Hi, yesterday I took over a patient at around noon from someone, and then the patient was to be discharged. So, I wanted to review her meds with her as to what or what not she had already had that morning, so I went into the computer, we chart with a scanning system and it shows the exact time the med was scanned.
The nurse who had had the patient all morning gave all her 8 AM and 10 AM meds together. I was surprised because I've always taken the administration times quite seriously and figure they are there for a reason. I asked another nurse what he usually does and he told me that he tries to adhere to the correct times too.
I assume she does this for her own convenience and efficiency. Our ratios were very good yesterday. She wasn't sick or anything, we switched patients for another reason.
What do you think of this practice? I saw it done on another floor before when I've floated and have picked up some patients and noticed that the previous nurse had given all the 8 AM meds and 10 AM meds together.
Specializes in Community Health, Med-Surg, Home Health.
That, I feel is the issue...the time factor. When I do floor nursing per diem, I have administered basic medications that had no real specific time factors, and I never had an order for 10am medications, but have had meds that had to be given at either 1 or 3pm, and I settled to give them at 2pm.
They tell you to start an hour before/hour after, but no matter how it is sliced, too many times, a person can be given 8am meds at 10am if they are distracted enough. The same for afternoon/evening pass, I am sure. Patients leaving the floor for tests, pharmacy late filling out the pyxis, emergencies, etc...all can lead to late med-pass and make some passes run concurrently. Like michelle126 said, no wonder we are tired.
I agree - giving both meds at the same time would be okay as far as they are not hourly meds. I prefer not to consolidate but sometimes you gotta do it.
Depends on the meds. Daily or BID meds, yes, I would. But Q4-6 hr. meds I would give as close to their scheduled times as possible, in order to keep the levels of the drug in the bloodstream at a steady state. Of course, we have an hour window on either end of the scheduled time within which it is okay to give meds, and for daily/BID meds, I can always have pharmacy retime them if needed. Only if the physician has specifically scheduled something for a certain time would this practice be unacceptable.
I don't remember having 10am meds, at least not recently. But I do have 12:00 and 14:00 and will give them together, also 18:00 and 20:00 I'll give together. Unless it was a specific med that was vital to be given at certain time.
I've never seen an order written "Give at 8 am daily." If I did, I'd try to adhere to it as closely as possible. Our meds are ordered "daily," "BID," "q6h," etc. and timed by the nurse who transcribes the orders. If they're timed strangely, I just retime them if there's no reason for the meds to be separated. If I have protonix scheduled at 08 and colace at 10, I either retime them or give both at 9. However, some meds are staggered for a reason - maybe they need to be before or after a meal, or the pt is on several BP meds plus lasix, and it drops too quickly when they're all taken together. Take a minute, think critically, and look up any interactions you may be unaware of, then do whatever makes sense.
I've never seen an order written "Give at 8 am daily." If I did, I'd try to adhere to it as closely as possible. Our meds are ordered "daily," "BID," "q6h," etc. and timed by the nurse who transcribes the orders. If they're timed strangely, I just retime them if there's no reason for the meds to be separated. If I have protonix scheduled at 08 and colace at 10, I either retime them or give both at 9. However, some meds are staggered for a reason - maybe they need to be before or after a meal, or the pt is on several BP meds plus lasix, and it drops too quickly when they're all taken together. Take a minute, think critically, and look up any interactions you may be unaware of, then do whatever makes sense.
This is how I practice as well. I used to worry over any criticism of my practice, even if the way I practiced made sense to me. Now I will listen to criticisms, but if I know I am right, or I have a better rationale, then I stop worrying myself over it. Two years ago, reading this thread wo's and uld have 's together at made me stress over "I'm not good enough!" but it's silly! Think about the medication you're giving, why you're giving it and if it's ok to put the 8's with the 10's, and it's within hospital policy to do so, you are NOT lazy, you are efficient and able to think critically
yep, think it all depends on the order and what type of meds.. if they are q day meds, or BID, I give 'em together, as long as there is no contraindication to doing so..at our hospital, all q day meds default to 10 am. At other hospitals I've been to it has been @ 9 am. So I feel fine giving those with say, a q 4 med that falls at 8 am..because 10 am is just a time chosen byTPTB, so to speak.
Thanks for the responses.It never occurred to me that it was okay to fudge so much on the times. I am occasionally a little late on a med. It sounds like this is fairly common and considered acceptable.
I also assumed that pharmacy had some reasons for the times they give.
Specializes in Burn, CCU, CTICU, Trauma, SICU, MICU.
I almost always give my drugs like that. Or at the very least, scan them like that! If I have zosyn, vanc and iv pepcid due, two at 8 and one at 10 - they are all getting scanned, probably close to 730. then I will do my assessments and hang them as they need to be hung as they run out over the course of a few hours. I do not have the time to keep running back and forth. By scanning them I am saying - i checked them, i've got my 5 rights down and the computer system does not know my patient or how my day is running. I am always directly at my bedside, its not like I'm leaving a pile of meds unwatched or monitored and would never do this with narcs. I wont dump all the antihypertensives in together, but I do know what meds need to be timed for a reason and what doesnt. Critical thinking. :)
We don't scan meds, but our MAR is electronic. I always document the actual time I give the med, in case anything happens. If, for instance, there is a question about an adverse reaction a patient had to a med, the time the med was given can easily be looked up and compared to the time the s/s appeared. It's also easier to judge the efficacy of drugs when you can look at the time of administration and compare it to the patient's response- for example, when a patient is receiving multiple meds for rate control or blood pressure control.
I almost always give my drugs like that. Or at the very least, scan them like that! If I have zosyn, vanc and iv pepcid due, two at 8 and one at 10 - they are all getting scanned, probably close to 730. then I will do my assessments and hang them as they need to be hung as they run out over the course of a few hours. I do not have the time to keep running back and forth. By scanning them I am saying - i checked them, i've got my 5 rights down and the computer system does not know my patient or how my day is running. I am always directly at my bedside, its not like I'm leaving a pile of meds unwatched or monitored and would never do this with narcs. I wont dump all the antihypertensives in together, but I do know what meds need to be timed for a reason and what doesnt. Critical thinking. :)
Doesn't your scanning of the med chart the administration time? That is how we chart when we gave the med. I will go on to the computer to see when meds were given.
As far as your 5 rights, the whole point of scanning the patient and the med is to help ensure the right time and right patient. How can you say you observed the 5 rights when you are giving the meds whenever you decide?
pagandeva2000, LPN
7,984 Posts
That, I feel is the issue...the time factor. When I do floor nursing per diem, I have administered basic medications that had no real specific time factors, and I never had an order for 10am medications, but have had meds that had to be given at either 1 or 3pm, and I settled to give them at 2pm.
They tell you to start an hour before/hour after, but no matter how it is sliced, too many times, a person can be given 8am meds at 10am if they are distracted enough. The same for afternoon/evening pass, I am sure. Patients leaving the floor for tests, pharmacy late filling out the pyxis, emergencies, etc...all can lead to late med-pass and make some passes run concurrently. Like michelle126 said, no wonder we are tired.