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1 hour window on med pass times...

Posted

I've read several posts describing the 1 hour window on the scheduled med pass time as being 1 hour before or one hour after. I believe this is wrong, it is 30 minutes before or 30 minutes after! Secondly, if Residents want (and are used to) getting their 20:00 meds at dinner, the nurse should send the physician a communication fax asking to change the scheduled time to 18:00. They will usually oblige this if the Resident wants them at that time and as long as it isn't a TID med which cant be given too close together anyway! These points will help keep you in compliance. Otherwise what in the world will you do if someone falls after having BP meds too early or when state is in house? :notgood:

VANurse2010

Has 6 years experience.

You are incorrect. It's one hour before to one hour after, but all of those windows are solely a facility policy issue and not a regulatory one. Most of the scheduled times are pharmacy generated defaults that are guided by facility policy, not actual times the MD thought to order. Outside LTC, you can often get the pharmacy to change the scheduled time without ever speaking with the physician.

loveofrn, BSN, RN

Specializes in MICU. Has 3 years experience.

I've read several posts describing the 1 hour window on the scheduled med pass time as being 1 hour before or one hour after. I believe this is wrong, it is 30 minutes before or 30 minutes after! Secondly, if Residents want (and are used to) getting their 20:00 meds at dinner, the nurse should send the physician a communication fax asking to change the scheduled time to 18:00. They will usually oblige this if the Resident wants them at that time and as long as it isn't a TID med which cant be given too close together anyway! These points will help keep you in compliance. Otherwise what in the world will you do if someone falls after having BP meds too early or when state is in house? :notgood:

in nclex world it is 30 min window

Frequency of administration and times are set by the provider not the pharmacy unless (s )he just states tid or am\pm. The provider can order a change in scheduling.

sharpeimom

Specializes in ortho, hospice volunteer, psych,. Has 20 years experience.

The pharmacist can change most med orders to fit the patient's at-home schedule. For example, I take Keppra 1000 mg. for partial complex seizures. I also take Neurontin as an add-on drug. I take the standard adult dosage, which works like nothing else ever has before. It is usually given in two equal dosages of 500 mg. first thing in the morning and the second dose at HS.

For me, that had to be adjusted somewhat because the entire morning dose makes me very very dizzy, nauseated, gives m a bad headache, and makes me feel generally yuck. There was a very simple solution. On my own, I tried 250 mg. when I got up, then

took the other 250 mg. with lunch or a little bit earlier or later. My neuro said if that schedule worked for me, great. It would be ordered the usual way if I were hospitalized but it would be simple to change it.

I worked in a state psych hospital for years and we often encountered patients who had always been night owls and that didn't change simply because they had been hospitalized. While some patients received their HS meds about 20:00, others got their meds nearer 23:00 or midnight. You have an hour on one side or the other of the ordered time. A little bit of wiggle room is essential because patients get taken to therapy or have tests scheduled, etc. and aren't always where you think they should be exactly when the meds are due.

Forever Sunshine, ASN, RN

Specializes in LTC. Has 7 years experience.

If someone told me I had 1 hour (30 min before/after) to complete my zoo of a med pass I'd laugh. If I finish in 2 1/2 hours thats a good day.

VANurse2010

Has 6 years experience.

Frequency of administration and times are set by the provider not the pharmacy unless (s )he just states tid or am\pm. The provider can order a change in scheduling.

You are incorrect. Frequency is obviously prescribed by the physician, but the actual literal schedule times are part of a pharmacy protocol that often times the pharmacy can change without direct permission of the MD.

VanNurse I understand what youre saying but I dont believe the pharmacy will change a BP med or scheduled narcotic from HS to 1800, I may be wrong but we're talking about those who are combining HS and 1800 med passes and being in compliance.

ktwlpn, LPN, RN

Specializes in Med Surg, Homecare, Hospice.

Per the DOH it is a two hour window for med admin. The facility sets their policy, the consulting pharmacy will make recommendations, they can't just change the times,not in our facility. The physician can concur or refuse those recommendations. Med admin times should be individualized for each resident. Our dementia residents often won't accept meds after they are in bed and have been asleep ,the doc will agree to change the BID meds from 9a and 9p to 9 a and 6p to facilitate acceptance. HS meds are often ordered for 7 pm for those early to bed people. Eye drops can be admin during the normal bedtime hours for the dementia folks who can not follow directions and open their eyes. When we are assessing B/P meds we will do b/p checks for a week or so.If a resident falls vital signs are part of the assessment. Frequent falls may warrant a med review by the consulting pharmacist in addition to any other appropriate recommendations.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

A medication scheduled for 9am can be given any time between 8am and 10am and be in compliance. Facilities, at least in Massachusetts, set the med schedule, not the pharmacy, not the doctor. Our once a day meds can be given any time between 6am and 11:45am. That is my facility policy. All the docs signed off on it. If a resident wants their meds at a particular time, we try to comply unless there is a clinical reason not to.

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

A medication scheduled for 9am can be given any time between 8am and 10am and be in compliance. Facilities, at least in Massachusetts, set the med schedule, not the pharmacy, not the doctor. Our once a day meds can be given any time between 6am and 11:45am. That is my facility policy. All the docs signed off on it. If a resident wants their meds at a particular time, we try to comply unless there is a clinical reason not to.

Not to derail but I have to ask: in your facility a qhs med (once a day) can be given at 6-1145? Or is that just on meds ordered qd without instruction?

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

Without instruction? Our docs write "Lasix 20 mg by mouth daily". Daily is daily.

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

Without instruction? Our docs write "Lasix 20 mg by mouth daily". Daily is daily.

"Remeron 7.5mg by mouth daily at bedtime" is something I write all the time. I assume it's being given at bedtime..maybe I shouldn't assume...

sharpeimom

Specializes in ortho, hospice volunteer, psych,. Has 20 years experience.

Speaking from a personal point of view, some meds should be given as close to when they're ordered as possible. I have had complex simple seizures since I was a year old and have been on Keppra and Neurontin for years. I take the Keppra at HS and I have to split the morning dose into a morning dose and a noon dose because the standard way makes me dizzy and Blecch! There is some carryover, but during allergy season, when I have a temp, or it's hot and humid, I need the pills by 1300 or I have a seizure. My seizures consist of vise grip strength contractions on the right upper quadrant of my face. No loss of consciousness, but still.

I've passed my share of meds and have been as far behind some shifts as anyone else and the only solution I've been able to come up with is to prepass meds like anticonvulsants when they're due, then start my regular meds pass.

"Remeron 7.5mg by mouth daily at bedtime" is something I write all the time. I assume it's being given at bedtime..maybe I shouldn't assume...

Bedtime and daily are two different things.

Giving a med between 0600 and 1145 would be "daily." But it wouldn't be "bedtime." (Well, it would often be MY bedtime!)

There are daily meds I take in the morning and daily meds I take at bedtime. Unless there was some compelling reason to do otherwise, I would think the facility could follow their own policy while taking into consideration what works best for the resident. I know that I've seen those accommodations in the past.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

Daily is once a day. If the patient wants their daily med at 11 am fine. If they want it at 4pm we would write 'give daily at 4pm'. It's a shame that the med pass seems to be the be all and end all at most places. It's only medication...its not the person's whole day. Do the residents need all those meds at a specific time? Debatable.

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

Do the residents need all those meds at a specific time? Debatable.

I guess we disagree on this issue.Many common medications have significantly increased efficacy and bioavailability when give at specific times. Many others have side effect profile that are improved by specific time of administration.