Medication delivery of late meds

[FshnRN5920]

A patient returns to the nursing unit after a procedure for which she had to be NPO. The patient did not receive her 0900 oral meds prior to the procedure and it is now 1100. What factors do I need to consider here for this situation.

Hope someone can help me out here. This is a discussion question for my pharm class.

[donsterRN, ASN, BSN]

Perhaps you can post about what you're thinking regarding this scenario. Tell us what you see as the important factors and your nursing responsibilities to them.

[classicdame, MSN, EdD]

is it once a day dosage? if yes, take now.

Is is dosed several times a day? check drug reference for details. May need to adjust this dose and the next 1-2.

Is it to keep blood glucose low? If pt has not had a meal yet I would not give it.

ALWAYS check the drug reference. Look to see what they recommend for "missed doses".

[Double-Helix, BSN, RN]

Some ideas:

1. What were the medications? Some meds, such as vitamins, can be given at any time of day and it won't cause issues if they are given a little off schedule or the dose is skipped. If it's a pain medication, an antibiotic or a bp med, missing a dose might be more likely to cause harm.

2. When is the next dose due? If it's a daily or a twice daily med, it's probably fine to give it and adjust the time of the second dose. But if it's a blood pressure medication, and the next dose is due in a few hours, you'll probably hold the morning dose.

3. What does the doctor want? Whenever you are giving a medication outside the scheduled time frame, you should consult the doctor about whether to hold or give the meds.

[FshnRN5920]

My intial thoughts were, what meds are they, what other meds am I giving at or near the 1100 time listed and are there any contraindications here. Also initially it's important to know if the pt is still NPO. Finally what is the method of delivery for these meds, as the patient could be unable to take an oral med at this time.

[FshnRN5920]

Wow, this is my first use of allnurses.com but I will have to say, you people are great! thanks for helping me out.

[FshnRN5920]

Thanks Ashley, that was a super response

[psu_213, BSN, RN]

Another thing to remember....at least in my state (I don't know if this is a state by state issue or a federal issue, etc.) all meds have to be reconciled after certain procedures (such as EGD, TEE, surgery). Some of the meds that they were getting before the procedure may not be appropriate for now.

[netglow, ASN, RN]

You might need to give doc/pharm a call due to timing issues, eg if for ex something to be given for x amount of time/days. If the lateness of the dosing messes things so that the patient does not receive a dose they should have if it auto removes from the EMR.

[carolmaccas66, BSN, RN]

The patient should have been given the 0900 meds irregardless whether NPO or not.

This question does not make sense to me. I or any other RN I've worked with does not withhold meds, unless specifically instructed by the doctor, or IV meds can be ordered for example if the patient is nil per os.

I've only really done a 6 week OT clinical, but we ALWAYS had to check pt's had their meds b4 surgery, (or not if on Warfarin for example).

I would argue against this whole case scenario - using critical thinking arguing and rationale for my answer.