Is giving meds early common??

[Bonnie86]

I just finished my 2nd week off orientation as a new grad and feel that all I'm doing is running around giving meds ALL DAY. I work 7a/7p and have been staying until 9:30 to do charting. I don't have time to look at labs, orders, do dressing changes...nothing.

Last night a slightly more experienced nurse told me she gives ALL her morning meds at ONE time (as long as it's safe). She even gives antibiotics early (due at 10 given at 8). I do full assessments and she told me she does focused assessments only. She said she used to stay that late catching up, but was griped at for OT so she had to do something.

Is this common and acceptable??? Last night I had a new admission which took me forever right before shift change and I missed two antibiotics, dressing change, and my 6 p.m. feeding to unconcious PEG tube pt. I did them all, but was there until 10 p.m.

Everyone says things will get better with experience, but by experience do they mean you learn you HAVE TO cut corners in order to get everything done in 12 hours????

[Sun0408, ASN, RN]

When I was a floor nurse I started my shift by checking on all my pts first. Then I would check each ones MAR. I would do dressing changes while I was doing my assessment and take them there meds. This way, I would not have to return 3 different times.. saves time. Now if it was 7:30 and they had meds due at 8,9 and 10.. I would wait til 9 and do all meds at that time. We have an hour before and an hour after to give meds and not get in trouble. You will become faster and more efficient.

Try to group tasks together and do them at once instead of several trips, this will help. Make yourself a brain sheet and highlight what MUST be done on your shift, do those things first. The other stuff can be done on the next shift. Remember, nursing is 24/7 for a reason. No, not everything can be done in a 12 shift. Some things will be passed on.

When your time management, prioritization and assessment skills improve you will get more things done in a day. Make a habit of looking at labs first thing in the morning.. This could be very dangerous to your pts by NOT doing it.

Hang in there...

[LynnLRN]

I agree with SUN. I do a lot of the same things she does. Lets say I get out of report at 730, I will see 2-3 pt's and do their assessments and have them charted by 0800. Then the next two I will bring their a.m. meds with me since its after 0800. So now its 0830, I have all my assessments charted and 2 patients meds given. Then I go back to the other 3 give them their meds and by 0915 I am done with morning assessments and meds. Also, I will assess my patient, do their dressing change, and give them their meds, then find the closest computer and hurry up and chart the assessment and dressing change. I figure whatever I need to do next has already waited and can wait 2 more minutes for me to get in the room. I am a big believer in charting in the moment, not for accuracy (although that is part of it), but because not having your charting done is a stressor. The most common thing i here from coworkers when they are running around like chickens with their heads cut off is "I haven't even charted a thing yet". I feel like you are more efficient when you can think clearly and when you are thinking about all the things you still need to do it stresses you out and makes you less efficient.

I also get to work 20 minutes early so I can see what meds my patients are on, their labs, and their medical history before I start report.

[PediLove2147, BSN, RN]

LynnLRN said:

I agree with SUN. I do a lot of the same things she does. Lets say I get out of report at 730, I will see 2-3 pt's and do their assessments and have them charted by 0800. Then the next two I will bring their a.m. meds with me since its after 0800. So now its 0830, I have all my assessments charted and 2 patients meds given. Then I go back to the other 3 give them their meds and by 0915 I am done with morning assessments and meds. Also, I will assess my patient, do their dressing change, and give them their meds, then find the closest computer and hurry up and chart the assessment and dressing change. I figure whatever I need to do next has already waited and can wait 2 more minutes for me to get in the room. I am a big believer in charting in the moment, not for accuracy (although that is part of it), but because not having your charting done is a stressor. The most common thing I here from coworkers when they are running around like chickens with their heads cut off is "I haven't even charted a thing yet". I feel like you are more efficient when you can think clearly and when you are thinking about all the things you still need to do it stresses you out and makes you less efficient.

I also get to work 20 minutes early so I can see what meds my patients are on, their labs, and their medical history before I start report.

All meds and assessments charted by 0915! I hope I can be as efficient as you one day!:) I was done morning meds and assessments (no charting) by 10 the other day and I was ecstatic. I too get to work early, I like to know what is going on with my patients before report.

[joanna73, BSN, RN]

Before I worked LTC, I was on an 80 bed med surg unit. We also gave 10 am meds at 8am and when taking vitals, we did a quick head to toe assessment. Otherwise, you'd never manage the load. As you'll learn, school and real life nursing is very different.

[Aurora77]

I work nights and will sometimes give meds early. Not antibiotics, though. Sometimes pts want to go to bed early, or want to group their 2100 and 2200 meds together. As long as it doesn't hurt the pt (i.e. drug interactions), I'll give it early.

[Lennonninja, MSN, APRN, NP]

At my hospital, we have up to 90 minutes before the med is due and 90 minutes after it's due to give it. I try and cluster things together as much as possible. I'm nights, so our meds are mostly due at 2100 and 2200. We do bedside report, so I'll do a quick visual assessment, and ask about pain meds while in report, and then start with people who have only 2100 meds, get them done first and do full assessments, meds, and dressing changes all at once. Then if I have people that also have 2200 meds as well, I can do them after 2030, so if it's safe, I want until after I've finished with the others who only have 2100 meds. I make notes on my sheet and then chart my assessments after I've finished my med pass. Usually I can be done charting all of my 2000 assessments on 5 pts by midnight. Sometimes I'll have midnight meds, not always. 0600 is another big med time for us, so I'll try to follow the pct around at 4:30 for vitals and do meds then, or if they need blood draws, I'll combine blood draws with 0600 meds.

Learn to cluster what you can safely, and you'll have a much more streamlined shift.

[GitanoRN, BSN, MSN, RN]

the key to is to prioritize and double tasking, this will come with time, which i have no doubt that you'll acquire... wishing you the best always... aloha~

[FLmomof5]

I work nights, so it is a bit different. I get report and then do a quick focused assessment on all my patients and write my name and phone # on their board. I take their MARs and check when they have their meds due. Any med delivery separated by 1 hour get combined unless it is not safe to mix. I start 9 PM meds at 8ish and am usually finished by 915PM. God willing, I begin my charting then. (Sometimes we have very needy patients or admissions that take priority over charting.)

BTW, I also create a per patient checklist on my brain....looks like

2100 __

0000 __

0400 __

0600 __

NN __ (short for nursing notes)

MAR __ (checking tomorrow's MAR against orders and current MAR)

24 __ (24 hour chart check)

This way I can keep track of where I am and what needs to be done and keep meds on time.

[Esme12, ASN, BSN, RN]

You will get better. I will give meds an hour early or an hour late but not 2 hours early. so lets say 8a meds and 10a meds all give at 9a. I the old days we kept our meds on a consistent time schedule..... 9-1-5-9, 9-9, 9a-5p-1a or 5a-1p-9p, 12-12.......all this 8a and 11a, 12p, 5p 6p meds no wonder it's driving you crazy. Initial doses were given right away and then the following doses were slightly moved closer to the scheduled hours.

[CapeCodMermaid, RN]

The dreaded med pass...ugh a blast from the past when patients got one or two meds. Now they get 19 or 20. We're changing our med times so the people can sleep in if they want so daily meds can be given between 6am and 1159am. If the doc still wants a specific time, we try to group everything we can at a few times so the med pass is not the be all and end all of the day.

[turnforthenurse, MSN, NP]

You'll get the hang of it.

At my facility, we have medication scanning...and any time we try to scan a med that is more than an hour before the due time, we get a little alert. The only time I will do this is if the med needs to be given early, usually after talking the physician. I have had scheduled (as opposed to prn) pain meds that won't be due for another 2 hours but after speaking with the physician, they will tell me to go ahead and give it early. When I do, I make a little comment "Dr. so & so stated to go ahead and give med early" or something along those lines.

If a patient has meds due at 2000, 2100 and 2200 (I work nights), I will try to give them all at 2100 as long as it is safe. Most of the 2000 meds are antibiotics, however, and those should be given on time. Sometimes I'll cluster the 2000 and 2100 meds to save time. Meds due at 1930 should be given by the previous shift...those are usually antibiotics. Same with Synthroid doses that are due at 0730 - night shift is responsible for giving them, unless the patient is off the unit for a procedure/test or if the dose is not available in our Pyxis and has to be sent up from pharmacy, which we do not have on nights.

As others have said, try to cluster care.