Gving all the meds all at once?

[ari3sdog]

I've been working as Nurse in LTC for 2 months now. Woot. I'm just concerned about the ways of other Nurses who gives all the meds for 5pm and 9pm all at once?

Is that bad?

I asked one of the Nurses if it is ok. She said.....

It's ok to give earlier if....

1. Vitamins

2. Eye drops

3. Docusate

4. Senakot

You have to give the other medicine on time if

1. B/P meds

2. Insulin

3. Heart Meds

4. Coumadin

5. Dilantin

6. Vicodin

7. Inhalers

8. Sleeping pills

I was thinking, if you guys do agree or disagree on these. It seems so hard to give all the 5pm meds and then later give all the 9pm meds on time. There are a lot of charting to do and Treatment, it so overwhelming.

They told me about the 1 hour before and 1 after rule on passing meds. They even laugh at me because I was doing the "Book Way" that pass all 5pm meds and then later 9pm meds, so I'm doing what they are doing. I felt I'm doing the wrong way, but everyone is doing it and nothing seems to go wrong. Also, I somehow agree about they told me about that certain drugs are ment to give on time, and some are ok to be late. Most of them are doing it for 17 years now and the patients are ok. Any comments to experience Nurses out there?

[Virgo_RN, BSN, RN]

I basically agree with that. There are some meds that you really need to give at specified intervals, and others that aren't so critical that way. For instance, if a patient has eight o clock meds and a ten o clock med, I might give them all at eight so I don't have to go back in and disturb the patient after they're asleep, especially if it's just a stool softener.

Where I work, at a hospital, med times often do not match what the patient does at home. For example, our standard "HS" med time is ten pm. Most of our elderly patients eat dinner and take their meds at five or six, then go to bed. Ten o clock is way too late to be going in their room and waking them up to take a stool softener. In cases, like that I have no problem giving meds early. But if it's say, a TID dose of metoprolol, I try to stick as close to the time in the MAR as I can. We also have the one hour on either side protocol, so it's nice to have that wiggle room when things are busy, which they almost always are.

[leslymill]

I don't agree with it and understand your concern. You need to document the time legally in a one hour time frame/ 5pm meds should not be given before 4pm and not later than 5pm without changing the MAR to reflect the change.

[joprasklpn]

giving 9 pm meds at 4pm is way out of your hour before or after. I don't know how your LTC facility is, but most places I worked at had a light 9 pm pass. Why not just change the time of the 9pm to 4pm and be documenting correctly if the meds can be given so early? Probably because they are to be given later than 4 pm. You have to do what you are comfortable with and not just do as others do.

[TazziRN, RN]

I partly agree with it. Nothing wrong with giving meds like vitamins, etc., earlier, but how do you get around the documentation? If any governing body were to come through and audit the med charting, every nurse there would be busted for not following orders, possibly even prescribing without a license because the orders were deviated from. Do you really want to be a part of that?

[SunbabiLPN]

Let's say the patient is a alzheimer patient and she will only take her meds disguised in food. Then you cant come in and give them at 9pm because she wont take them. Another example is when a patient goes to bed at 7pm and refuses to get up to take their meds at 9pm. These patients are missing vital doses of their meds due to time frames. The legal way to go about correcting these problems is to identify the issue then call the doctor and explain it to him. He will then change the times these meds are given so they will take them and your license wont be at risk. I dont know why some nurses dont just call the doctor for issues like this instead of taking it upon themselves to make their own plan. Giving meds early because of your own convienence is never ok. You need to do some charting throughout the shift instead of waiting until the end when it is all piled up. This is also helpful if something goes wrong towards the end of the shift to throw your time frame off then you already have half of your charting done.

[ari3sdog]

Thank you for all your responses. Basically, If the State Board is there, they know the drill. (if you know what I mean)

Some Nurses doesn't even look at the MAR because they have been giving the Meds routinely. For me, I can't memorize them all and I still read them because it's the right way, also there might me a change of Order.

I partially agree on giving the Vitamins early. But I'm careful giving the other meds. Because they are considered deadly.

I have this patient who wants all meds taken all at once because the patient doesn't want to get bothered at 9pm. The patient is suppose to take 200mg of Neurontin at 5pm and 9pm. So basically, the patient is taking 400mg all at once. It was already documented though that she does wants to take them all.

I don't think they will get busted, because it's been going on for quite year now. Like what I said, they know the drill.

[ari3sdog]

Let's say the patient is a alzheimer patient and she will only take her meds disguised in food. Then you cant come in and give them at 9pm because she wont take them. Another example is when a patient goes to bed at 7pm and refuses to get up to take their meds at 9pm. These patients are missing vital doses of their meds due to time frames. The legal way to go about correcting these problems is to identify the issue then call the doctor and explain it to him. He will then change the times these meds are given so they will take them and your license wont be at risk. I dont know why some nurses dont just call the doctor for issues like this instead of taking it upon themselves to make their own plan. Giving meds early because of your own convienence is never ok. You need to do some charting throughout the shift instead of waiting until the end when it is all piled up. This is also helpful if something goes wrong towards the end of the shift to throw your time frame off then you already have half of your charting done.

Thanks..I'll take your word on that.

[Spidey's mom, ADN, BSN, RN]

Why don't you just let the doc/docs know about it and change the times?

An order is an order. I think what the nurses are doing is wrong. Not that giving a vitamin early is going to hurt the patient but going against the order.

And if they are signing that they gave the 9 p.m. med at 9 p.m. BUT really gave it at 5 p.m. then they are lying.

I just don't get it . . . . why we set ourselves up like this. Professionals, lying.

steph

[SuesquatchRN, BSN, RN]

Some Nurses doesn't even look at the MAR because they have been giving the Meds routinely. For me, I can't memorize them all and I still read them because it's the right way, also there might me a change of Order.

That's bad practice on their part for the very reason you state.

[ari3sdog]

giving 9 pm meds at 4pm is way out of your hour before or after. I don't know how your LTC facility is, but most places I worked at had a light 9 pm pass. Why not just change the time of the 9pm to 4pm and be documenting correctly if the meds can be given so early? Probably because they are to be given later than 4 pm. You have to do what you are comfortable with and not just do as others do.

Thanks for the advice. I will take your word on that. =D

[ari3sdog]

giving 9 pm meds at 4pm is way out of your hour before or after. I don't know how your LTC facility is, but most places I worked at had a light 9 pm pass. Why not just change the time of the 9pm to 4pm and be documenting correctly if the meds can be given so early? Probably because they are to be given later than 4 pm. You have to do what you are comfortable with and not just do as others do.

Thanks for the advice. I will take your word on that. =D