This is wrong, right?????

[Graduatenurse14]

So glad you all are here for us new RN's! Will be off orientation in 2 weeks! and don't feel ready!

Background: We use Sunrise (which I hate) and we don't scan meds or patients at my hospital so you have to go back in and document the time that you gave the med. Most RN's pull each patient's med individually from the Pyxis- policy says this is preferred way but not a must.

A med is due at 8:00 am and given at 9:30 am. The RN's I've been with, go back in and document that the med was given at 8:00 am. This is done for all of the meds due at 8:00 am so if you have 5 patients and your last med was given at 9:30am, in the computer, it looks like that RN's patients got their med at exactly 8:00 am!

I was creating new time columns for the actual time that I was giving the meds and was told that we don't have to do that and it's fine to say that all of your 8:00 am meds were given at 8:00 am even if they weren't. That's wrong, right??? I don't know what the policy says, but would be shocked if it really said that this is acceptable.

I did clinicals at big system that uses Cerner and scans meds and patient so it's documented for you. I also worked as a nursing assistant at one their hospitals and am so used to doing it and seeing it done.

I would rather spend time creating correct med administration time columns than charting in detail about their teeth, gums and tongue instead of just clicking WDL/WNL and clicking at least 6 boxes to show how I'm preventing a fall to only satisfy CMS/JC requirements!

I'm just picturing me up there on the stand being drilled with questions about this!! HELP!!

[RN403, BSN, RN]

Not sure what your policy says, but, I would personally document the time that the med was truly given.

[Pangea Reunited, ASN, RN]

In most cases, it probably doesn't make a huge difference. There are plenty of times that I scan a medication, then go back to get a medicine cup, then get stopped by the unit clerk on the way with a message, then return to the room to find the patient in the bathroom for 20 minutes, then listen to a long story about the patient's dog/cat/child before they finally drink up!

The time they take the medication is not exact, but it's close enough.

[Glycerine82, LPN]

This isn't directed at the OP, just in general. I'm learning.....

I think giving a med 90 minutes after you said you gave it could be dangerous in many circumstances, and if It were me I'd document when It was actually given, or at the very least document the latest point in the "window".

What if you give a med at 0930 thats then due again at 1200? If it was due at 8, and the second dose is given on time they're getting it every 2.5 hours, instead of every 4...... isn't that a big deal?

[Pangea Reunited, ASN, RN]

"What if you give a med at 0930 thats then due again at 1200? If it was due at 8, and the second dose is given on time they're getting it every 2.5 hours, instead of every 4...... isn't that a big deal"

Yes, it can be ...but in most cases, those aren't the circumstances. If a patient's getting 4mg of IV dilaudid every three hours, I'm not going to give it an hour late, then an hour early. If they're getting colace BID, exact timing doesn't matter as much.

[Glycerine82, LPN]

Oh lord, I wouldn't be able to remember what I gave or to whom, lol.

[Graduatenurse14]

This isn't directed at the OP, just in general. I'm learning.....

I think giving a med 90 minutes after you said you gave it could be dangerous in many circumstances, and if It were me I'd document when It wYeras actually given, or at the very least document the latest point in the "window".

If it's med that has a strict Q4/Q6 or whatever and the RN has the autonomy then we can change the time it's due again so there is the 4 hr/6hr space in between.

What if you give a med at 0930 thats then due again at 1200? If it was due at 8, and the second dose is given on time they're getting it every 2.5 hours, instead of every 4...... isn't that a big deal?

We can move the next time back to make sure there is the ordered time lapse in between.

[Ruby Vee, BSN]

You're wrong, kind of. If the med is due every four hours, or even every six, I'd be danged sure I gave it within the one hour window. So if a patient had meds due that frequently, I'd get to them first. If I couldn't get to them first and actually gave it at 9:30, I'd chart it in the 9:00 column. And then, depending upon what it was and how frequently it was due, I'd "stagger it" to get it back on the proper schedule.

If it's due every 12 or 24 hours, it's really not that big of a deal and you create all sorts of hassels for every other nurse, not to mention for Pharmacy and whoever's doing chart audits by creating new time columns.

Unless it's a one time med due at a specific time because it's on call to the OR, given immediately prior to dialysis or stat because of some issue the patient is having. Those are worth creating a new time column for if you must.

Your colleagues are going to hate you if you insist upon nitpicking this way. More new nurses lose their jobs because their colleagues don't like them than for any other reason, so pick your battles. "Poor fit for this unit" or "not a team player" are the euphimisms often used. This probably is not the hill you want to die on.

[Graduatenurse14]

Thanks!!!!

If the med is due every four hours, or even every six, I'd be danged sure I gave it within the one hour window. So if a patient had meds due that frequently, I'd get to them first. If I couldn't get to them first and actually gave it at 9:30, I'd chart it in the 9:00 column. And then, depending upon what it was and how frequently it was due, I'd "stagger it" to get it back on the proper schedule.

Agreed. I didn't understand why the decision on who to give to meds to first wasn't based upon those type of orders but when everything is charted as given at 8:00 am, I now understand it. The one RN I precepted with did stagger them to get it back on track.

If it's due every 12 or 24 hours, it's really not that big of a deal and you create all sorts of hassels for every other nurse, not to mention for Pharmacy and whoever's doing chart audits by creating new time columns.

I see why the time with this is more fluid but I'm not sure how creating a new time column creates hassles for the next nurse or auditors. However, on clinicals using Cerner with scanning and while precepting using Sunrise with VeriScan, I had to look back to see when meds were given 12-24 hours prior yet without fairly close times, I wouldn't have been able to see what really had been done. What am I not seeing?

Unless it's a one time med due at a specific time because it's on call to the OR, given immediately prior to dialysis or stat because of some issue the patient is having. Those are worth creating a new time column for if you must.

Agreed!

Your colleagues are going to hate you if you insist upon nitpicking this way. More new nurses lose their jobs because their colleagues don't like them than for any other reason, so pick your battles. "Poor fit for this unit" or "not a team player" are the euphimisms often used. This probably is not the hill you want to die on.

I'm not nitpicking to them that they do it this way at all. I see my creating the correct time columns as the marrying of "Right Time" and "Right Documentation" for safe med administration that protects me and my patient. That's not correct? What am I missing?

[KelRN215, BSN, RN]

I think you need to get over the fact that your facility doesn't use the same computer systems you used in clinicals or when you were a CNA.

8am meds are usually standing meds and it's unlikely to make much of a difference if they were given at 8am or at 9:30am. If the patient takes these meds at home, he might take it at 8am on work-days but 9:30 am on weekends/holidays when he sleeps in. When I worked in the hospital, our original eMAR didn't have scanning. If your meds were timed at 0800, when you went to sign them off, the computer signed them off at 0800 unless you changed the time. I don't really think this is something worth getting too excited about- let other people do it their way, you do it whatever way you see fit. You said that the nurses are appropriate with rescheduling q 4hr, q 6hr, etc meds so they are not given too closely together so I don't really see what the big deal is. I documented all my vitals and neuro assessments at 8,12 and 4 when I worked in the hospital. Obviously I didn't do everyone's assessment exactly at 8am but it was their 8am assessment.