Frequently changing a scheduled med's schedule

SinikRN101 · Oct 22, 2013

Yes on the consistent schedule. The only person that can change the schedule would be a Doctor's order. Check with your nurse practice act and/or state board. Ours states that we have one hour before and up to one hour after. IE) Order states to give at 2100, we can give it beginning at 2000, or up to 2200, after that it is considered a med error for missing one of the 5 rights. Patient, med, time, dose, route... etc. Also, the unique challenge of PDN, is you can check the BP all you want and if you miss the time, then the parent can decide they want to give the med. At that point all you can do is document in the nurse's notes "mom gave propanolol at this time" and inform the next nurse in report (if there is one). Hope this helps.

ventmommy · Oct 23, 2013

I think you need some clarification on the parameters for holding/skipping.

Ex. +8, BP too low

+9, BP okay, give med

next dose is +7 from this dose (gets you back on track)

OR

+8, BP too low

+9, BP okay, give med

next dose is +8 from this dose (adjusts schedule for foreseeable future)

OR

+8, BP too low

Skip

next dose is +16 from last dose

OR...there are several other variations on this. I just think that clarification from the doctor is in order based on the needs of the child. Will her BP skyrocket if she misses a dose completely? If so, then skipping isn't an option and you and the other nurses will need to be prepared for frequent schedule changes so that she isn't missing a dose.

No doctor ever set times for giving meds for my son. I made his schedule based on the dosing frequency and what made him queasy if given together.

tcooks7 · Oct 23, 2013

I think you need some clarification on the parameters for holding/skipping.
Ex. +8, BP too low
+9, BP okay, give med
next dose is +7 from this dose (gets you back on track)
OR
+8, BP too low
+9, BP okay, give med
next dose is +8 from this dose (adjusts schedule for foreseeable future)
OR
+8, BP too low
Skip
next dose is +16 from last dose
OR...there are several other variations on this. I just think that clarification from the doctor is in order based on the needs of the child. Will her BP skyrocket if she misses a dose completely? If so, then skipping isn't an option and you and the other nurses will need to be prepared for frequent schedule changes so that she isn't missing a dose.
No doctor ever set times for giving meds for my son. I made his schedule based on the dosing frequency and what made him queasy if given together.

I totally agree! I think the mom would be upset if I did call the pediatrician because she thinks she has to handle everything & I know I won't have the support from the other nurses seeing how they just do whatever she wants them to do. But this is all in the best interest of the child so I will give her doc a call. Thanks for the advice everyone!

ventmommy · Oct 23, 2013

Just tell her that you need clarification and don't want to risk an overdose. And give an example. Hopefully she'll see it as "I care about your kid and want to do things right" and not "I don't want to be controlled by an overbearing parent"

Nurse A gives med at 0800 because she held for 3 hours.

No note.

Drug starts working at +1 and peaks at +6 (or whatever. I don't know because I've never used this med)

Nurse B gives meds at 1300 because she didn't know about the extra 3 hours.

Now onset of second dose will occur while first dose is peaking which could cause extreme hypotension.

JustBeachyNurse, LPN · Oct 23, 2013

What about your clinical supervisor for support & clarification? Theoretically there is high potential for an overdose or med error here and the nursing supervisor should be aware. It's possible the MD needs to be contacted for clarification or an order/drug modification.

I've seen orders written like ABC hypertensive drug give 100mg via GT q 8 hrs. Hold if DBP 70 give dose and adjust dosing schedule accordingly. If DBP is

This was a med that dosing again too soon could bottom out BP. We also had q4 VS (HR, RR, pulse ox & BP) around the clock when awake, continuous pulse ox while asleep orders for this patient.

systoly · Oct 23, 2013

what ventmommy said

it's not a facility where you have to have a policy for AM, BID, etc.

we don't even have admin times on our Mar's

the rx is for q 8h, so check BP 8 hrs after last admin

i would leave it exactly the way it is

adding more parameters sounds good in theory

but the more complicated an order the higher the chance

for mistakes and this order is pretty straight forward

tcooks7 · Oct 26, 2013

So glad I don't have to deal with that crazy woman anymore! My replacement finished her orientation today and I start a new case Monday! I wish the best of luck to her daughter and pray that she treats the next nurse better so that they can take care of her daughter like I tried to!