Do I give the med or hold?

Nurses Medications

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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 the other nurses give this med and not worry about this.

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)

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Nor do I find it wise or ethical for you to tell new grads that the drug book shouldn't be followed because common sense supersedes research... I would hope that any new grads reading this post would have the common sense to not listen.
You're taking it out of context. I never said the drug book should be disregarded. I use it a lot myself. But following it's recommendations without question isn't always practical. The book also says to crush and give each pill separately when through a tube. This is impractical, too.
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Specializes in Case Management, ICU, Telemetry.

Yes, you wake them up 30 minutes before breakfast. And yes, the nurses that have been doing it for years are wrong, this is what we call "evidence based research" and second, it takes a month for the thyroid levels to change in the blood but symptoms of too high or too low levels vary from day to day. It easy to see that you are unwilling to change your practice because an LPN with 9 months of education and 3 years experience knows more about a drug than the people who crated it, this is the mentality that impedes improving patient outcomes.

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Specializes in Case Management, ICU, Telemetry.

We have obviously gotten off of topic from the original post, if you would like to discuss this further you can private message me.

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All right, I'll just add one more thing. I said our synthroids are *scheduled* at 8am. Which means the doctor obviously is aware and is fine with it. Please understand that the 3rd shift LPN has 80 or 90 residents. "30 minutes before breakfast" is patently impossible. To wake up the perhaps 30 residents on synthroid so early would risks of falls and interfere with the or quality of life. If you can come up with a logistically possible way to administer this med the way you think ot should be, I'm all ears.

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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?

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)
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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.

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Double post

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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.
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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.

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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.

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.

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Specializes in Case Management, ICU, Telemetry.

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....

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