starting an antibiotic

strawberryfields · Jun 22, 2014

No one? *bump

Editorial Team / Admin · Jun 22, 2014

What do the facility policy/procedures say to do? That would be the best place to look.

As an example, the policy for my facility is if it is within 3 hours of the default scheduled time (0900 and 2100 for bid medications), we are to give it at that time and then follow the schedule. If it is more than 3 hours, we are to give it and then gradually adjust dosing times by one hour until we are on the appropriate schedule.

TheCommuter, BSN, RN · Jun 24, 2014

In the state where I work, the initial dose of an antibiotic is supposed to be initiated within four hours of receiving the verbal, telephone or written order from the physician. The rationale for this rule is to treat the patient's infection as soon as possible.

I would have administered the antibiotic at 22:30pm with a small snack such as some yogurt, pudding or crackers to comply with the recommendation that the drug be taken with food.

Moreover, if I receive an order for an antibiotic, I prefer to be the one who gives the initial dose so as to avoid liability issues later on down the line. I'd rather not pass this type of task onto another nurse on another shift. Sometimes nurses receive orders for antibiotics during the evening, fail to give the initial dose, and the patient makes a turn for the worse during the night.

If the patient or family sues, an astute lawyer is going to read the medical record and pounce on the fact that the nurse assigned to the patient failed to give the initial dose during his/her shift, and instead, passed the task onto another shift. Receiving an antibiotic order at 22:30pm and not giving it until 9:00am can be viewed as delaying patient care.

vintagemother, BSN, CNA, LVN, RN · Jun 24, 2014

Hi Commuter....I'm in CA....I have seen nurses admit residents prescribed an ATB and order it from pharmacy. 24 hrs later, the med wasn't recvd. No one is concerned, either.

Do you know what best practice is in this situation?

Does best practice depend on the setting?

TheCommuter, BSN, RN · Jun 24, 2014

Hi Commuter....I'm in CA....I have seen nurses admit residents prescribed an ATB and order it from pharmacy. 24 hrs later, the med wasn't recvd. No one is concerned, either.
Do you know what best practice is in this situation?
Does best practice depend on the setting?

The situation depends largely on the laws in the state where you live, as well as the policy and procedure at your place of employment.

If an ABT has not been delivered by the pharmacy within 24 hours in an LTC/SNF or ALF, I would bug the pharmacy and have them deliver the medication STAT. If your facility keeps an e-kit, I would pull the initial dose from the e-kit.

amoLucia · Jun 25, 2014

In LTC, some places will have a backup pharmacy that the primary contracted pharmacy can contact for something needed that can't wait. Like the local Walgreens or CVS. But it's already in an agreement somewhere, not something that the facility can just call up,

It burns me when a nurse will delay starting an ABT 'just because' the USUAL policy states a certain time to start will fall tomorrow. And that's when it gets plotted out for administration. If it were 'me or mine'' I'd be real PO'd that we had to wait unnecessarily while still being uncomfortable and possibly deteriorating. Would that nurse accept her own decisions re administration if it were her kiddo or hubby or herself as the pt??? I seriously doubt it.

So just figure out how to get the med and get it started as quickly as poss (as safely recommended by mfr).

You know what else gets delayed, a Medrol pack. Medrol is given for allergic reax and someone is going to wait to start it!!??!! The pt is miserable with S&S and the allergic reax could progress, and someone's going to wait!!!???

Am incredulously smacking head!

TheCommuter, BSN, RN · Jun 26, 2014

I totally agree. We must remember to assess the patient, not the policy. When it comes to antibiotic therapy, we want to initiate as soon as possible. Always look at the big picture.

Some nurses miss the forest for the trees.

In LTC, some places will have a backup pharmacy that the primary contracted pharmacy can contact for something needed that can't wait. Like the local Walgreens or CVS. But it's already in an agreement somewhere, not something that the facility can just call up,
It burns me when a nurse will delay starting an ABT 'just because' the USUAL policy states a certain time to start will fall tomorrow. And that's when it gets plotted out for administration. If it were 'me or mine'' I'd be real PO'd that we had to wait unnecessarily while still being uncomfortable and possibly deteriorating. Would that nurse accept her own decisions re administration if it were her kiddo or hubby or herself as the pt??? I seriously doubt it.
So just figure out how to get the med and get it started as quickly as poss (as safely recommended by mfr).
You know what else gets delayed, a Medrol pack. Medrol is given for allergic reax and someone is going to wait to start it!!??!! The pt is miserable with S&S and the allergic reax could progress, and someone's going to wait!!!???
Am incredulously smacking head!

amoLucia · Jun 27, 2014

I totally agree. We must remember to assess the patient, not the policy. When it comes to antibiotic therapy, we want to initiate as soon as possible. Always look at the big picture.
Some nurses miss the forest for the trees.

Thank you. My point exactly!

CapeCodMermaid, RN · Aug 31, 2014

Why are you treating for 10,000 colonies? We usually don't treat unless it's over 100,000 and the patient is symptomatic.

Nica-RN, RN · Oct 20, 2014

We have to start the ABT as soon as we receive the order. And we'll get it from the EDK.

firstinfamily, RN · Oct 24, 2014

Ditto, we always started the antibiotic ASAP. You could provide a snack when giving the ABT. Usually we would have a stat dose and then time the ABT around the clock according to the MD orders.