Standardized meds times in the NICU

RainDreamer, BSN, RN · May 16, 2008

Yep, all of our medications are standarized for 0900 if QD, then 0900/2100 if BID. The only meds that aren't standarized for those times are antibiotics (with the exception of amp).

elizabells, BSN, RN · May 16, 2008

Our BID meds initially come up on the EMAR as 09/21, but we are able to change them. If they order BID Lasix at 2300, it's kind of silly to wait for ten hours, isn't it?

PO meds are generally given at 8, 11, 2, or 5, because those are our feeding times.

littleneoRN · May 16, 2008

We do not use standardized times. Most of our kids are on one of four feeding schedules---8/11/2/5, 9/12/3/6, 10/1/4/7, or ad lib. The med times are scheduled accordingly for PO meds, and IV meds are whenever they need to be. This does allow for meds to be missed more frequently, but it works well generally.

RainDreamer, BSN, RN · May 16, 2008

If they order BID Lasix at 2300, it's kind of silly to wait for ten hours, isn't it?

If that was the case for us, we would go ahead and give the Lasix at 2300, then they would give it again at 0900 and then keep it on the 09/21 schedule.

We have a chart we go by to tell us if it's too late to give the med or if it's ok to give it now and then resume the 09/21 schedule. For instance, if that Lasix didn't come up until 0500, then no, we wouldn't give it, we would just wait until 0900. I think 0400 is the cut off .... if it comes up before 0400, we give it and then give it again at 0900, if it comes up after 0400, then we hold it until 0900.

Mimi2RN, ASN, RN · May 16, 2008

We give IV meds at standarized times, which drives me crazy! Imagine giving a first dose of Ampicillin on a sick kid at 0400, then waiting many hours until the next dose is due that evening. We are supposed to give them all at 2200, which is impossible. I don't mind changing times over a few days, but why compromise the baby for the sake of pharmacy convenience? PO meds Q day are given with the am feed, usually between 8 and 10am, and BID at similar times in the evening as well.

Close to discharge we get orders to change the med times again so that we can discharge the infant on day shift or in the early evening.

We started this about three years ago. It makes our night shifts very busy as we also change out IV fluid and tubing every evening, supposed to be at 8pm. This is, of course, prime visiting time, so we have to be able to assist with feedings, and spend lots of time with breast feeding moms....... and let's not forget kangaroo care!

On the plus side, we have a wonderful group of nurses, who work together to keep things as smooth as possible. Despite the lack of understanding by the powers-that-be, who quickly forget what it is like to be a staff nurse. :rolleyes:

elizabells, BSN, RN · May 17, 2008

The thing that's especially dumb about our system is that it depends on how the med is ordered - if it's "q12h" or "q24h", it comes up on the EMAR with an open schedule, and the first time it's given determines the interval. If they order it "BID" or "Daily" it's standardized. So like last night, when I needed to give a glycerin suppository that was ordered "PRN Daily" I had to hunt all over the MAR for it and enter a reason for rescheduling it from 0900. Before I found it on there, I almost didn't bother because the NP would NOT have appreciated being called at 0300 for glycerin orders. But the kid hadn't pooped in 36 hours and was VERY unhappy about it.

Additionally, if something is ordered TID it comes up at like 8, 2 and 18. For an antibiotic that really needs to be equally spaced around a clock, that's just idiotic.

2curlygirls · May 18, 2008

Some are standard. Like multi vit's are at 08 or 09.

abx just depend on when they were started.

I wish people would stop giving caffeine at 2100! Duh!

preemieRNkate, RN · May 18, 2008

Some are standard. Like multi vit's are at 08 or 09.
abx just depend on when they were started.
I wish people would stop giving caffeine at 2100! Duh!

Us too, poly-vi-sol at 0900. Except we give caffeine at 1200 daily. Boluses are given whenever they are ordered and arrive on the unit from pharmacy. We also use standardized times for chlorothiazide (1400/0200), aldactone (1800 if Qday or 1800/0200 if Q12), fer-in-sol (1200), amoxicillin (1400), Zantac (0800/2000 if Q12, 0800/1600/0001 if Q8). That's what I can think of off the top of my head. We have a list in the med room of the meds that have standardized times. Of course, things get changed for various reasons.

ETA: Oh, and we rarely have anything ordered BID or TID so we can space things evenly around the clock.

hikernurse · May 18, 2008

Pharm always schedules in standardized times, but it is the rare patient that follows that schedule :rolleyes: . We adjust it according to feedings if it is an oral med or with abx, as soon as they come up, then however many hours later. We end up with some pretty odd times (multivites at 0130 :confused: ), but it seems to work out. Pharm will reschedule, but it's just as easy to do it ourselves as to contact them :).