can you give prevacid (PPI) "too early"?

miniangel729 · Jan 26, 2013

oops.. nevermind.. I found the answer.. (don't know how to delete the question, thought might as well post the answer)

Peak: 1.5 - 3hr

Duration: 24hr

Half-Life: 1.5 hr

so it still works, just less effective...

KelRN215, BSN, RN · Jan 29, 2013

Why can't you just reschedule it for her to take it when she wakes up? I'd be pretty annoyed if I was in the hospital and got woken up several hours before I wanted to be awake to take prevacid.

Sun0408, ASN, RN · Jan 29, 2013

KelRN, don't go into the hospital.. You will be woken to take meds at strange hours, woken for vitals at midnight and 4am not to mention assessments. Hospital nursing is 24/7 so while we try to allow pts to sleep as much as we can, we can not stop treatments etc just because they are sleeping...

Our pts are all scheduled protonix at 6am every morning. I wish we could get it changed to 4am. This way we only have to wake them once. Labs are due at 4am, assessments are due at 4 also. Then I have to wake them again for their 6am meds UGH...

KelRN215, BSN, RN · Jan 29, 2013

I know what the hospital is like... I worked in one for 5 years and have spent time in one as a patient- multiple times. Prevacid is not a time-specific med, there's no reason why it HAS to be given at 7am.

Why can't you change the protonix to 4am or even 8am? When I worked in the hospital, if I found meds scheduled for stupid times, I retimed them.

Sun0408, ASN, RN · Jan 29, 2013

We can't re-time them, it would make things so much easier if we could.. Pharm won't change the times with out MD order, and the protonix is a "fixed" time.. That's why I had the big UGH behind my response :) Some things should be changed and scheduled with others nursing duties to decrease interruption and I as well as many of my other co-workers do as much as we can to minimize but some things are out of our control..

KelRN215, BSN, RN · Jan 30, 2013

You know, this kind of thing... the hospital's "we have to do it this way because this is the way we do things" attitude is one of the reasons why I left hospital nursing. I can't deal with this kind of backwards rationale. "Why do we give the Prevacid at 7am? Because that's what time we give it here." If there's not a real reason why the PPI has to be given at 7am or at 6am, it's stupid to insist that it HAS to be given at that time. People who take this medication at home don't take it at precisely the same time every day just like I don't take my morning medication at the same time every day... I'm ddAVP dependent on BID dosing... I usually take my meds around 9 and 9 but if I sway from the norm, it's not a big deal. If I sleep until 10am on the weekends, I take it when I wake up. If I have to get up at 5am to drive 5 hours to New Jersey as I did on Saturday, I take a fractional dose (enough to prevent me from breaking through on the drive) and then get myself back on my normal schedule during the day. When I was in college, I would take my night time medication at 9pm on weeknights but sometimes not until 2 or 3 am on weekends.

If I was a patient on either of your floors, the nurses would probably label me a "difficult patient" as I'd be refusing this med if the hospital insisted I wake up at the crack of dawn to take it. The only scheduled PO medication I have ever woken a patient up to take is decadron... and that's for patients who were on it q 6hrs following surgery. But, even then... try to get them on a 9, 3, 9 and 3 schedule- give them the 9pm dose before bed and then wake them up between 3-4 and do everything... VS, neuro checks, meds, all at once. I rescheduled meds every day of my life as a hospital nurse... our system was so dumb that if a patient was admitted in the middle of the night and ordered for "daily" meds, it timed them all to be given at 3am (or at whatever hour was closest to when they put the order in). Not when they take them, so we retimed them to the appropriate times. For some patients, maybe these were night-time meds that they'd just taken at 11 or midnight... were we going to give them again because that's what time they were timed for? No. Were we going to waste our time calling the Resident (who we finally got to enter these orders for the patients' regular meds after physically handing them the list and reminding them 3x) and telling him to enter a different start time? No. And, you know, the system was so stupid that even if the MD ordered a "daily" med and wrote a comment "give at 12pm", if the order was entered at 3am, it got timed for 3am. It was always the nurse who did the retiming. All BID meds were automatically timed at 8A/8P but, again, for some patients that wasn't when they took their meds. If I'd had to call the MD every time I needed to retime a med, I would have done nothing but stare at the MAR for 12 hours on end.

Sun0408, ASN, RN · Jan 30, 2013

I so feel ya and hear ya..

KelRN215, BSN, RN · Jan 30, 2013

I so feel ya and hear ya..

You made me feel happy that when I worked in the hospital, this (nursing not being able to retime meds) was one stupid rule I didn't have to deal with. :)

Sun0408, ASN, RN · Jan 30, 2013

My last hospital we could and then we would call Pharm and have them change all other times since we could only change the first dose.. This hospital while great has a few minor kinks I am still trying to get used to. No, I wouldn't call you a difficult pt, many of my pts I let them know ahead of time what to expect through out the night and love the ones that say"can we hold off on that" or "can we do that later".. I do try to let them be as much as possible but sometimes I/we can't

P.K.RN · May 3, 2014

miniangel and Sun0408 -

I think this speaks to several larger issues. First, I recommend that you talk to your Nursing Practice Committee about looking into this issue. As reimbursements for hospital care is being increasingly tied into patient satisfaction, and multiple interruptions during the night has been identified an enormous pt. disatisfier, it's worth looking into by nursing and hospital management. There is evidence that improving sleep in the hospital not only increases the patients perception of satisfaction, but also that improved sleep decreases actual length of stay as well as pain scores and anxiety levels, and increases retention of education (possibly decreasing patients being “bounced back” into the hospital, another Medicare reimbursement issue). So, there are many compelling reasons that administration should look into your concerns and ideas for minimizing patient interuptions during the night and early morning. It may help, or you could also suggest, that pharmacy and patient advocates be involved in this discussion as well. At our facility, we tried to get the PPI times changed (currently 0700), but the GI docs threw a little fit and said it wasn’t appropriate to give it later.

If you are working in a hospital large enough to have a Trauma/Surgical ICU, I'm assuming it also has a robust nursing practice council, nurse researchers who would probably be thrilled to hear from bedside nursing about suggestions for policy change, a patient advocate position, and a medical librarian who can take your request for a research stream and give you evidence based articles about the issue you're interested in - for example, the effects of loss of sleep on patient outcomes. I work in a moderately sized hospital, and our librarian LOVES working with nurses to find things they are passionate about, and is in general a great person to know for just such reasons.In my own practice, I will give it when the patient wakes naturally (to pee, or ask for pain meds or whatever), and we have the option under our electronic charting to specify WHY a med was given at a time different from that ordered; in this case, I’m able to indicate “patient request”, or “other”.

Remember that patient outcomes improve when we practice up to the full extent of our education – in this case, that includes YOUR knowledge of administrating medications appropriately, assessing effect, and making informed suggestions for change when this is outside your scope of practice. Your practice also needs to be based on clinical evidence, and if you can support your position with good research, your manager SHOULD be interested in what you have identified as practice issues - if not, well, that's a pretty big problem, isn't it? Also, it is your ethical responsibility as an RN to advocate for your patients well being and to respect patient autonomy. You are well within your rights to ask your patient, after discussing with them why a PPI was ordered, if they are OK being woken for this, if they would prefer that it be retimed, and documenting that the pt. refused the med or requests times be changed, which IS THEIR RIGHT.

It may seem like this a minor inconvenience, or a small work around, but it seems to me like this is reflecting a much larger issue inside your facility, and suggests an environment that is dismissive of the scope and knowledge of nursing. Don’t take it lying down – advocate for you patients as well as your profession!!!!

MomRN0913 · May 4, 2014

KelRN, don't go into the hospital.. You will be woken to take meds at strange hours, woken for vitals at midnight and 4am not to mention assessments. Hospital nursing is 24/7 so while we try to allow pts to sleep as much as we can, we can not stop treatments etc just because they are sleeping...
Our pts are all scheduled protonix at 6am every morning. I wish we could get it changed to 4am. This way we only have to wake them once. Labs are due at 4am, assessments are due at 4 also. Then I have to wake them again for their 6am meds UGH...

I dont fully believe in this concept. I would not wake a pt up for a 6 am Prevacid. Sleep is also a vital part to healing. No way in heck am I waking up my pt is Prevacid is the only reason they need to be woken for.

you most certainly can retire certain meds for pt comfort.