Time Frame for Med Administration

[Unknown member]

Hi,

In school, we learned that meds can be given within an hour of the designated time frame. In other words, if a med is due at 2100, it can be given between 2030-2130. Here on AN, I've noticed others saying that they combine 2000 & 2200 meds and give them at 2100 as to save time and let patients sleep. I understand that it really depends on the medication, but generally is this acceptable in the real world of nursing?...because in school, it was not. I start my first job soon and it's night shift. I want to allow my patients uninterrupted sleep but I've never seen nurses giving meds an hour late and an hour early (well, purposely. of course meds are given late all the time due to other circumstances!). Any thoughts?

[nurse2033, MSN, RN]

Many nurses make compromises every day to try and follow the rules and give good patient care. Just be aware that if you take shortcuts you open yourself up for being disciplined or fired, especially if something bad happens. Find out what the policy is where you work and follow it to the best of your ability. Even if the accepted practice flaunts the policy, your license is what is at risk. To answer your question, yes things like that happen but accepted by your coworkers and accepted by JHACO or the nursing board is something else.

[Anna Flaxis, BSN, RN]

Whether it is acceptable depends upon the policy of the institution in which you work. When I worked the floor at the hospital, policy allowed us to combine 2000 and 2200 meds by giving them at 2100 because we had an hour window on either side of the scheduled administration time. Find out what your facility's policy is, and follow that.

[rn undisclosed name]

Anywhere I have worked at I've been able to give meds within an hour either way. So 9:00 meds can be given as early as 8:00 or as late as 10:00 and still considered on time. Of course it depends on the medication, especially if it is time sensitive such as certain antibiotics (like vancomycin).

[AnonRNC]

I recall the 1/2 hour rule from nursing school 830 - 930 for a 900 med, and my first hospital followed that rule. However, my current hospital give us an hour either way 800 - 1000 for a 900 med...makes life easier. That said, if you have a med dosed any closer...than...I dunno, maybe q4...I'd try real hard to stay on schedule.

[Lynx25, LPN]

We have a two hour window, and since I'm LTC, honestly there's some days where people are going to get their stuff a little late.

Judge me if you want, but hey, it happens.

HS meds are awesome, because I have many people who want to go to sleep RIGHT after supper- they get their 5pms, and their HS sleeping stuff all around 5:30 after dinner.

[Been there,done that, ASN, RN]

Are you documenting by electronic record? In my current facility .. you would need to explain why the med was given outside of the parameters, before documentation of the administration will occur.

There are several "explanations" that make it legal.

Patient is NPO.. Patient refused.. patient is nauseated. etc. ( My personal favorite.. The FAMILY refused administration)

And the ALMIGHTY.. "nursing judgement".

We use this all the time.. as the nursing judgement is... "how can I possibly pass a gallion pills to a gallion patients within that time frame!

Scope out how the seasoned nurses get around this impossible restriction.. and go with it!

[MunoRN, RN]

CMS's current rule is that medications should be given within 30 minutes of of their scheduled time in the MAR (which is a little meaningless since CMS has no problem with Nurses changing the scheduled time. There are of course some meds where this is appropriate, but it's not a good absolute rule mainly for safety reasons.

Most describe the rule as idiotic, although ISMP states more eloquently but with the same general message:

CMS 30-minute rule for drug administration needs revision

Our facility is a CMS provider yet we still have our 2-hour window by policy, we just referred the CMS surveyor's to the ISMP position during their last rounds.

[Nurse SMS, MSN, RN]

Anywhere I have worked at I've been able to give meds within an hour either way. So 9:00 meds can be given as early as 8:00 or as late as 10:00 and still considered on time. Of course it depends on the medication, especially if it is time sensitive such as certain antibiotics (like vancomycin).

This is the policy where I work as well.

[Esme12, ASN, BSN, RN]

It depends on the facility policy. Those nurses are working a technicality. Me? Personally? as a routine to administer on late one early as a routine? Like Muno said "There are of course some meds where this is appropriate, but it's not a good absolute rule mainly for safety reasons."

I wouldn't do it as a routine "habit" to let the patients sleep....in an acute care setting. Long term? I might consider it differently and cater more to my patients habits.

[CT Pixie, BSN, RN]

I work LTC and we have an hour window on either side..can give it one hour earlier than scheduled dose or 1 hour after.

[That Guy, BSN, RN, EMT-B]

Check your policy. But what you ultimately do is up to you. I think the 30 before and after rule was ridiculous. You would always be going into rooms when you have 7-8 patients. It got real old real fast. But someone like me I have to play by the rules