Meds:Initial Dose LTC

  1. I work a medicare/LTC unit. We do not have an in house pharmacy, nor a Pyxis. Many times, our admits come in after 1500.. We get the orders, transcribe and fax to pharmacy. The pharmacy delivers tid..approx 1000, 1500 and 2100. The DON wrote orders last week for a homeopathic <what ever>OTC for C-Diff, to be given bid. As I transcribed, I put 0800 and 2000 for times (standard on my hall..adjoining hall woulda been 0900 and 2100)
    OTC didn't come in until 2130, so I began the med the next AM.

    Today I was "written up" because I didn't give the med. I have been taught from day one in nursing school that the "Right Time" is an hour before to an hour after, in this case 1900-2100 would be correct.
    I raised that to DON and she stated " But you give the initial dose anytime. You could give it at midnight, and it would still be the 2000 dose"

    Am I wrong on this one?? I anm pretty upset...doing what I was taught to do, and get slammed in the head for it...
    If she (DON) is correct..I think education and discussion instead of punishment was more appropriate .

    I think I'm going to write the BON and get a written opinion
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    About joyflnoyz

    Joined: Jun '01; Posts: 492; Likes: 61
    LTC facilityto begin Home health soon!; from US
    Specialty: 7 year(s) of experience in home health

    21 Comments

  3. by   LPN1974
    I was taught to give the intial dose as soon as I got the medication.
    It needs to be started as soon as possible.
    You made the patient wait until the next morning, just because it was 30 minutes past the time frame of 1900-2100?
    Why would you do that?
    IMHO I would take my write up from the supervisor and leave the BON alone.
  4. by   CoffeeRTC
    Technically...no you shouldn't give it. BUT...I would have given it. And wrote a nurses note. It all depends....definaltly would start ABTs and some others....Don't think it should be a write up tho..just a teaching thing. Find out if there is a policy or what your docs want done. Our pharmacy delivers around 9pm then whenever they get the meds out might be 1 or 2 am? We try to use the E box for things needed and (gasp) borrow..med if needed.
  5. by   UM Review RN

    The DON wrote orders last week for a homeopathic <what ever>OTC for C-Diff, to be given bid.
    I'm just dying of curiosity--what was the med?

    Because if it wasn't a prescription med, if it was an OTC med, I wouldn't think it was a really important one either.

    Lots of times we don't give meds to patients coming into the ER because they already took the med at home. So if you didn't have knowledge of the last dose taken, I could understand your reticence to give the med.

    However, if it was a start-dose, then I would've given it if it was available.
    Last edit by UM Review RN on Mar 1, '05
  6. by   LPN1974
    Quote from michelle126
    Technically...no you shouldn't give it. BUT...I would have given it. And wrote a nurses note. It all depends....definaltly would start ABTs and some others....Don't think it should be a write up tho..just a teaching thing. Find out if there is a policy or what your docs want done. Our pharmacy delivers around 9pm then whenever they get the meds out might be 1 or 2 am? We try to use the E box for things needed and (gasp) borrow..med if needed.
    Michelle, I am curious as to why you say "technically, no you shouldn't give it"?
    The nurse in this episode, decided what times to give and wrote them on the MAR.
    If the doctor had ordered something q6hr and say the med came in from the pharmacy, you could specify the times according to whatever time the med was delievered and start from there. Say 9-3-9-3 or 6-12-6-12,
    I don't understand why you would make the patient wait for something that they obviously need to get into their system to get treatment started.

    Just wondering why you say, technically, no you shouldn't give it?
  7. by   CoffeeRTC
    I think Im wrong in what I said...I would still give it....Late is better than not at all. It would be considered an error in time. As far as retiming things...it works best in LTC to keep them on the facility time for passing meds..If giving something late I will tell the next shift so they can take it into consideration.
    BTW...I wouldn't accept the write up!

    What was the med? Lactinex? yeast?

    We had issues with this before esp with ABX ordered in the pms...thats why we have an E box...some will wait and start it in the am.
  8. by   LPN1974
    I still don't understand OP's reasoning for making the patient wait almost another whole 12 hours as opposed to giving it 30 minutes after the time frame. What is 30 minutes compared to almost 12 more hours? And C-Diff, at that.
    Where is the reasoning for that delay? HER schedule??
    If I'm sick, in the hospital or nursing home, I want some medicine. Get me something and give it to me, I don't care if it's 2:00am.
    And I don't see any need for not getting meds out in a more resonable time, if they're delivered at 9:00pm, as opposed to getting them out 4 or 5 hours later.
    Is this customary to make patients wait that long?
    Or is it just where I work? Am I not in the real world anymore?
  9. by   CoffeeRTC
    LPN1974....most LTCs don't have a pharmacy in house. Our pharmacy is about 30 miles away or at least 45 minutes. They don't do stat drug deliveries only for rare emergencies and its dificult to get them stat at that is 2 hrs? We have an E Box for some cardiac and abt meds
    Last edit by CoffeeRTC on Mar 1, '05
  10. by   bobnurse
    In most cases you give the med when it becomes available...ive never heard of this drug, but if its for c-difficile, i would of given it. THere are very few things i would wait 12 hours to administer........But this is hospital settings..........Ive never worked in LTC centers.....SO waiting 12 hours might be the norm, but i would think the patient suffers in this situation.......

    And if you gave the med say at 0100, wouldnt you time the next dose at 1300?
  11. by   LPN1974
    Quote from michelle126
    LPN1974....most LTCs don't have a pharmacy in house. Our pharmacy is about 30 miles away or at least 45 minutes. They don't do stat drug deliveries only for rare emergencies and its dificult to get them stat at that is 2 hrs? We have an E Box for some cardiac and abt meds

    I know....I've worked in LTC facilities several times.
    But still, wouldn't you start a medication in a reasonalble time as soon as it is delivered?
  12. by   webblarsk
    I agree it should have been given when it arrived.
  13. by   kidluvinRN
    In my experience LTC had an E-box; for antibiotics and frequently needed meds. Our Drs knew what we had, and would order what we could give right away!!! Me, I would have given the med 30 min late, write it in my note, and inform the next shift. I'd feel funny sitting in report saying that I had received but not yet started the med. .
  14. by   webblarsk
    Quote from LPN1974
    I still don't understand OP's reasoning for making the patient wait almost another whole 12 hours as opposed to giving it 30 minutes after the time frame. What is 30 minutes compared to almost 12 more hours? And C-Diff, at that.
    Where is the reasoning for that delay? HER schedule??
    If I'm sick, in the hospital or nursing home, I want some medicine. Get me something and give it to me, I don't care if it's 2:00am.
    And I don't see any need for not getting meds out in a more resonable time, if they're delivered at 9:00pm, as opposed to getting them out 4 or 5 hours later.
    Is this customary to make patients wait that long?
    Or is it just where I work? Am I not in the real world anymore?
    Easy does it. OP already got written up at work. Isn't there a nicer way to state opinion?

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