anyways, I think I've decided that I will only give antibiotics about 15 min early, BP meds same (maybe earlier if they're needing it right then), the rest I guess an hour just because that's what our policy is. I'm still confused about how late is ok. Like if antibiotics are due at 1900 and I don't get med from pharmacy until 2200....is it still ok to give it?? That's a little harder.
    I would call pharmacy about the antibiotic. Tell them that it just arrived and you will administer it, they can retime the future doses. Antibiotics should never be "missed" but if necessary can be administered late (not yet delivered from pharmacy, pt in testing, ect...).

    I will give pain meds 30 minute early on occasion. Especially if the patient is in acute pain and their interval is q4hr or q6hr. I won't do it more than once a shift though because I feel if the patient is requiring pain medication early more than once then the physician needs to be notified and they need an order for something else for breakthrough pain.
  10. by   Lennonninja
    Go with what is acceptable in your facility. At mine we have 1hr before or after to give it. In that situation, as long as there weren't contraindications for any reason I would have given the 4:00 and 6:00 meds all at 5:00.
  11. by   TeeKay12
    My facility's policy is an hour either way is okay. When I go in, I map out when each medication is due throughout my shift and plan my med passes. 2100 is a popular time, and let's face it, no-one is going to pass multiple meds to 6 patients at 2100 and be on time with all of them. I start my med pass at 2000 and usually finish right at 2200. Antibiotics, I try to get hung within 30 minutes of their scheduled time. Vancomyocin I try to get up within 15 minutes. At no time would I give anything 2 hours early just so it's more convenient to me! IF antibiotics are late coming up from pharmacy, you hang it when you get it, chart it as being unavailable at the ordered time and call pharmacy to retime all future doses.
    pain mdications I will not fudge more than 3 minutes. If the patient is in so much pain they can't wait, I'll call the doctor and either get an increase, change in dose, change in medication, or a PCA ordered. Think of it this way: if pain meds are q3 and you gave it at 1900 and the patient asks for it at 2100 - will you give it? When would the next dose be available? 2400 or 0100? Then, if you fudge it again and again, you're setting up for giving the patient more than prescribed and that's out of our scope of practice.
  12. by   Twinmom06
    the only med I would do that with is Lovenox/Heparin. In our facility AM meds are due at 0800 and Heparin/Lovenox at 1000. When I did dayshift I'd just give the shot since wasn't affecting BP/BS etc...
  13. by   grandpaj
    The house pharmacist is your friend when you have questions about scheduling and/or giving late meds.
  14. by   akulahawkRN
    Quote from Birdy2
    I know the general rule is 30 min-1 hr, but When I was passing meds the other night a very experienced nurse told me to give 6 o'clock meds at 4. One was a BP med and the other was Nitropase. She said just get it done that way I don't have to go back. Then I asked others what they thought and they said that's too early and I could get in trouble, which is what I was thinking. But I did it because I'm new and that nurse was positive it was fine. I guess I should have used my own judgement. Obviously u wouldnt give antibiotics early or late, but what do you guys think about the others?
    First, as others have said, pharmacy is an excellent resource for you. Also, your facility should have a policy for med pass timing. At one hospital that I was at recently, if it was a pain med due Q4 or less, we had a 15 minute window on either side. Any other Q4 med or any antibiotic had a 30 min window on either end. A Q6 or Q8 med (any) had a 1 hour window early or late. Q12 meds had (I think) allowed 2 hours early or late, and I'm pretty darned sure that Q24 could be given 2 hours early or late.

    It has been about 6 months, so I'm not as certain of policy as I used to be. School was very insistent upon the 1 hour before/after window... but pain meds had effectively no early window.

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