Is this a med error???

[proudLPN83]

If you give a prescribed narc. PRN 30 mins early is it a med error? (2RNs said it was fine)

Brand new LPN who was on orientation

[NicoleRN07, RN]

I don't think so....I've done it before and I know others who have done it. If it was several hours, then it would be considered a med error.

[proudLPN83]

Should have more specific...sorry. It was Q2 hrs and was given at 1 1/2 hours. The dose was later that day increased to Q1 hr because it wasnt effective at the Q2 dose

[dijaqrn]

For most routine, scheduled meds 30 mins before or after is usually fine. In the case of a q 2 hr prn it's probably not ok. That's 12 doses in 24 hrs when given q 2 hrs. If you gave all doses at 1.5 hr intervals it would be 16 doses. My employer would consider this a med error.

[JasonsGirl1983]

Many nurses do this, especially on the OB floor that I work on from time to time, the Dr orders pain meds (pills) either 12 or 24 hours (I don't remember I usually work with baby's) after a c/s and sometimes if the IV site is bothering the patient the nurse will take it out early and give the pill pain meds instead usually around a half hour early, most nurses would say it was okay, however admin and nursing supervisors or any employer in a hospital would not agree, this would be considered a med error

[Chaya, ASN, RN]

That is kind of a grey area and most nurses where I am would use their judgement acc to situation. If I have a pt who is requesting the med early every time I won't give it because the cumulative number of doses will be greater than intended. In that case, as the op said, the dosage is ineffective and overall pain control plan needs to be reassessed by MD. If it's a one-time thing or the pt is going off the floor for active therapy or out of the facility to an appt or something, I will give it.

[proudLPN83]

For most routine, scheduled meds 30 mins before or after is usually fine. In the case of a q 2 hr prn it's probably not ok. That's 12 doses in 24 hrs when given q 2 hrs. If you gave all doses at 1.5 hr intervals it would be 16 doses. My employer would consider this a med error.

It was just that dose 30 mins early.

[elizabeth321]

These things are not to be decided on a case by case basis....there is policy and procedure in your place of employment....look it up, call your pharmacy, speak to your clinican.

If a patient is on q2h anal and is needing it sooner a doctor should be called and the order reassessed. Don't ask your co-workers and for goodness sake don't make a decsion based on your own opinion...that is prescribing which is not in your scope of practise.

Liz

[nrsang97, BSN, RN]

The OP stated the drug was given 30min early at one time and then changed to q1h prn. So no I wouldn't consider this a med error. I typically will give a med a few minutes before they are due if the pt is asking but no more than 10-15 min. I remind the pt the med is (q2,4,6,etc), but if they will be going off unit for MRI, or other testing I will give up to 30 min early, or if too soon I will call for a one time order to cover the pt.

[jannrn]

I can't remember exactly but I think there is a rule somewhere about a certain percentage of time depending on how often the med is scheduled? So an every 24 hour med has a greater time window around it that it can be given, an every 1 hour would be very small like 5 or 10 min early max.

I have only heard that once and I have always liked to use 30 min early for narcs as my comfort zone. This is when a pt has what you can say very brittle pain control, and starts to get painful before the next dose is due. At night I try not to call md's if absolutely possible, but will if needed. so if this works I do it, as long as the 24 hour max dose of tylenol is not exceeded. when possible, call the md as they need to know that the pt needs more med or more often and they can change the order or the med to be more effective for the pt.

[LilRedRN1973]

My patient last night had methadone ordered Q 6hr and I gave it at 2330 and 0530 instead of 0000 and 0600. I don't consider it a med error. And it must have been 6 hours since the last dose was pulled out; otherwise, our MedSelect would have popped up a message saying "It has been less than 6 hours since the last dose was dispensed. Do you still want to dispense medication?". It can be helpful to remind you not to give medications off schedule or too close together, I guess.

Melanie = )

[proudLPN83]

I can't remember exactly but I think there is a rule somewhere about a certain percentage of time depending on how often the med is scheduled? So an every 24 hour med has a greater time window around it that it can be given, an every 1 hour would be very small like 5 or 10 min early max.

I have only heard that once and I have always liked to use 30 min early for narcs as my comfort zone. This is when a pt has what you can say very brittle pain control, and starts to get painful before the next dose is due. At night I try not to call md's if absolutely possible, but will if needed. so if this works I do it, as long as the 24 hour max dose of tylenol is not exceeded. when possible, call the md as they need to know that the pt needs more med or more often and they can change the order or the med to be more effective for the pt.

This pt was dying and in a lot of pain.