Largest med pass

Forever Sunshine, ASN, RN · Mar 16, 2010

Unless there is a specific reason it has to be given at 9pm for hs, you can adjust the time based on nursing judgement. Some things you don't need to ask the doc about.

Exactly, there are some meds that I wouldn't give early. I don't do this for every patient but like for example.. I am not going back to them just to give a colace. Theres a patient who gets a xanax at 10p. It wouldn't make sense to give it at 5 with his 4:30 pills. That is entirely too early. Same goes for blood pressure pills, coumadin or antibiotics that have scheduled times. Those I don't want to mess with so I will give them at their schedule time(or close to lol)

Doing my med pass for the first time..one of the things I HATED.. was waking people up to swallow a cup full of pills. So I try to give them everything while they are awake.

morte, LPN, LVN · Mar 16, 2010

Unless there is a specific reason it has to be given at 9pm for hs, you can adjust the time based on nursing judgement. Some things you don't need to ask the doc about.

we have this discussion every time this issue comes up.....if the P+P says 9pm and the doctor ordered it that way (at hs) then 9pm becomes a doctors order....you need to have the doctor order it differently or you would be practicing medicine without a lic.

cherrybreeze, ADN, RN · Mar 16, 2010

we have this discussion every time this issue comes up.....if the P+P says 9pm and the doctor ordered it that way (at hs) then 9pm becomes a doctors order....you need to have the doctor order it differently or you would be practicing medicine without a lic.

Well, I have not had this discussion before, and I disagree with you. If I called a doc and asked if I could give a patient's routine hs med at 1900, instead of 2100, because that's when they take it at home, I'd get the phone hung up on me.

morte, LPN, LVN · Mar 16, 2010

Well, I have not had this discussion before, and I disagree with you. If I called a doc and asked if I could give a patient's routine hs med at 1900, instead of 2100, because that's when they take it at home, I'd get the phone hung up on me.

this has been brought up more than once before HERE AT ALL NURSES....that is my reference, not that YOU specifically have been involved.....and the fact remains that you cant change it without doctors order....even if it is a general one such as "may take meds as at home". This is usually more of an issue in LTC, and it seems you are in hospital??

Forever Sunshine, ASN, RN · Mar 16, 2010

this has been brought up more than once before HERE AT ALL NURSES....that is my reference, not that YOU specifically have been involved.....and the fact remains that you cant change it without doctors order....even if it is a general one such as "may take meds as at home". This is usually more of an issue in LTC, and it seems you are in hospital??

This was not asked at me but.

I am in LTC. Since I cannot give all the meds at their exact stated time, I give them when I can. If a patient is in their room awake or passing by in the hallway on their way to bed and it is in reasonable judgement to give them their night meds a little early. I am going to do so.

cherrybreeze, ADN, RN · Mar 16, 2010

this has been brought up more than once before HERE AT ALL NURSES....that is my reference, not that YOU specifically have been involved.....and the fact remains that you cant change it without doctors order....even if it is a general one such as "may take meds as at home". This is usually more of an issue in LTC, and it seems you are in hospital??

I understand what you meant about it being discussed here before, I was saying that I had neither seen nor participated in such a discussion. If you don't want to have the discussion again, that's fine with me, I was just voicing my opinion on the matter since it was brought up in this thread.

Yes, I am in a hospital.

I disagree that it can't be changed without a doctor's order. The doctor doesn't write the P&P, so when s/he orders a med "at hs," they aren't specifying a time. I don't think it's actually a part of the P&P anyway; where I work, yes, the computer system schedules the med at 2100 but it isn't a *rule* that it HAS to be at that time. Same with a "daily" med. Our "daily" meds automatically go in for 9am, but if a patient wants a med at 0800 with their breakfast, I see no problem with that (as long as the med doesn't have to be given on an empty stomach, or whatever). As long as it's given "daily," that's all the doctor's order reads. The computer sets a standard time for things, for ease of use and med passing, but I think it's negotiable when necessary.

Same as meds (like antibiotics) being scheduled "q6h". Our computer schedules those for 0001, 0600, 1200, and 1800. We may adjust that to 0400, 1000, 1600, 2200 to coordinate with night shift assessments, say, or based on when they got the dose in surgery, so that the next dose isn't delayed. As long as it's still being given every six hours, the doctor doesn't care. Once in a while, we have a surgeon that will specifically write for the first dose of antibiotic to be at a certain time; then, we don't change them. Otherwise, while I understand your rationale, I respectfully disagree with it.

morte, LPN, LVN · Mar 16, 2010

I understand what you meant about it being discussed here before, I was saying that I had neither seen nor participated in such a discussion. If you don't want to have the discussion again, that's fine with me, I was just voicing my opinion on the matter since it was brought up in this thread.
Yes, I am in a hospital.
I disagree that it can't be changed without a doctor's order. The doctor doesn't write the P&P, so when s/he orders a med "at hs," they aren't specifying a time. I don't think it's actually a part of the P&P anyway; where I work, yes, the computer system schedules the med at 2100 but it isn't a *rule* that it HAS to be at that time. Same with a "daily" med. Our "daily" meds automatically go in for 9am, but if a patient wants a med at 0800 with their breakfast, I see no problem with that (as long as the med doesn't have to be given on an empty stomach, or whatever). As long as it's given "daily," that's all the doctor's order reads. The computer sets a standard time for things, for ease of use and med passing, but I think it's negotiable when necessary.
Same as meds (like antibiotics) being scheduled "q6h". Our computer schedules those for 0001, 0600, 1200, and 1800. We may adjust that to 0400, 1000, 1600, 2200 to coordinate with night shift assessments, say, or based on when they got the dose in surgery, so that the next dose isn't delayed. As long as it's still being given every six hours, the doctor doesn't care. Once in a while, we have a surgeon that will specifically write for the first dose of antibiotic to be at a certain time; then, we don't change them. Otherwise, while I understand your rationale, I respectfully disagree with it.

and most times, in hospital, you will "get away with it", just be forewarned you want to not get on the "bad side of a doc or midlevel....

cherrybreeze, ADN, RN · Mar 16, 2010

and most times, in hospital, you will "get away with it", just be forewarned you want to not get on the "bad side of a doc or midlevel....

I don't consider it "getting away with" anything.

Calling and asking to give an hs med at 1930 instead of 2100 will get me on the bad side of a doc or midlevel much faster than just doing it. I know which docs want phone calls for certain things and which ones don't. Many of the docs I deal with regularly I've worked with for years, and trust my judgement without a phone call for every little thing, and this, to me, is a little thing (and NOT something that requires a call in the first place). I'm not a new nurse, I know the things I can do, or not do. Nothing I've stated is trying to "get away" with something, that's ludicrous.

NurseGloria · Mar 16, 2010

I have worked in more than one LTC where I had 50 patients, intermediate care, to pass meds to. They each had probably 9 to 11 meds.

I was supposed to pass the meds within an hour before and after 9 AM. In LTC, many of your patients have digoxin. We know we are supposed to take a pulse for a full minute. Ha, ha. I had 40 some patients on dig one time. If a pulse was regular and not even close to being as slow as 15 beats in 15 seconds, the patient got dig. Otherwise I did take a pulse for the full minute and further assessed.

The nursing homes also owned the pharmacies they used and also had a house physician for most of the patients. PROFIT CITY!

You may not be happy to have surveyors in your building, but surveyors are your best friends. Imagine how bad things could get without them.

I remember when surveyors used to follow the medication nurse for a full med pass. Then they changed to following for maybe 30 minutes. Surveyors know it is not possible to do a med pass the way you are supposed to and finish in the proper time.

When I was in that situation, I did always tried to impress upon everyone that the meds needed to be given to patients in the same order. Otherwise, when you have four hour long med passes, if a patient is last on your list and first on the next nurses list, TID and QID meds could be given really close together. Not a good situation.

kathy313 · Mar 17, 2010

When I worked in LTC, the biggest pass was 1700 (30 residents), I started about 1530 and usually finished about 1900. It was crazy, dayshift tossed many meds and dressing changes onto my shift. When I'd get a new admit and try to schedule the meds differently, the dayshift nurse would change the times...again! Her excuse being,"We always do it this way." She's been an employee there for 25 years, so she gets her way.