Do I give the med or hold? - page 5

by spectrabrite | 12,231 Views | 79 Comments

I work in LTC, my resident is given gabapentin (time release capsule) along with a lot of other tablets. This resident chews all meds and will not listen that gabapentin states "swallow whole, do not chew, or crush". I see all... Read More


  1. 0
    What's a PI sheet?
  2. 2
    Quote from BrandonLPN
    *sigh*, as I understood the OP's post, this guy has been taking this pill this way for ages. And is fine. What makes you think he's suddenly going to have a "reaction" or something? In this case all "holding" the poor guy's neurontin is going to do is probably result in some unnecessary neuropathy pain! If this were a brand new order or something that would be different.

    This reminds me of when a new grad came to my floor and decided that we need to reschedule all our 8am synthroids and prilosecs for 6am because "the drug book says they need to be given on a empty stomach." Give me a break! You really want the night nurse to go around and wake 20 ninety year olds at 5 am to give them a pill they've been taking safely at breakfast for years? Really?? Do people in the "real world" set their alarms for 5am to take their syntroid? No! Do they die of thyroid disease as a result? No! Common sense, people. Common sense.
    Brandon - I usually agree with what you post, but not this time...YES. We had to reschedule/give all our synthroids for 6:30 am. My facility could not bypass the pharmacy consultant inspection report that required us to follow phramaceutical directions.I'm from a super regulated state in the country. Just because "we've always done it that way" won't cut us any slack with our DOHSS survey inspectors. No way! I agree that it was stupid for a synthroid, but common sense doesn't pass survey.
    SL2014 and spectrabrite like this.
  3. 0
    the other people administering are med techs not nurses that just give what is ordered and dont think about these things or watch for problems.

    Quote from BrandonLPN
    You're missing the bigger point that this resident has been taking this med this way for a long time without any apparent adverse reactions. Did you ask the other nurses on the floor about it. I'm betting they'll tell you that everyone (including the doc) knows about it already. If he's NOT aware of the chewing, then I'm sure he'll change it. But don't be suprised if he doesn't. Just because the med book says "do not crush or chew" does NOT mean it's unsafe to do in every case. If this is how the resident gets his therapeutic dose, why on EARTH would you change it?? Trust me, common sense trumps the med handbook every time....
  4. 0
    I have been told that by chewing it realeases all at once, the resident will be fine no pain complaints for about 1 - 2 hours then calls demanding pain meds till the next routine dose and he has no PRNs.
  5. 1
    Our facility wakes the residents for there 600 - 700 synthroid and prilosecs

    the state wouldnt let it get pushed for to long before they noticed


    Quote from BrandonLPN
    *sigh*, as I understood the OP's post, this guy has been taking this pill this way for ages. And is fine. What makes you think he's suddenly going to have a "reaction" or something? In this case all "holding" the poor guy's neurontin is going to do is probably result in some unnecessary neuropathy pain! If this were a brand new order or something that would be different.

    This reminds me of when a new grad came to my floor and decided that we need to reschedule all our 8am synthroids and prilosecs for 6am because "the drug book says they need to be given on a empty stomach." Give me a break! You really want the night nurse to go around and wake 20 ninety year olds at 5 am to give them a pill they've been taking safely at breakfast for years? Really?? Do people in the "real world" set their alarms for 5am to take their syntroid? No! Do they die of thyroid disease as a result? No! Common sense, people. Common sense.
    amoLucia likes this.
  6. 0
    Quote from spectrabrite
    I have been told that by chewing it realeases all at once, the resident will be fine no pain complaints for about 1 - 2 hours then calls demanding pain meds till the next routine dose and he has no PRNs.
    Like I said, I'd put it on sick call for clarification. But, in this case, I don't see the point in holding it. Better he get a "quick release dose" than no dose at all.
  7. 0
    Quote from spectrabrite
    Our facility wakes the residents for there 600 - 700 synthroid and prilosecsthe state wouldnt let it get pushed for to long before they noticed
    The ironic part of working at a state facility is that we don't have to worry about state regulations. Maybe that's why I have a hard time understanding those nurses who do. So many of those state rules seem so asinine. Why wake those poor little old people up at the crack of dawn?
  8. 0
    I am mixing it in applesauce till I can get clarification from the MD
  9. 0
    Have your tried giving it in apple sauce or yogurt?
  10. 0
    Brandon - This is a good conversation, and I'm enjoying the back & forth. I pretty much feel as you do that the state of nsg today is XXX and I've just about reached my limit. I agree that some rules are stupid, asinine and expletive. But as Unit Mgr on a LTC unit, I once had to address a med pass error by an RN (usually very good) who punctured a COLACE (YES, a colace) and she squeezed it out for the pt. Oh, she told the State surveyor she'd get the order chg'd to liquid, but AFTER she squished the colace and gave it.

    I don't have all medications' actions, peaks, durations, side effects, etc memorized and I don't have Pharm D initials behind my name. I can only pass meds as recommended by the drug company (PI = pharm instructions?) and by the silly R & R estab by those who pull the puppet strings. And that's what's expected of all others who pass meds, do tx, ck VS, work equip, etc. When discordance occurs, it is nsg to correct - that's what we do.

    And as I said earlier, just because "we've always done it that way" doesn't make it right. Most of the times, there's no problem, but I think of that lady I first posted about who bit her imdur (and I was giving it correctly). We're reading about all the angst these newbies are experiencing with their med errors. Warnings are written for a reason! My motto has been 'when in doubt, err on the safe side'.

    So back to OP - I'd hold the neurontin and get it clarified. I mean, how much time are we talking when it's one dose and there are easy alternatives avail? PIA, yes. But it could be an imdur. And thank you for the dialogue, honest.


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