pt refuses, wants med later

[chsc]

If a QHS med is due at 2100 and the patient refuses THEN comes back and asks for it around 10:30, do I need an order for the late med administration? For example, if it was a once a day anxiolytic. Our EHR system prompts you if you give a med outside the one hour window, and you select a reason. Our policy is one hour before or after, but there are no specifics on this special circumstance. What is the LAW on this? I hate to pester on-call people in the wee hours of the night for something like this.

[loriangel14, RN]

I would give it late. I see not reason why you couldn't.

[rachel0609, ADN, RN]

We used a pt touch device at the CHS hospital I worked and we had an option to reject or delay and then give a reason. Unless your hospital has a specific policy regarding this I would think delaying due to pt request would be acceptable.

[MrChicagoRN, RN]

QHS is hour of sleep. That's not a specific time.

just because your organization defines that as 9pm doesn't mean that the patient wants to go to sleep at 9pm. I know I don't go to sleep then. Within reason, the patient should get it when they want it. We are talking about a once a day medication, there is no harm in giving it 90 minutes later. You may need to reschedule it in the EMR, or call pharmacy, but it can be done.

Just document that it was declined at 9pm, rescheduled for 1030 per pt request. Did you investigate why the patient wanted it at a different time. Sometimes there needs to be some patient education done regarding onset of action, interaction with other meds, etc. If the pt is going to be there for awhile, and is going to always want it at that time, then consider getting an order to change the time.

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[toomuchbaloney]

I agree...QHS is not 2100, it is when the patient goes to bed.

Talk to your supervisor as the employer rules will be upheld by the employer relative to medications.

[KelRN215, BSN, RN]

QHS is bedtime. The patient did not want to go to bed at 9PM so he wasn't ready for his medication then. I don't see the issue. I'd simple reschedule the med and sign it off when I gave it.

[ChristineN, BSN, RN]

At my hospital we can retime QHS meds or q day meds without a physicians order. I remember one time taking care of a pt that worked night shift, so he preferred to take his Q day Synthroid at 2200 instead of 0600 when we usually give it, since this pt would wake up at 2200.

In nursing we have to be flexible and not all pts can fit nicely into a pre-made schedule

[locolorenzo22, BSN, RN]

Even if the time on the med is 0800...if the patient doesn't want it until later, that is their right. I would just comment with the administration something simple like "patient request". That way you are covered.

[sharpeimom]

If I were to be hospitalized, I'm afraid I'd have to insist that one of my

med times be adjusted. Not to be a pain, but if it's given the way the

drug company recommends, I will be very dizzy, nauseated, and have

even more balance problems than usual.

Keppra 1000 mg. is usually given split into two doses at morning and

HS. I take 1 1/2 pills in the morning and the other half with lunch.

I take the usual dose at bedtime.

I guess all I'm saying is don't be rigid and unyielding. At least listen.