What do you do when a patient takes their meds at an "unusual" time?

estrogen · Aug 23, 2005

In the hospital I worked in, that also had computerized MARS and pixys, I would just call the pharmacy and ask them to change the administration time. Sometimes they wanted an explanation why fist, bu usually they just obliged.

As far as the Levoxyl/Synthroid issue goes, I don't know why you couldn't change brands since is just a different name for the same drug. I wonder if your endocrinologist has an endorsement contract with one drug company and not the other... Our hospital usually carried only one brand of each, if the makeup of the drug was the same. If a pt. insisted on something else, he/she would have to have their own broght in and sent to pharmacy for dispesing.

sbic56, BSN, RN · Aug 23, 2005

Just got out of the hospital...spent three days there with the most horrible headache, fever, N/V I've ever had (West Nile!!!). But that isn't the point...
I take Levoxyl 50 mcg, once daily. Levoxyl is supposed to be taken on an empty stomach...most people take it first thing in the morning, before breakfast. I work night shift and most of the time, I am either asleep (on days off) or do not have an empty stomach. I am pretty consistently awake and have an empty stomach at 4:00 in the afternoon, so I take the Levoxyl then. Three mornings in a row, at 6:00 AM I got woke up to a nurse trying to give me the Levoxyl...three mornings in a row, I refused it and told them I wanted it at 4:00 PM...I even got my doctor to specify the time on his orders, yet for some reason, the pharmacy kept putting 6:00 AM as the administration time. Before we went to computerized MARs, we were allowed to change times...I guess now, the computer assigns times and the med nurses are supposed to stick to those times. Also...the pharmacy picks up all D/Cd meds, meds of patients who were discharged, and meds that were refused at 3:00 PM...so every by 4:00 PM, my Levoxyl was back in the pharmacy and the pharmacy techs were mad because they had to "uncharge" me for the Levoxyl that I had refused...
So what do you do? Are patients allowed to take certain meds on their usual schedule? I know that there is no way that everyone can have everything according to their usual routine but I always thought things like seizure meds, psych meds, and thyroid supplements should be taken at the same time every day...
I ended up having my husband bring my Levoxyl from home so I could take it at the time I am used to taking it...my doctor was fine with that, but my coworkers were not so thrilled...even had a charge nurse come in and DEMAND that I give her my Levoxyl to lock up in the med drawer (we have med drawers outside each room)...not a problem since I have a key...
Also...what do you do about patients who want to take certain brands of meds? I wanted LEVOXYL...not Synthroid, not generic levothyroxine...I wanted LEVOXYL. My endocrinologist told me not to change brands so...

Boy, oh boy. Computerized systems are nice, but are only as good as whoever programs them! The pharmacy should be scheduling your Levoxyl on the MAR for 4 pm. There is a doctors order for it, so there is no excuse. Since they did not do this, I don't blame you for taking it upon yourself to get your med when you need it. That charge nurse was out of line for sure with her snotty approach! Sounds like a real sweetheart. :) I bet she's the same one that enforces the no time changing on the MARS. "It's the rule" kind of thinking. These types make me crazy!

I hear you on the brand thing, too. I have to take Synthroid. The generic won't work as well at all for me. Again, this should be specified in the doctors orders and the pharmacy should be sending the drug that is ordered, otherwise it's an error.

flashpoint · Aug 23, 2005

Yeah...the charge nurse is a real pain in the ***. She is the entire reason I REFUSE to go to day shift. :)

I don't know the logic behind being brand specific with the Levoxyl, but since I am no loger sleeping 15-20 hours a day and being so cold I ahve to wear sweats when it is 98° outside, I am not changing anything...

Jolie, BSN · Aug 23, 2005

In the hospital I worked in, that also had computerized MARS and pixys, I would just call the pharmacy and ask them to change the administration time. Sometimes they wanted an explanation why fist, bu usually they just obliged.
As far as the Levoxyl/Synthroid issue goes, I don't know why you couldn't change brands since is just a different name for the same drug. I wonder if your endocrinologist has an endorsement contract with one drug company and not the other... Our hospital usually carried only one brand of each, if the makeup of the drug was the same. If a pt. insisted on something else, he/she would have to have their own broght in and sent to pharmacy for dispesing.

My mom takes thyroid medication and had problems with symptoms and blood levels when the pharmacy switched from one brand to another, despite the strength being the same. She has been advised by pharmacists and her physician NOT to switch brands, as there is some difference in bioavailability of the drug, despite drug companies' claims that they are identical. I've been told the same for some types of insulin, as well. These meds have such a small "margin of error" that changing brands can impact on the patient.

sbic56, BSN, RN · Aug 23, 2005

Yeah...the charge nurse is a real pain in the ***. She is the entire reason I REFUSE to go to day shift. :)
I don't know the logic behind being brand specific with the Levoxyl, but since I am no loger sleeping 15-20 hours a day and being so cold I ahve to wear sweats when it is 98° outside, I am not changing anything...

There is much controversy as to whether one brand is better than another, but the person experiencing the symptoms of hypothyroidism that are not relieved with the so called equivilents, knows there sure is a difference! I recently tried the generic as my doc forgot to check the "no generic" box and since it was a 90 day mail order supply, I thought I would try it again despite a poor experience with it about 5 years ago. Well, I was dragging, constipated and muddle headed for the 3 months I was not taking the right drug. It was amazing how good I felt when I got back on the Synthroid last month. Synthroid is a cheap drug anyway, so the few bucks a month saved by using the generic is no savings at all when it comes to how I feel.

PamUK · Aug 23, 2005

Why dont you suggest introducing "Patient Self Medication" in your hospital? It is such a huge problem when patients have been taking the same meds for years, come into hospital and we change thier routine because of "systems" With some drugs, changing their routine can have consequences (as you well describe)

At my hospital, each bed has a locked cupboard for this very purpose. When patients have been taking the same meds for years, the nurse will make a full assessment to see if they are still capable of taking them themselves. If they are, "the rules" are explained to them and they continue to take them at the times they have always taken them. Nurse only give out newly prescribed meds

It works well for us anyway

sbic56, BSN, RN · Aug 23, 2005

Why dont you suggest introducing "Patient Self Medication" in your hospital? It is such a huge problem when patients have been taking the same meds for years, come into hospital and we change thier routine because of "systems" With some drugs, changing their routine can have consequences (as you well describe)
At my hospital, each bed has a locked cupboard for this very purpose. When patients have been taking the same meds for years, the nurse will make a full assessment to see if they are still capable of taking them themselves. If they are, "the rules" are explained to them and they continue to take them at the times they have always taken them. Nurse only give out newly prescribed meds
It works well for us anyway

Sounds like a great system, Pam. I love the thought of increased patient responsibility in their care.

(I bet that charge nurse on cotjocky's unit would blow a gasket at the thought of losing control of the patient, though! :chuckle )

estrogen · Aug 23, 2005

My mom takes thyroid medication and had problems with symptoms and blood levels when the pharmacy switched from one brand to another, despite the strength being the same. She has been advised by pharmacists and her physician NOT to switch brands, as there is some difference in bioavailability of the drug, despite drug companies' claims that they are identical. I've been told the same for some types of insulin, as well. These meds have such a small "margin of error" that changing brands can impact on the patient.

OH!!! Okay, I didn't know that. Thanks for the interesting info. :specs:

Rena RN 2003, RN · Aug 23, 2005

in our facility, we simply write "patient prefers to take at ________" beside the MD order. if there is a question regarding switching the time, pharmacy calls the MD.

sharann, BSN, RN · Aug 24, 2005

Did you really have West Nile? Are you ok?

p.s: I vote for taking the meds when you find most effective.

flashpoint · Aug 24, 2005

Did you really have West Nile? Are you ok?
p.s: I vote for taking the meds when you find most effective.

Really have West Nile...ended up as an inpatient for hydration and pain management... I feel OK now...more tired than anything. I initially went in because I thought my TSH was elevated.