Do I give the med or hold? - page 6

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... Read More

  1. Visit  spectrabrite profile page
    0
    My facility wakes all the residents on synthroid every morning about an hour before breakfast between 0630 - 0730


    That is the way the orders are written, what happens when the state comes through and you are not giving it as ordered?

    Quote from BrandonLPN
    So you're saying we should wake half the floor up at 5 or 6 in the morning to give them a synthroid? Why? We check thyroid levels. How we are giving it is working. Im sorry, but for a new grad to come in and say the nurses there have been doing it wrong for years is a little offensive. (not saying the OP did this)
  2. Get the hottest topics every week!

    Subscribe to our free Nursing Insights newsletter.

  3. Visit  BrandonLPN profile page
    0
    I lied, one more thing to add. In LTC this is the patient's *home*. I feel we have an obligation to make this as homelike as possible while still maintaining a safe level of care. Years before I started here, the medical and nursing staff got together and decided the practice of having the 3rd shift LPN pass one or two pills to half the population at 6am is silly and inefficient. With a few rare exceptions (ABX and timed pain meds) these meds were en masse moved to 8am. In return, on each floor, the doc took residents who are naturally early risers and rescheduled all their 8am meds to be given by thirds at 6am. This is a HUGE help to day shift. And we have happy, healthy residents to justify this practice. None of these time changes are recommended by the drug companies, but we need to be flexible. And, remember, medical staff backs this all the way.
  4. Visit  BrandonLPN profile page
    0
    Double post
  5. Visit  BrandonLPN profile page
    0
    Quote from spectrabrite
    My facility wakes all the residents on synthroid every morning about an hour before breakfast between 0630 - 0730That is the way the orders are written, what happens when the state comes through and you are not giving it as ordered?
    Happily, as a state facility we are ironically freem from the intrusive hand of state surveyors. And these meds are ordered at 8am. Never once in a single post here did I ever advocate giving meds contrary to orders. Doctors decide how meds are ordered, not the pharm companies themselves.
  6. Visit  spectrabrite profile page
    0
    we are given orders for a medication but must follow the pharm / drug guides unless specific written orders are given otherwise.

    Sounds like you are bending the rules because you know you are watched by the state like a normal facility.

    It is not bad / strange or harmful to wake them up for synthroid or fosamax that the guide specifies to take on an empty stomach before breakfast. Does you docs 8am orders state does not need to be on an empty stomach? If so I would take that to mean 8am med and breakfast is given between 830 - 9am sometime.
  7. Visit  morte profile page
    1
    yes the theraputic effect is greater on an empty stomach. However, balance this against an increase in falls in this group of demented elderly persons...I think the higher dose with food is going to win that arguement hands down. This is the realistic, real world reality we work with. And meds that need/should be given on an empty stomache don't nec. need to be given before breakfast, could be before lunch or dinner. And Brandon is giving this WHEN it is order to be given.
    Quote from spectrabrite
    we are given orders for a medication but must follow the pharm / drug guides unless specific written orders are given otherwise.

    Sounds like you are bending the rules because you know you are watched by the state like a normal facility.

    It is not bad / strange or harmful to wake them up for synthroid or fosamax that the guide specifies to take on an empty stomach before breakfast. Does you docs 8am orders state does not need to be on an empty stomach? If so I would take that to mean 8am med and breakfast is given between 830 - 9am sometime.
    BrandonLPN likes this.
  8. Visit  SL2014 profile page
    0
    Last time I checked doctors done order meds for a specific time lol the order is written "levothyroxine xmcg PO QAM" sometimes with "ac" after QAM... The time listed on the mars is not the physican's order, it's the time as chosen by the person who transposes meds to mars... VERY rarely does a doc ask for a med to be given at a specific time....
  9. Visit  SL2014 profile page
    0
    And morte, levothyroxine is almost exclusively a QAM drug, so it will only be given before breakfast. Other drugs that designate "on an empty stomach" means 30 minutes before and 2 hours after food.
  10. Visit  SL2014 profile page
    0
    And a final note, if you ask a lot of these people, when they are at home they take their synthroid before breakfast... It's a point that is emphasized by primary care. That being said if a person is at your facility and you are improperly giving their synthroid with breakfast and they go home and take it the way it should be, now their dose will likely need adjustment. Not only does this recommendation improve absorbtion but (assuming everyone follows the same rules) ensures the absorbed dose is consistent despite setting.
  11. Visit  spectrabrite profile page
    0
    all the orders we get state time except for prn meds. Must just be my facilities policy with the docs.

    Quote from sarrah
    Last time I checked doctors done order meds for a specific time lol the order is written "levothyroxine xmcg PO QAM" sometimes with "ac" after QAM... The time listed on the mars is not the physican's order, it's the time as chosen by the person who transposes meds to mars... VERY rarely does a doc ask for a med to be given at a specific time....
  12. Visit  BrandonLPN profile page
    0
    A few points: a) our breakfast is at 730. b) the doctor explicitly changed the med time to first shift, to avoid third shift having to wake people up so early c) in my facility, and many others, nobody is going home. They are here till they die. d) the third shift nurse has upwards of 80 residents some shifts so popping in 30 minutes before breakfast is not as easy as you suggest. It can not be done by any human on the planet. She would have to start giving them at 5 am or earlier.
  13. Visit  morte profile page
    0
    Quote from sarrah
    And morte, levothyroxine is almost exclusively a QAM drug, so it will only be given before breakfast. Other drugs that designate "on an empty stomach" means 30 minutes before and 2 hours after food.
    there in lies the key, in the real world things are not ALWAYS optimal. and AM goes until 12N. Had to change a patient's time to 10 am because she wouldn't take it at 6. It was aborbed quite well, her TSH went from 9 to 1.
  14. Visit  morte profile page
    0
    I am with you brandon. Reality can be daunting, but must be dealt with.
    Quote from BrandonLPN
    A few points: a) our breakfast is at 730. b) the doctor explicitly changed the med time to first shift, to avoid third shift having to wake people up so early c) in my facility, and many others, nobody is going home. They are here till they die. d) the third shift nurse has upwards of 80 residents some shifts so popping in 30 minutes before breakfast is not as easy as you suggest. It can not be done by any human on the planet. She would have to start giving them at 5 am or earlier.


Nursing Jobs in every specialty and state. Visit today and find your dream job.

Top