Night shift medications

Long Term Care Columnist / Guide · Sep 19, 2020

Sleep meds, of course. Pain medications at HS and during the night. And antipsychotics...lots of antipsychotics. ?

GrumpyRN, NP · Sep 19, 2020

A lot of years ago one of the duties of the night shift drug round was to give a tin of beer to certain patients just before bedtime - prescribed by medical staff.

Jedrnurse, BSN, RN · Sep 19, 2020

11 minutes ago, GrumpyRN said:

A lot of years ago one of the duties of the night shift drug round was to give a tin of beer to certain patients just before bedtime - prescribed by medical staff.

...a glass of red wine for one of my long-term patients.

Sour Lemon · Sep 19, 2020

All of them. The type of patient you're working with is probably a much bigger factor than the shift you happen to be working. You'll also be there early in the morning if you're doing twelve hour shifts. At my hospital, the super-common early morning medications (given by night shift) are insulin, synthroid, protonix and zyson. The rest of the shift, there's way too much variation to even attempt a list.

JKL33 · Sep 19, 2020

This is kind of like your other post wanting a list of push times for medications.

You are going to be giving many different medications and will need to look them up every time at least until you become more familiar with them and even then any time that you remotely have a concern or question about what you are doing.

I appreciate that you sound like you want to become prepared for your new role, but the safest way to deal with the matters you're asking about is to simply be prepared to use critical thinking and prepared to consult reliable resources in real time. There really isn't a list or chart or table of facts that if you have it all in one place you're home free--and you really don't want to be operating off of pieced-together random info from internet strangers anyway. Additionally, your specific workplace will likely have policies that pertain to administering medications and you will want to incorporate these into your understanding of what you need to do. Most importantly, you will always need to be mindful of individual patient situations and specifics, which is information not covered by the types of lists you're seeking.

Any workplace that does not have appropriate resources available at all is probably not the best environment.

I know all of this may seem scary; but it's really just that it is a serious matter, not so much scary per se. You will be safer in the beginning and in the long run if you commit to critical thinking and appropriate consultation of resources at the point of care.

Advanced Practice Columnist / Guide · Sep 19, 2020

I don't work at the bedside but as a hospital-based NP, I order meds and look at med administration data for my patients. The big things for night shift are time-sensitive around the clock meds such as some antibiotics, insulin coverage, anticoagulants such as warfarin and heparin drips that are adjusted based on lab values. As mentioned, PRN pain meds and sleep aids are typical meds at night.

HiddencatBSN, BSN · Sep 20, 2020

13 hours ago, JKL33 said:

This is kind of like your other post wanting a list of push times for medications.

You are going to be giving many different medications and will need to look them up every time at least until you become more familiar with them and even then any time that you remotely have a concern or question about what you are doing.

I appreciate that you sound like you want to become prepared for your new role, but the safest way to deal with the matters you're asking about is to simply be prepared to use critical thinking and prepared to consult reliable resources in real time. There really isn't a list or chart or table of facts that if you have it all in one place you're home free--and you really don't want to be operating off of pieced-together random info from internet strangers anyway. Additionally, your specific workplace will likely have policies that pertain to administering medications and you will want to incorporate these into your understanding of what you need to do. Most importantly, you will always need to be mindful of individual patient situations and specifics, which is information not covered by the types of lists you're seeking.

Any workplace that does not have appropriate resources available at all is probably not the best environment.

I know all of this may seem scary; but it's really just that it is a serious matter, not so much scary per se. You will be safer in the beginning and in the long run if you commit to critical thinking and appropriate consultation of resources at the point of care.

What I think is helpful in the beginning too is to keep a running list of the meds you give and once you identify the common ones, you can research them at home. But the common meds you give will be very unit specific: my top 10 meds given will likely be very different than what ends up being your top 10.

We use epic and lexicomp is integrated in to the charting so when I have questions about an unfamiliar med or want to review dosing and administration for a med I’m familiar with but want to be sure about I can click from my MAR. My first job kept our med formulary books next to the pyxis.

I started in peds so to prep for my first job I reviewed my peds notes and text book. If meds are something you’re anxious about, pull out your pharm notes and review your course materials. More specific prep is going to be hard because even within the same specialty there’s a lot of variation based on facility, the provider preferences, etc. For example, the sepsis bundle meds have varied at every hospital I’ve worked at, same with the heme onc with fever, sickle cell treatment, etc.

There is a ton you will learn in your first year (and beyond) and I devoted a fair amount of time studying especially in my first few months. Take this time for a more foundational review and you’ll learn what the specifics are for your unit as you progress through orientation and your first year.

Newnurse23 · Sep 20, 2020

Thank you!

I just wanted to know common drugs given at night so I can look them up in my med book at home while I’m bored. I know I’ll learned a lot my first couple years.

KKQU2 · Sep 21, 2020

good to see you thirsting for knowledge and wisdom. and utilizing boredom time to help in setting a good firm foundation.

But as stated above each facility and specialty area will have an individual protocol.

Once at work, try to find a coworker you can relate to, and ask for support from them. Keep a pocket med formulary with you, and when unsure, or just to double check by looking it up. Just follow the 5 R's. Every patient/ SHIFT/ FLOOR will be different so go with the flow. In the Mean time RELAX !

As you said look up medications, so you can become familiar with the usual ones.

As listed above more common ones will be : Pain meds: demerol, morphine, codeine based such as Oxycodone, zyson, percodan, tylenol #3, tramadol.

A few sleep meds but these are usually on 2nd shift: seroquel, chloral hydrate, nembutal, ambien.

Antibiotics: keflex, keflin, pen-k, amoxicillin,

zithromycin, doxycycline, Bactrin-DS:

blood thinners Heparin, coumadin:

In last med run in early morn, you will give things such as:

ALL TYPES of Insulin, Thyroid meds (these need to be given on empty stomach 30- 60 min ac meals -) Digoxin, Check all IV's for times of drugs to be changed,Start setting folks up for early baths and bed changes and breakfast routines, and morning tests.

Depending on Speciality Area you can review the ordered test procedures for each patient assigned earlier in evening for protocols required.

I always enjoyed doing teaching to patients that were awake and review meds tests and Questions they had

I liked to review Lab values, and cross reference them with Meds and Dx formulate a care plan and leave notes for Drs about concerns/Questions/ and do same for future shifts to consider.

Just remember NO QUESTION IS TOO STUPID TO ASK

NEVER ASSUME because "assume" stands for: You make an *** OUT OF YOU AND ME for not asking. Safer to ask than to be sorry.

Remember to become friends with your CNAs & LPNs - FOR THEY WILL BE YOUR EXTRA EYES AND EARS and can help you out a lot! Same goes with secretary, and housekeepers too. All are a team working as a whole to give BEST of qualified Care.

Hopes this gives you starters on looking up meds

Newnurse23 · Sep 21, 2020

Thank you so much!!

MunoRN, RN · Sep 21, 2020

4 hours ago, KKQU2 said:

good to see you thirsting for knowledge and wisdom. and utilizing boredom time to help in setting a good firm foundation.

But as stated above each facility and specialty area will have an individual protocol.

Once at work, try to find a coworker you can relate to, and ask for support from them. Keep a pocket med formulary with you, and when unsure, or just to double check by looking it up. Just follow the 5 R's. Every patient/ SHIFT/ FLOOR will be different so go with the flow. In the Mean time RELAX !

As you said look up medications, so you can become familiar with the usual ones.

As listed above more common ones will be : Pain meds: demerol, morphine, codeine based such as Oxycodone, zyson, percodan, tylenol #3, tramadol.

A few sleep meds but these are usually on 2nd shift: seroquel, chloral hydrate, nembutal, ambien.

Antibiotics: keflex, keflin, pen-k, amoxicillin,

zithromycin, doxycycline, Bactrin-DS:

blood thinners Heparin, coumadin:

In last med run in early morn, you will give things such as:

ALL TYPES of Insulin, Thyroid meds (these need to be given on empty stomach 30- 60 min ac meals -) Digoxin, Check all IV's for times of drugs to be changed,Start setting folks up for early baths and bed changes and breakfast routines, and morning tests.

Depending on Speciality Area you can review the ordered test procedures for each patient assigned earlier in evening for protocols required.

I always enjoyed doing teaching to patients that were awake and review meds tests and Questions they had

I liked to review Lab values, and cross reference them with Meds and Dx formulate a care plan and leave notes for Drs about concerns/Questions/ and do same for future shifts to consider.

Just remember NO QUESTION IS TOO STUPID TO ASK

NEVER ASSUME because "assume" stands for: You make an *** OUT OF YOU AND ME for not asking. Safer to ask than to be sorry.

Remember to become friends with your CNAs & LPNs - FOR THEY WILL BE YOUR EXTRA EYES AND EARS and can help you out a lot! Same goes with secretary, and housekeepers too. All are a team working as a whole to give BEST of qualified Care.

Hopes this gives you starters on looking up meds

Are chloral hydrate and nembutal commonly used sleep meds where you work? Not judging, just curious, are you in the US?