Med error or not?

[Sub brunch]

A patient ,mental health, declined a 2100 zanaflex because she was worried about b/p sys 90. She was unable to sleep at 0200. She had nothing else ordered so the 2100 dose was given at 0200. B/p at 0200 120/70. Med error?

[Esme12, ASN, BSN, RN]

What is the order for the Zanaflex?

[cayenne06, MSN, CNM]

Was it a scheduled med or prn? Did the provider know the patient declined the scheduled dose? I don't know the specifics of the situation or your facility's policies, but for us, we are allowed to give certain prescribed med past the scheduled time if the patient had previously declined, and it wouldn't interfere with the next scheduled dose. For example, if a patient has a schedule synthroid to be given before breakfast and declines it for whatever reason, we can give it later on, if the patient requests it (of course we try to shoot for an empty stomach). However, we have standing orders to do so, and obviously many meds cannot be given outside of their scheduled time for various reasons. Of course, if it is PRN, then that's a different story- you give it when you need to, as long as it is at an appropriate interval.

So, short answer is that it is hard to determine if it is a "med error" without for info.

[cayenne06, MSN, CNM]

Rule of thumb, call the provider when in doubt about a med. Of course, it is easy for me to say that because our providers are accessible and friendly. Working in a situation where you do not have easy access to consultation makes things more complicated.

[Sub brunch]

Oops, yes scheduled tid. The drs do not like to be called early am.

[VivaLasViejas, ASN, RN]

It doesn't matter whether the doctors "like" to be called in the early mornings---that's why they get paid the big bucks to be on-call.

I'm a little surprised that your facility doesn't have a policy on how long before/after scheduled doses of medications can be given. Everywhere I've worked, it's been an hour on either side of the scheduled time.......for example, if a med is given at 0800, 1200, and 1700 and the patient doesn't take the morning dose by 0900, they don't get it till the next scheduled time.

PRNs, of course, are handled differently; if you pull a PRN and the patient changes her mind, then wants it a couple of hours later, you can still give it (just make sure you document accordingly). It doesn't sound like this is the case with your patient who refused the Zanaflex at 2100 and then wanted it at 0200. Of course, what I want to know is why she doesn't have an order for a sleep aid, and if Zanaflex is for sleep, why she's getting it TID.

[Havin' A Party!, ASN, RN]

Whether this would be a med error or not depends on your facility policy.

[mon00707]

I don't think it would be a med error, I thinker errors of giving the wrong med, the wrong dose etc. Meds like that are typically a prn so I don't think it's too concerning and I personally would not call the dr for a refusal of that med and the fact that she could not sleep you did fine. The only thing is making sure the next dose is given so many hours after and not too close like say 8 hrs. I work in mh and would not call the dr for refusal of an anti anxiety med unless the cl was visibly anxious and out of control.