Initial doses for po antibiotics

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Ill make this short: Im a recent LVN grad and stumbled over this at work. If a patient is started on antibiotics per say Levaquin QD po to be given in the mornings. Do you administer the initial dose since the order was received at 10 pm or do you wait to give the dose in the AM as scheduled? How true is it antibiotics have to be administered within 2-3 hrs of getting order? Would this be double dosing to some extent? Thank you everyone

Specializes in Med/Surg, Ortho, ASC.

Look to your facility's Policy/Practices for the correct answer. We have no way of knowing what your facility expects.

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
Ill make this short: Im a recent LVN grad and stumbled over this at work. If a patient is started on antibiotics per say Levaquin QD po to be given in the mornings. Do you administer the initial dose since the order was received at 10 pm or do you wait to give the dose in the AM as scheduled? How true is it antibiotics have to be administered within 2-3 hrs of getting order? Would this be double dosing to some extent? Thank you everyone

Although I do think looking at your policies is important, I would start the ABX as soon as possible after receiving the order. The need for the ABX trumps the timing. It has been ages since I did floor nursing, but in the ED we would start any antibiotic immediately. During report I gave the floor/ICU nurse the time I administered it, and I know that nurse had to adjust with subsequent does per the antibiotic times policy. As far as giving an antibiotic within 2-3 hours, check your policy, but you are at the mercy of pharmacy getting any med to you. You didn't say what kind of facility you work in, but is there someone you can ask at work?

I would give it. Policy/pharmacy would be able to dictate the administration of the am dose. Some core measures for reimbursement require that initial antibiotic dose be given within a very specific time frame (and let's face it, reimbursement is the big dude in the room).

We have a binder at our facility that adjusts second doses based on the time first dose is given and the frequency. I would check to see if your facility has such a reference for you. Good luck!

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

In the state where I live (Texas), nurses in the extended care/LTC/SNF setting are legally required to administer the initial dose of an antibiotic within four hours of receiving the order. The point is to treat the patient's infection promptly so he/she will start clinically improving as soon as possible.

Exceptions are made only in instances when the drug is rare or difficult to obtain, such as IV Nafcillin.

Specializes in Transitional Nursing.
Ill make this short: Im a recent LVN grad and stumbled over this at work. If a patient is started on antibiotics per say Levaquin QD po to be given in the mornings. Do you administer the initial dose since the order was received at 10 pm or do you wait to give the dose in the AM as scheduled? How true is it antibiotics have to be administered within 2-3 hrs of getting order? Would this be double dosing to some extent? Thank you everyone

If it's a once a day dose I start it the next morning, because all once daily meds are given at 0800, so giving it at 10pm would put the two doses close together.

If it's 2 or more times a day I would go ahead and administer the 10pm dose, because BID meds are given at 8 and 8.

I'm sure you have a policy on administration times given how meds are ordered, if not you can always clarify with the MD.

Also, look at Abx being given via other routes, was an IV route given today? then administer the po in the morning. If a new order, give it and retime the subsequent doses if necessary.

Specializes in Psych, Addictions, SOL (Student of Life).
Ill make this short: Im a recent LVN grad and stumbled over this at work. If a patient is started on antibiotics per say Levaquin QD po to be given in the mornings. Do you administer the initial dose since the order was received at 10 pm or do you wait to give the dose in the AM as scheduled? How true is it antibiotics have to be administered within 2-3 hrs of getting order? Would this be double dosing to some extent? Thank you everyone

This would depend on policies and procedures for your facility and applicable state regulations. If you took the order personally it would be prudent to ask the doctor if he/she wanted the 1st dose now. In California when and antibiotic is ordered for an active infection the 1st dose should be given within 4 hours of the order. The way we would enter this into an electronic MAR is one entry as a single one time dose now. Then another entry for the following doses to be administered. Never second guess the Dr. If you are not sure - call and verify the order. If he/she yells at you so be it you have protected yourself and your patient.

Hppy

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