Time Frame for Med Administration

0402 · May 25, 2012

At the 2 hospitals I have worked at, it's one hour on either side. And with 6 (sometimes 7) pts, it's a challenge to get everyone's 2200 meds during that 2 hr time span. I was trying to combine 2000s with 2200s, at 2100, but that only works if only one pt has 2000 meds, but lately 4/6 of my pts have had 2000 meds, generally being coreg or abx. I try to make sure I do the coregs first so that it has time to work for reassessment before I give any 2200 htn meds. I also look at the scheduling for the abx. For some reason, I have been getting stuck with q24h or daily abx to be given at 2000, so I give those more leeway (probably going to be given right when I go around to meet pts, around 1930 or given with 2200 meds), but if it's a q6h, I try to be as close to that 2000, as possible, especially since with only generally having 1 0200 med, I tend to give that pretty much right on time. If they tried to limit us to 30 minutes on either side, it would be come generally impossible. Maybe if I only had 3-4 pts, I could do it, but I would also need them to stop sending me admissions between 2000 and 2200- that really jacks up my schedule, too. =) I do the best I can and make sure I know what everyone is getting so that I can prioritize, but I will admit that on rare occasion, I'm giving meds a little bit late. Once I figure out how to clone myself, and ensure that my duplicate can do accurate med administration, I'm sure I won't have this issue any more. Oh, and if they would stop short-staffing us, that might help, too.

nerdtonurse?, BSN, RN · May 25, 2012

We have 1 hr either side. Some meds don't go together, but most of the time, I try to "bundle" my meds -- would you want me in your room every hour all night for non-emergency meds --- here's your 1am protonix. Here's your 2am lovenox. Here's your 3 am 81mg ASA. Here's your 4am q24h solumedrol. Here's your 5 am 10cc IV flush. In that case, I would do the 1 and 2ams as close to 1 as the computer will allow, and the 3 and 4 as close to 4 as the computer will allow. I'm checking on my folks all the time, but I try not to wake them if I've finally managed to get them to sleep. Your body doesn't make critical hormones unless you're asleep. I keep you up for a few days around the clock with only cat naps, I'm going to snarl up your endocrine system.

Now, it it's cardiac or resp drugs and the patient's really sick? I'm in there with a syringe or pill every 30 minutes. It just depends.

Mandychelle79, ASN, RN · May 25, 2012

Our Emar opens the meds up to be given up two 2 hours on either side of the scheduled dosing time. Because of the unit I work, when the patients come up for the meds between 8 and 10 I give them all at the same time, which is what they will be doing at home, if they are even compliant.

I only do this with non narcotic scheduled meds. Scheduled Narcs I give usually within 10 mins of time frame when I can, and PRN's only on or after the allowed next dose.

morte, LPN, LVN · May 25, 2012

When they gave pharmacy the scheduling duty, it went to Hades in a handbasket. I know nerd was only giving examples, but so many meds do not need to be given at noc, at all and nursing would work those times into a more realistic time frame over a couple days...now? geesh.

merlee · May 25, 2012

Well, here it is, after 10 AM, and I need to take my own daily AM meds.....oh well, I have my own window!!!

But, seriously, most places I worked had 1 hour on either side. People who are at home usually 'bundle' their own meds differently, to suit their own needs.

I hated waking people up at 6 AM to take just one pill, like thyroid meds. Most of them told me they take it when they get up, at home, and by the time they do their morning routine, it was about an hour before they ate their breakfast. Or they took all of their AM meds at one time.

Try your best to follow your facility's policies.

nurseprnRN, BSN, RN · May 25, 2012

"in school, we learned that meds can be given within an hour of the designated time frame. in other words, if a med is due at 2100, it can be given between 2030-2130."

no, "within an hour" means plus-or-minus one hour, not plus-or-minus one half hour for a total of one hour.

if i say, "i will meet you within the hour" at 9:00am, you don't expect me by 9:30, but by 10:00. if when we meet at 10:00, i say, "the fire started within the last hour," that's because it started sometime since 9:00, not 9:30.

therefore it is perfectly acceptable to give 2000 meds and 2200 meds at 2100, as long as there is no other contraindication (interactions, for example) to giving two concurrently, or one is not a q2h med that really has to be given q2h.

as for the q24h or q12h meds, when did nurses cease looking at the overall med schedule and figuring out the best time for those in an individual basis? i don't care that "policy says we give all xx at 0800 and 2000," because if there's a valid reason for it (like, "our patients need uninterrupted sleep") policy can be changed. advocacy and initiative here.

GitanoRN, BSN, MSN, RN · May 25, 2012

needless to say, in this case you must follow your rules & regulations at the facility where you work in this manner there's no confusion and no need to explain yourself to anyone when administering meds....just saying :cool:

morte, LPN, LVN · May 25, 2012

this what i meant by my post about pharmacy setting the times. apparently it is no longer a nursing judgement, and can't be changed by nursing. i go through this in long term care, the p+p will specify that all q24 hour meds are given at 8/9 am....so, i will see prevacid, thyroid, pravastatin, etc at that time. the thyroid i can get away with changing, the others i have ended up having to get a docs order to change. blows the mind,eh?

"in school, we learned that meds can be given within an hour of the designated time frame. in other words, if a med is due at 2100, it can be given between 2030-2130."
no, "within an hour" means plus-or-minus one hour, not plus-or-minus one half hour for a total of one hour.

if i say, "i will meet you within the hour" at 9:00am, you don't expect me by 9:30, but by 10:00. if when we meet at 10:00, i say, "the fire started within the last hour," that's because it started sometime since 9:00, not 9:30.

therefore it is perfectly acceptable to give 2000 meds and 2200 meds at 2100, as long as there is no other contraindication (interactions, for example) to giving two concurrently, or one is not a q2h med that really has to be given q2h.

as for the q24h or q12h meds, when did nurses cease looking at the overall med schedule and figuring out the best time for those in an individual basis? i don't care that "policy says we give all xx at 0800 and 2000," because if there's a valid reason for it (like, "our patients need uninterrupted sleep") policy can be changed. advocacy and initiative here.

GLORIAmunchkin72 · May 25, 2012

The hour before and hour after, of course, wouldn't apply to PRNs.

If a PRN tyl was given at 8 am and the order is every 4 hrs then it wouldn't be due until 12 Noon. But if you applied the hour before you would be giving it at 11 am and that would be too soon.

MN-Nurse, ASN, RN · May 25, 2012

I understand that it really depends on the medication, but generally is this acceptable in the real world of nursing?...because in school, it was not.

You are correct. In school, it is not acceptable.

In the real world, it is unavoidable. Any given shift, I might have 50 meds to give between four patients, all due at 0800 - then they have more scheduled (and PRN) almost around the clock. No way those are all given as scheduled, although some sure are.

buytheshoes11, MSN, RN · May 25, 2012

Where I have been in school and where I work now I've been told it's a one hour window for acute and a two hour window for LTC.

Unknown member · May 25, 2012

"in school, we learned that meds can be given within an hour of the designated time frame. in other words, if a med is due at 2100, it can be given between 2030-2130."
no, "within an hour" means plus-or-minus one hour, not plus-or-minus one half hour for a total of one hour.

if i say, "i will meet you within the hour" at 9:00am, you don't expect me by 9:30, but by 10:00. if when we meet at 10:00, i say, "the fire started within the last hour," that's because it started sometime since 9:00, not 9:30.

therefore it is perfectly acceptable to give 2000 meds and 2200 meds at 2100, as long as there is no other contraindication (interactions, for example) to giving two concurrently, or one is not a q2h med that really has to be given q2h.

as for the q24h or q12h meds, when did nurses cease looking at the overall med schedule and figuring out the best time for those in an individual basis? i don't care that "policy says we give all xx at 0800 and 2000," because if there's a valid reason for it (like, "our patients need uninterrupted sleep") policy can be changed. advocacy and initiative here.

i know what "within an hour" means...thanks... i used it incorrectly but didn't need a whole 2 paragraph explanation. in school, we were told a half hour before or a half hour after. not "within an hour"...my apologies.

anyway, thanks everyone for the replies! makes sense, i just wanted to clarify because this was drilled into our heads in school. if i didn't give an 8am med by 830am it was late.