Giving meds late o.k.?

[MikeyJ]

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."

[smk1, LPN]

I can't imagine 6-10 students trying to give meds with the instructor in an LTC. Some should get to give morning and others get afternoon and switch off the next week. It is a med error, meds are supposed to be given 30-60 minutes before or after the assigned time.

[SuesquatchRN, BSN, RN]

I don't understand why they have to be there to give med's in the first place. I understand IV pushes and perhaps injections. But it is really hard to screw up PO med's.

You are giving the meds on her license.

It isn't hard to screw up PO meds.

Did you take the apical?

Can the patient swallow or did you just choke the old guy?

Is the BP too low for med A?

Do you know what you're giving?

Do you know who it is to whom you're giving it?

Don't get cocky.

:)

[deeDawntee, RN]

I can understand the charge nurse becoming concerned in this situation with a nursing instructor not managing her students and med passes in a way that gets the meds administered in a timely fashion. I can see that would disrupt all the staff nurses and stress out everyone. Obviously, the instructor needs to come up with a better plan.

Now, it is acceptable to give a med a hour early or an our late, but in the real world, you will do what you have to do given extenuating circumstances when medications are actually given.

Examples: You have a pt with nausea/vomiting...you are going to hold their po meds (obviously) until the n/v has passed...(no matter how important the med is...if you have to call the MD for an IV version of the med, you do that)

I have never seen anyone actually get written up for giving a med early or late....for instance, I have 2000 and 2200 meds to give, I have just completed my 2000 assessment and what my pt needs more than anything else is some uninterrupted sleep...I will give all 2000 and 2200 meds plus do the HS blood sugar at 2000, so the pt can sleep...that is considered nursing judgement...because those medication times are for the most part arbitrary and set by the pharmacist or defaulted by the computer.... A quick note in the comment field (we have computerized charting) is all that is required.

[anc33]

The bigger issue here is not that QD meds were given an hour outside of the window but that your instructor is having you chart that you gave them at 0800 IMO. Always write the exact time you gave something, regardless of the scheduled time. Falsifying a MAR can get you in some really hot water.

[santhony44, MSN, RN, NP]

Y

It isn't hard to screw up PO meds.

Did you take the apical?

Can the patient swallow or did you just choke the old guy?

Is the BP too low for med A?

Do you know what you're giving?

Do you know who it is to whom you're giving it?

Precisely.

It is not difficult to screw up PO meds, and yes you can hurt someone that way.

I don't blame the charge nurse at all. I don't blame the students either, the instructor has problems. The charge nurse has probably been more patient with her than I would be. I'd be having a discussion with the head of the program. Ultimately, the charge nurse is responsible for the patients.

The instructor should be teaching students the correct, "by the book" way of doing things. Teaching students to document that a med was given at 8:00 when it was actually given at 10:00 is not correct. If the med is timed at 9:00 with a 1-hour window, then that is how it should be given. For students, the only exceptions should be occasions when it cannot be given- the patient is off the floor, throwing up, etc. It's hard to know when to bend, break, or make exceptions to the rule when you don't really know the rule.

If she expects to watch each student give every med- which she should, it's her license- then she needs to figure out how to do this so that the meds are given correctly. Having only a couple of students give meds each day, having some give AM and some give PM, and so forth. Ideally she would also be able to have the students pull the meds with her watching, as well.

Something's broke here and needs to be fixed, and it's not the students nor the facility.

[MikeyJ, RN]

You are giving the meds on her license.

It isn't hard to screw up PO meds.

Did you take the apical?

Can the patient swallow or did you just choke the old guy?

Is the BP too low for med A?

Do you know what you're giving?

Do you know who it is to whom you're giving it?

Don't get cocky.

:)

I apologize if I came across as cocky but I didn't mean to portray it that way. I understand that things can always go wrong. But I would hope that by this time in our program the students would understand those potential complications and be aware of them.

[suzanne4, RN]

The instructor was completely wrong in this case, and the nurse that was legally responsible for the patient should have given the meds at the time that they were do. Even though the meds given by the students are under the license of the nursing instructor, the nurse that is assigned to that patient is also liabe for things that happen to the patient during that time.

It is the instructor's responsibility to be there at the appropriate time, and if running late, then all of her students are not going to get meds passed at that time.

Does not matter her reason, but the fact is that meds cannot be late like that because she was someplace else. She needs to make better use of her time.

[suzanne4, RN]

We also do not know the types of meds that were to be given and to think that all were stool softeners does not fly with me. Mornign meds also consist of anti-biotics, heart meds, even diabetes meds, etc.

So times should not be shrugged off lightly. And in the real world of hospitals, most have a specific window that they can be given in, it is not any time that the nurse wants to. And as more facilities go towards the electronic systems, if a med is not given during the open window of time, a reason why has to be placed before you can actually give it. And it is well documented and researched as to why it was not given when ordered and the nurse is held accountable for this.

Because the instructor was not there, then the responsibility falls to the staff nurse assigned to the patient to go ahead and give the meds.

Teachers are there to teach you the correct way to do things, not the way that this particular instructor was doing. Sorry, but this is one time that I am not taking sides of the instructor. They need to be written up for this.

[SuesquatchRN, BSN, RN]

I apologize if I came across as cocky but I didn't mean to portray it that way. I understand that things can always go wrong. But I would hope that by this time in our program the students would understand those potential complications and be aware of them.

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!

[suzanne4, RN]

In the real world, nurses in nuring homes have to pass out medications to about 50 patients..And that is one nurse doing that..Say, you have 50 patients and all of them have 9 am medications..Sorry to say but it would be impossible to do..Some pateints will recieve their meds late if they are the last ones to recieve the medication..Some would be very late...

You can go by NCLEX and their own rules about 30 minutes to 1 hour after or before in passing medication, but in the real world, it is quite different on what is acceptable..

Sorry, but your ideas are not that of the real world. If you do follow the guidelines of what was even on the NCLEX exam and have meds to pass for that many patients, you start approximately 60 minutes before they are to be given per the MAR, and then are done before the hour is past the due time. It should never be longer than that to pass the meds in the first place, no matter how many patients.

0900 meds can be started just after 0800 and then finish before 1000, and all rules are kept. If you start the 0900 pass at 0915, then you are going to be late, and that is the fault of the nurse, not the system.

A med due at 0900 should not be given at 1100 unless there was a specific reason for it, not that the med nurse started late. That does not hold up in a court of law either.

It is your responsibility to get the meds administered within the appropriate timeframe that they were ordered in. Any changes without a good reason, leave you open to the wolves. And I mean the court system here. If you cannot get it done, then perhaps another job would be better suited for you.

[Jo Dirt]

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

It was not humanly possible to give meds according to the textbook when I worked at the nursing home. When I brought up this concern the DON assured me the patients were not going anywhere and I had 8 hrs. to prioritize and decide which meds needed to be given "on time" (you know, insulin and coumadin, etc.) and which meds could wait awhile.

It all boils down to reality and common sense and it's true what they say about real world vs. textbook nursing.

[Azee]

At my hospital the students are allowed to give meds with the nurse's or their instructor. 99% of the time the instructor is off the floor. I always have the student check the meds with the MAR and then I double check. I stay with the student to give all PO, injections, IV abx, etc. I feel it is my responsibility as they are my patient. (Students don't always see little details, for example :to cut tab in half for correct dosage, no offense!) As far as late meds....we have a 30 minutes before and after per policy. After that I would cross out time and write time given. Then also retime upcoming meds as necessary for my shift and next shift.