medication time regulations

I don't live in PA, but we are supposed to give medications within half an hour of the scheduled time because that is what medicare thinks we should do. I don't think most people really make much of an effort to pass meds this way, unless it is a medication that needs to be given close to the scheduled time. Does it really matter if your stool softner or lipitor is given at 2100 instead of 2030? It is impossible at times to pass meds within half an hour of the scheduled time.

We have people who want to go to bed very early (I work nights)... if someone wants their 2100 meds at 2000, of course that's fine, but sometimes there are 2200 colace, vitamin C and other meds like that... I'm giving it early so they can go to sleep. I write notes how they request meds early. If they have BP meds I'm usually a stickler on times.

Yeah, I'm in MS, and we're supposed to do 30 minutes before or after the scheduled time. This is only a priority with me if it's an important med, such as digoxin, coumadin, or an abx, etc. Stool softeners and baby aspirin go to the bottom of my med pass priority list. It's not like I'm passing them 3-4 hrs late or anything, but when I've got more important ABC type situations going on, I just let them slide until I can get to them.

I work in PA also, in LTC. We go by the 1 hour before/after timeframe. With a PRN med, if it is q4H, we can't give it closer than 4 hours apart, ie: if it was given at 0100, we can't give another dose before 0500.

In LTC, many med passes can barely (if at all) be done within the 2 hour window. I can't imagine it changing!

The new CMS guideline is 30 minutes on either side of the scheduled time. ISMP is strongly opposed to the new guideline has just put out their most recent protest of the rule:

CMS 30-minute rule for drug administration needs revision

This is just one of many idiotic CMS rules that have poor compliance and for good reason.

Our facility does not follow the rule because we don't consider it to be safe so we are sticking with 1 hour to either side of a time, and 2 hours for q daily medications.

It doesn't actually appear the rule is necessarily that strict, since it says medications should be given within 30 minutes of the time in the MAR, and there are no rules as to how medication times get changed in the MAR.

My take on the topic is this: There is a difference between what pharmacy puts on the MAR as a time for the med to be given, and what the doctor's order actually says. Seriously. An order that says "q12 hrs" or "daily" or even "at bedtime" does not have a time written in. Now for the ones that are in specific time increments I will do my best to stick to the correct times. Then you have to wonder, for a vancomycin infusion that takes two hours... when have you fulfilled your obligation? If you start it an hour and a half early, is the med really early if it finishes a half hour later than the time on the MAR? See... it's not all cut and dried.

Pharmacy puts times down and facility has policies stating that "three times a day" is to be interpreted as 0900, 1300 and 2100, well okay and fine but the doctor's order didn't say that. They are trying to think for you, is what's happening here, just give you a little guidance. Many "daily" med regimens include blood pressure meds and other important things, so of course you'd like to be consistent from one day to the next, and I didn't say that guidance is a bad thing necessarily. I just separate guidance with regard to times, from legality with regard to following a doctor's order.

So when my times differ by more than an hour on the MAR I simply retime them and that way the medical record reflects what I did. This is especially necessary sometimes with antibiotics that had to be given late due to other crap going on with the patient. One dose thrown off, screws up the rest of the times but hey, you're trying to do the future doses according to the order. I really think CMS needs to get their head out from up their collective butts regarding this non-issue.

Before sending someone for a cath, we're required to give them their daily/BID cardiac meds even if it's >2 hrs. early. Also, if someone goes off the floor for dialysis or a test, we're supposed to use our best judgment in catching them up. The proposed brainless bureaucratic micromanagement replaces nursing judgment with blind obedience and does not support the best interest of the patient.

One thing that I am grateful for is my hospital does not buy into this 30 min rule. We have a 4 hr window to give an everyday scheduled med and an hr to give a time specific med like an antibiotic. They would prefer us not to make med errors based on being rushed.

We have an hour window on either side to give meds in general. However meds that are given very frequently and insulin I try to give closer to the scheduled time. I have often questioned HS meds though in my facilty they are scheduled at 2100, but 75% of my pts are asleep by this time. Should they be given by the pt's hour of sleep? My hospital says no. Since we have gone to computer mars, anything outside of the window sends an automatic incident report to the nurse manager. I recently got one on a pt who refused her scheduled tylenol then an hour later requested it. No prn tylenol ordered so i gave the earlier dose.

I hate HS meds. You go to give them to the patient @ 2100. The pt. says "I never go to bed before midnight or 1 AM so that's when I take these at home". So you say something to the pharmacist or the doctor and they say "Well, here he's going to take them when WE say." May not be much of a problem with stool softeners but Coumadin or Coreg? Is switching back and forth from one time to another really a good thing?