Giving meds "on time"......

GooeyRN, ADN, BSN, CNA, LPN, RN · May 31, 2011

I like to give a super duper quickie assessment (problem area's only) and see if anyone has any immediate needs (this includes pretty much just chest pain, SOB, bleeding, need for pain meds, or toileting- drinks/food/blankets will WAIT). Then I give my meds so they are on time. I do like to see if people need pain meds before pulling meds, it saves time from having to run back and forth to the pyxis more. I can just pull that patients meds first and include their pain meds with the rest. After meds are given and problems/requests stomped out, I go back and do a better assessment. If I do a full assessment and see what people need before giving meds, I don't get the meds out anywhere near on time. You will find what works for you- there is no real right or wrong way to do things unless you are not assessing at all or not listening to report prior to giving meds.

Student Mom to Three · May 31, 2011

This is how I handle the crazy morning rush........

After report I would quickly look at patients and make sure they were in no distress. I would figure out which one was most acute, would grab their morning meds and go in for assessment and meds...also bringing the glucometer if they were diabetic. I'd do a focused assessment and give meds. I would use the computer in the room (loved having computers in the room) and chart, ask about what else they might need, what was going to happen for the day and write pertinent info on the whiteboard.

This worked for me. Was every med always given on time? No. Not always. But more often than not.

The most valuable thing that I learned was to be very focused in my morning assessment. If they are in the hospital for pneumonia- do I need to look at their toes first thing in the morning? Nope- I could do that later in the day when they are getting up to walk.

Congrats on finishing up your program!

loriangel14, RN · May 31, 2011

I usually go in and update the white board, have a quick chat " how are you, how was your night/day? need anything for pain/nausea/whatever ?" grab their vitals and then go pull their meds. I will do a more thorough assessment later.If it's days I will do my glucometers first and if shift report mentions someone with ongoing pain issues I will see them first.

MunoRN, RN · May 31, 2011

Agree with Gooey about doing a quick check of all your patients first, including need for PRN meds. If by "1 hour time frame" you mean you have half an hour before and after the scheduled time for the med then that is an unsafe policy, 1 hour before and after the scheduled time is what the ISMP advised to avoid dangerous shortcuts. Not all meds are the same, the importance of timely administration needs to be considered in terms of each med and prioritize accordingly, just make sure you sacrifice too much in terms of safety to get the meds "on time".

roma4204, BSN, RN · May 31, 2011

It totally depends on the med and route of administration. If it's someone's baby aspirin they take once a day at home when they eat breakfast, this is very different than IV vanco that has a trough the following day, etc.

Gotta love those critical thinking skills :)

brownbook · May 31, 2011

Like munorn said, ISMP studied this and emphasized how dangerous arbitrary time frames are for giving medicine to patients. Check out the ISMP web site.

RadBSN · May 31, 2011

My patients tend to have meds at 8, 10, 12, 14, 16, and 1800. If I got all their meds to them "on time" I would never do anything else. Last weekend I had someone with meds at all those times plus, 7, 11 and 1500. Sometimes their Cipro is scheduled to be given at the same time as their Magnesium Oxide and their "take an hour before meals" med is scheduled at the same time as their "take with meals meds". What this means is that I always take a look at the MAR while I'm getting report and highlight my "must give on time" meds, such as IV abx. We do bedside report/pt handoff, so that's when I check to make sure they're not laying on the floor or in any acute distress and check a pain level. Then I plan my day and give any insulin (if pts are eating). Sometimes I'll do my assessment while I'm giving meds (esp if the pt takes pills one at a time). I use a lot of nursing judgment/critical thinking when figuring out the timing of my meds. The MAR timing is set up by the pharmacy computer based on the schedule of the med, for example, meds written as "every 6 hours" show up differently than ones written as "4 times a day". It's not always logical.

3dayRN · Jun 1, 2011

I work 7p-7a so my med pass isn't quite as bad as the first med pass on day shift. My routine is to assess each patient (I never have more than 5 patients), then I start my med pass, then I chart all my assessments. With an admission, prn med, phone call, etc.. thrown in there. If I have a daily med I'm not so concerned if it's a little late. The meds I always try to keep on time are meds such as antibiotics that are ordered q6 q8h etc. Or also for example solumedrol that is bid or qid. Depends on the med and the patient.

demylenated, BSN, RN · Jun 1, 2011

Is your window a one hour window strictly, or a one hour before and one hour after (thereby being a 2 hour)?

After report, I check my patients. Make sure they are clean, in bed (not on the floor), breathing, and listen to their lungs and heart. I ask if they have any immediate needs. We would have 7-10 patients, and have 2 hours to pass.

IMHO, it is IMPERATIVE you LAY eyes on each of your patients FIRST thing in the morning before you do ANYTHING (preferable before the other nurse leaves the floor in case you have any questions). I usually made an agreement with the off going nurse. After report, we'd do a walk through together... or do a bedside report. This is for patient safety and for continuity of care... also to CYA - because if you passed meds on 3 pts in 40 mins, and got to your 4th and found them on the floor, you have NO IDEA how long they've been there. The off-going nurse may have checked on them up to an hour before leaving the floor.

Trust me, it GETS EASIER!!! Much easier and much faster...

Congrats!! And, good luck!

~Demy

Flo., BSN, RN · Jun 1, 2011

I think it depends on your floor. I pass meds and asses my patients at the same time. This is because the MDs, PAs, NP, and charge RN round on he pts during shift change. So basically the whole floor gets seen as the RNs are getting report. If this didn't happen I would take a quick peek at my pts.

ShayRN · Jun 1, 2011

I also do a check on all my patients as I start my shift. Just kind of "Hi, I am ShayRN and I will be your nurse. Are you in pain? Do you need anything at this moment?" That way, if previous shift has been busy and they were waiting for their nurse, they know a new one is on. Has worked great so far.