Giving meds late o.k.?

Nurses General Nursing

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Is it typically acceptable to give a medication after more than an hour has lapsed from the scheduled time?

I ask this because last week during my clinicals (I am a nursing student) our clinical instructor was incredibly slow when passing meds with us. For whatever reason she requires that she be with us whenever we give any kind of med's (even PO) and as a result some of us have to wait till 9:30 or 10:00 to give 8:00 a.m. med's. We were always taught that you have an hour window before and after the scheduled time to give the med's. Our clinical instructor has us write down that we gave them at 08:00, even if we gave them at 10:00.

Last week the charge nurse became aware of one student who was still holding her 0800 med's. By this time it was 0945 and the charge nurse took the med's and said she could no longer give them. Our clinical instructor was angry with the charge nurse and said, "yes I understand it is late, but these med's are not scheduled again until tomorrow morning.. so we might as well give them now."

What is done in the nursing home is different from what is done in the hospital, and there is no leeway because the instructor was two hours late getting to the floor; then it becomes the legal responsibility of the nurse assigned to the patient to make sure that they are administered on time.

Sorry, but it is not the nurse to decide what can be given now and what can wait until the end of the shift. Meds are ordered at specific times for a reason, and if the state comes in and audits the facility, they will be dinged significantly, and if times are not truthful as to when something was given, then you can be held accountable for posting of inaccurate times and can lose a license over same in some cases.

Sorry, but a med pass in a nursing home should not take more than two hours, and that time falls within the scope of med administration if started one hour before meds due until one hour after. Anything else and you are liable for it, and can be brought on issues by the Board of Nursing for your state. What a DON tells someone to do, does not make it legal for you to follow, she is not the BON that can take a license.

Specializes in Peds, PICU, Home health, Dialysis.
No, you didn't, that's why I said don't GET cocky. ;)

Of course by this time the students should know. But don't you have a few classmates who make you say, "How the **** did she get in here?!" I sure did!

Haha.. yes, there are a few I question how in the heck they ever made into nursing school.

Sorry, but a med pass in a nursing home should not take more than two hours, and that time falls within the scope of med administration if started one hour before meds due until one hour after. Anything else and you are liable for it, and can be brought on issues by the Board of Nursing for your state. What a DON tells someone to do, does not make it legal for you to follow, she is not the BON that can take a license.

It wasn't possible for me or those with whom I worked in LTC. It simply wasn't, if one did it safely and properly.

Specializes in PCU/Telemetry.

There were 10 students in my clinical group in fundamentals and med pass was a disaster. We would have 10 students first waiting in line (with 4-5 nurses trying to take care of their OTHER patients) at the accudose to pull meds. THEN we had to wait for our instructor, who drilled us on each med we were giving: class, action, side effects, adverse reactions, contraindications, etc. Then she went with us for med pass. It was definitely a long process. We were lucky if we got our 9 am meds passed before lunch. My instructor was usually OK with us passing meds with the patient's primary nurse though. Maybe you could ask her if it would be OK to ahve the primary nurse accompany you to pass them.

Specializes in LTC, assisted living, med-surg, psych.

I've done time as a nursing-home nurse too, and I will be the first to admit that getting med passes done on time was one of the biggest challenges I faced. But the fact is, you HAVE to get those meds out in the time frame allotted, or be able to explain why you didn't. This means that if you give an 0900 med at 1100, you must document the reason on the back of the MAR (and for gosh sake, take care not to administer the next dose at noon, even if it's due then).

We all know things happen in real life that make it difficult, if not impossible, to give all meds on time every single time; residents fall, choke on their food, have MIs, and die. However, chronic failure to complete med passes on time usually means either a systems problem or an individual problem, and in my experience it's most often an individual problem. But even when it IS a systems problem, a nurse still has the obligation to try to fix it---it's not OK to just say "I can't do this" and leave it at that.

Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

It sounds as if the way we did it when I was a student (yes, back in the day!) actually worked better.

We took turns being the medication nurse. The student giving meds did not have a patient assignment, but rather gave meds to a hall or group of patients. We were expected to know about the meds our patients were getting, whether we were giving them or not. When it was your turn to be med nurse, you were expected to know all of them! The instructor could help other students in between med passes but didn't have to chase around with every student to give meds.

It seemed to work well.

It is your responsibility to get the meds administered within the appropriate timeframe that they were ordered in.

If they were ordered "Q day" then as long as they're given once a day, they're being given in the timeframe that they were ordered in. And I would argue that I know better than a pharmacist that has never seen my patient what time of day is best to give them. I currently work peds. I'm not going to wake a sleeping baby to give prevacid at 0859 just because a pharmacist thinks they need to be given within an hour of 0800. Doing something just because the pharmacist picked a random time to call "QD" on the MAR is just as mindless as doing something just because the doctor ordered it, whether it makes sense or not. One facility has TID at 08,14,20 and one down the street has 10,16,22. I can't believe that giving the same med at 1000 in the first facility (as long as I adjust other times that day) is dangerous because it's past the magical hour, but it's the "proper" time to give it in the second facility. If the BON wants to take my license because I gave a qday med once a day, then it's my time to get out of nursing.

Specializes in icu, er, transplant, case management, ps.
If they were ordered "Q day" then as long as they're given once a day, they're being given in the timeframe that they were ordered in. And I would argue that I know better than a pharmacist that has never seen my patient what time of day is best to give them. I currently work peds. I'm not going to wake a sleeping baby to give prevacid at 0859 just because a pharmacist thinks they need to be given within an hour of 0800. Doing something just because the pharmacist picked a random time to call "QD" on the MAR is just as mindless as doing something just because the doctor ordered it, whether it makes sense or not. One facility has TID at 08,14,20 and one down the street has 10,16,22. I can't believe that giving the same med at 1000 in the first facility (as long as I adjust other times that day) is dangerous because it's past the magical hour, but it's the "proper" time to give it in the second facility. If the BON wants to take my license because I gave a qday med once a day, then it's my time to get out of nursing.

I hate to point this out to you, medications, even one given once a day, is given within a specific time frame. You are aware of the half lives of various medications, aren't you. Medications are absorbed and excreted at a specific rate. It may not be important to you but it is important to the patient's well being.

Woody:balloons:

I hate to point this out to you, medications, even one given once a day, is given within a specific time frame. You are aware of the half lives of various medications, aren't you. Medications are absorbed and excreted at a specific rate. It may not be important to you but it is important to the patient's well being.

Woody:balloons:

If it needs to be given within a specific timeframe, it needs to be ordered "q 24 hour" (antibiotics for example.) The average qday med, being given at 0901 instead of between 0700 and 0900 isn't going to make such a big difference that I need to disturb my patients' sleep or ignore a pressing need in another room to give my meds "on time." My point is that I have just as much respect for nursing judgement than arbitrary times set by a pharmacist that hasn't laid eyes on the patient.

I think what bothers me most (and has nothing to do with the OP) is that we spend so much time worrying about little rules like giving meds within an hour of the ordered time, rather than worrying about why it's a rule, and whether it applies to our patient and is actually best for them.

Sorry, but a med pass in a nursing home should not take more than two hours, and that time falls within the scope of med administration if started one hour before meds due until one hour after. Anything else and you are liable for it, and can be brought on issues by the Board of Nursing for your state. What a DON tells someone to do, does not make it legal for you to follow, she is not the BON that can take a license.

Med passes shouldn't take more than two hours but where I worked you were lucky to get them passed out at all, especially taking into account all the disruptions the nurses dealt with: difficult patients, unexpected occurences, phone calls, and there was even a special inservice where the nurse's were singled out because of complaints they were not giving PRN pain meds in a timely enough manner when the aides or whomever instructed the nurse to give them. This often meant stopping med pass, locking up the cart, usually to go way down to the other end of the hall, and if we were technically doing as we should this meant pulling out the charts and starting on the paperwork which was even more time consuming. Oh yea, and we were to answer call lights, too. Call lights were to be answered within a minute or two, which would mean locking up the cart yet again and going down the hall and depending on what they wanted this could take a minute or ten minutes. Not to mention the way the MARS were set up if it was done just as the MARS said, even using the hour before or hour after window, we would have been passing out meds around the clock. It was especially bad because we had certain doctors who loved to prescribe pills in excess. Everytime we would orient a new nurse she was appalled at the amount of medications we were to give.

I've worked 7a-3p and 3p-11p and 11p-7a and 3-11 was the worst shift to pass meds on.

Anyway...

I'm no longer in LTC and I'll be scrapping junk cars to make a living before I go work in another nursing home. I've been followed by the inspectors with their clip boards, I've even met them on a surprise visit when a disgruntled, terminated employee wanted to create a little excitement for the facility. They (inspectors) were nice actually, and usually understanding. In spite of the dings the facility always fared pretty good. I can see a purpose for the inspectors, but it seemed like each one decided things should be done differently and some of the so-called standards were not reasonable and it looks to me like if things keep going the way of more and more expectations and standards most nursing homes will eventually be regulated right out of business.

But I can see how it would be perfectly reasonable to expect meds could be given on time in a hospital.

Specializes in home & public health, med-surg, hospice.
I think what bothers me most (and has nothing to do with the OP) is that we spend so much time worrying about little rules like giving meds within an hour of the ordered time, rather than worrying about why it's a rule, and whether it applies to our patient and is actually best for them.

THANK YOU, Wooh!

See, this is a nurse that has an appreciation of the concept of a nurse having autonomous control over his/her own practice!

And, Woody62, I'm quite sure that Wooh is

aware of the half lives of various medications...Medications are absorbed and excreted at a specific rate
.

In fact, I would go so far as to say that most nurses are aware of those issues, considering pharmacolgy is a heavily emphasized portion of NCLEX and that most spend the biggest majority of their days as staff nurses in dealing with medication administration and its effects on their patients.

And Wooh is right. If it needs to be given at specifically 0800 or an hour thereof, then it would be written q 0800 NOT q day.

Furthermore, guess what...it's not the pharmacist's position to make that determination either but rather the prescriber's.

The point is, nurses have the knowledge to make accurate judgments regarding time of administration if not otherwise specified and if we were truly practicing our profession autonomously we would be doing so!

ETA: I'm gonna go check out Wooh's other posts b/c I think she/he ROCKS!

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