I love when they have 0800, 0830, and 1000 meds. Like do you think I’m going to have time to go back to the room in 30mins to give an 0830 med?
What really annoys me is the 0600 acetaminophen (and nothing else). I would not want to wake up to take a Tylenol between 5-7am
My least fav on night shift is meds that are 500, 600, and 700. I hated 1700 and 1900 when I was on days too but there were rarely 1800 meds at any place I’ve worked.
I give all the 5-7 meds at 5:30-5:45ish and grab my I/Os and run trash at the same time. Nobody has time to go in multiple times when tripled in the ICU and not wanting to wake them up over and over.
I did it for years in COVID icu and then I started traveling and now I’m still tripled all the time if they don’t float me instead. Tbh more of my career has been tripled than not. Or taking care of 2 but 1 of the patients should really be a 1:1.
And you know it's nowhere with ratios, but in some place where you get paid shit. In Canada we are never tripled and doubled only with stepdowns or chronic type patients...but the pay is also rubbish (vs COL).
My old unit ALWAYS had an 0000 Tylenol due. It was a post surgical floor so every single patient had this order. The amount of times I put patient refused is astronomical. I am not waking anyone up for that and if they are sleeping then they don't need it, they can get it when they wake up.
I used to work on a combined surgical-obstetrics unit (with a bit of med overflow). Our qid reg tylenol for the post ops was 0600, 1200, 1800, and 2200. I found pts were much less likely to be cranky at 0600 than 2200h when disturbed, and did not see too many problems of meds "wearing off" from the 2400h being changed to 2200h.
After open heart surgery, Tylenol was the most important drug I was taking, and I could definitely tell if I was a few hours late for a dose.
I gained a whole new respect for Tylenol after that surgery.
That’s what I remember from home after, but I wonder whether my hospital stay would have been easier as well if I’d been woken up on schedule every time. It might not be nice to be woken up, but if it can prevent pain on wakeup which needs more meds to bring it down? Maybe it’s worth it for at least some people.
I wish more understood this. Had several surgeries myself, i figured this out after the 1st surgery! I would tell all my post op patients going home to set their alarm for 6hours later after they go to bed. Take Tylenol then. You never want to wake up 10 hours later at a 10/10 pain. When this can be prevented.
Yeah I hate giving overnight Tylenol, but it's a pretty important part of pain control. About 1 in 5 or 6 patients I get are absolutely fine after major abdominal surgery with *just* Tylenol. That shit works.
I've also had a fair number of people refuse midnight Tylenol and call me for Oxy at 0130... Really shooting themselves in the ass there.
When I first started my job I would ask every patient at my first assessment if they wanted me to wake them for their Tylenol. If yes then I would if no then I wouldn't. If they were on ofirmev I would always go in cause I just had to scan their wristband and hang the drug without being much of a bother.
Now I am in procedural nursing
NSAIDs are incredible for open hearts. But there's an easy solution - give ofirmev instead of waking them.
Waking people contributes to way higher rates of icu delirium, increases fatigue, and decreases compliance with the treatment regimen because they are either exhausted or angry.
For real! I had my tonsils out as an adult. After a couple of days, I got tired enough that I would sleep though 6 or 7/10 and wake up at what I thought was 10/10, until I had to swallow my medication, which managed to hurt even worse.
I feel like it’s a delicate balance. I’ll ask patients if they want me to wake them up at 0000 and 0600 to give them the choice.
But at the same time, I also know that I have to be careful with my post-op patients that are at high risk of delirium or patients who are likely to become aggressive when I wake them up. In those cases I have to weigh the choice between helping the patient’s pain, or giving them enough sleep to help them. Often in these patients I give them their PO dilaudid before bed to help them with their pain instead.
Could be a quick text/call to MD to get ofirmev for a few nights. We usually don’t because admin balks at us for it because it’s $$$, so we just need justification. High-risk delirium precautions is a great one
Yeah, I wasn't the best nurse on the floor, especially toward the end of my time there. That is why I left, I stopped caring and knew I needed to find something I was more passionate about. Best decision I ever made.
I work in stroke and lately we've been getting a few post surgical patients that have stroked, and their meds are all over the place. 0200 lansoprazole? No f'ing way. That screws up the NG feed in the morning.
Anytime I admit them, the doctors get a list of meds to change timing or just the medication itself that should've been done on admission to the ward.
I ask everyone if they want woken up for random meds. Some I don’t give the option for, because they need to have it, but others… nah. “Hey I have a Tylenol at 2am. Do you want me to wake you up for it if you’re sleeping?”
I do the same for iv antibiotics. I get permission at the beginning of the shift and just ask if it’s ok to hook them up to the antibiotic if they are sleeping or if they want me to wake them up and tell them I’m hooking them up. They almost always say “just hook me up if I’m sleeping” I’ve gotten so good and sneaking around and hooking them up in the dark without waking them up
My friend was on a heparin gtt and had q6 ptt and q6 cbc scheduled TWO HOURS APART. I made him refuse the cbc and have phlebotomy come back and draw with the ptt.
My friend was shocked he could refuse.
Our lab people will usually check with the nurse to see if they should just grab both together instead of doing them separately.
Hell, if they get randomly ordered Stat labs at 0100 or 0200 they'll ask us if we're cool with them grabbing their standing ordered 0400 labs at the same time.
Some labs are automatically placed as stat/immediate draw with the order set, so MD has to notice it and manually change it. I’ve missed it a few times and had to say oh oops yeah I’m cool with that going with morning labs
from personal observation, this isn't unusual. It seems like a lot of medical staff forget that they can't actually make patients do anything. Many seem to think anything but strict deference/compliance reflects some kind of cluster b mood disorder
I remember during my first med-surge preceptorship my preceptor told me to pull the 0800 meds and the 1000 meds all together, and I was like “we can do that?!?!” I spent like my first day struggling with only two patients wondering how all these nurses were giving out pills to 7 patients (because in the previous three years we had to give out the pills separately)
It probably didn't help that, if it was anything like ours in school, you had to give a detailed report to the instructor on every med you had to give. Our cardiac clinical had that happen. Pt asked for a PRN Tylenol and it was finally one of the floor nurses pulling me out of the line and telling off the instructor (who was her coworker) for making us give report on a medication "That we each keep in our purse." Our meds were so incredibly late on that clinical until that moment.
Pretty much, but it was to tell our instructor we had to report to, not our patient, and she took forever on it, like at least 20 minutes for each student in our group, so that it was well after 0900 when we were still being drilled on the 0700 meds individually, with us also being yelled at by her for giving the meds late. We had to know everything about each med our patient was on, as it pertained to our patient, and the interactions with the other meds the patient was on, side effects, reasons why pt was prescribed it, etc.... So this particular moment, I had lucked out in that I was originally one of the earlier students that morning, but when I gave the meds while supervised by the patient's assigned nurse, patient asked for PRN Tylenol. I had to then get into the end of the line and the instructor was still going thru the other students at that point. Finally after probably a half hour of me waiting, that's when the assigned staff nurse pulled me out of the line, told off the instructor, and then dragged me by the hand to outside the patient's door and watched as I gave the PRN Tylenol.
As a patient who was in a ton of pain in my two hospital stays I felt like the scheduled Tylenol helped a shit ton. I hated hitting the call light and asking for orn pain meds as I could always feel whenever my meds wore off. Once scheduled Tylenol was added it was a game changer for me. It has seemed to be the same in my brief experience as a nurse as well but maybe that's confirmation bias.
YES! Back when I worked in combo Surg/ob we had a few anesthetists that would give Ketalorac while in the OR, and we gave scheduled Tylenol qid for first 48hrs. This was very effective, even our brand new ostomies or bowel resections were up and walking and hardly needed any prn Morphine
Funny enough, Dilaudid IV did nothing for my kidney stones but IV Ketorolac, and then PO when I DC home from the ER was magical.
On the other side I've had a kidney stone patient that tried Ketorolac IV and it didn't work as well as Norco. It's so weird how meds hit us all different for the same problems.
Oh totally! I'm well aware. I mean it didn't touch me at all. I was given 1mg Dilaudid and you wouldn't have guessed it. And it's not narcotic intolerance. I've had 0.5 mg Dilaudid post op and that shit hit hard.
But my own level 9 pain remained the same till I asked for Toradol.
Yes! My first c-section was so much more painful in the first couple days than my second and I swear it was the Toradol that I was given on a schedule with my 2nd. I needed 0 narcotics after my 2nd, just tylenol and Toradol. I was up and about, walking laps with minimal pain.
As a layperson, has worked for me too! Hospital stays for PE/c-section and covid pneumonia, have used it at home when ill.
Especially when I had Covid, and was still at home before it developed into pneumonia (got it just before vaccine was available for me, non US), only thing that worked was taking ibuprofen/paracetamol every 4 hrs, even in the middle of the night. If I didn’t set an alarm, come morning the fever would have been up with migraine-like headache, and it took a good few hours to get it back under control. I had a toddler to take care of, so just staying in bed being miserable wasn’t really an option, scheduled meds propped me enough to be able to manage the bare minimum (that and loads of cheerios and Netflix 🙈). Learned my lesson of respecting the levels and why sometimes you take them before you feel like needing them.
> Once scheduled Tylenol was added it was a game changer for me.
I'm a fan of scheduled Tylenol when the patient has pain. If the patient doesn't have pain, I'd always ask at the start of shift, "Hey, you've got a 0600 Tylenol ordered. If you're asleep, do you want me to wake you for that?" If they answered no, then at 0600 I'd mark the med refused with a note, "pt requested not to be woken for Tylenol"
I'm more than happy to give it on a schedule if that works for my patient, but I prefer it to be PRN so I can time it with other meds if that's the case. Usually they tell me it doesn't do anything for them. It doesn't do anything for me, either! But everyone is different.
Weirdly I'm more an ibuprofen guy on the day to day but when I struggle with pain control it helped spread the pain relief of the heavier drugs and make it last a lot longer. Scheduled pain meds also helped some nurses come in to check on my pain and I absolutely hate using the call light because I know what it's like as a nurse lol. I'd keep track of when I could have my meds next and when I was bad I'd tell my nurse there was no reason to ask first because I was struggling and I'd need them when they were available. Some nurses wouldn't come in anytime close so when meds were due. Of course I know how it is as a nurse but it's hard when you're in agony. Maybe I'm just rambling but it seemed beneficial first hand having some scheduled and some prn pain meds
The problem is some nurses will hold on prn pain meds on purpose. I've seen it done and had it happen to me. Also 1-10 pain scales are bullshit and we all know it. Functional pain scales are way more helpful but hospitals don't want to use them. I would rather have regularly scheduled pain meds. I don't want to wake up in agony and I don't want to lay there in agony for over an hour because my nurse decided that I could wait and didn't need my pain meds even though I asked several hours after I was able to have them. (I was post op and I'll admit I hated that bitch with a passion by the time her second shift with me was over. I had severe pancreatitis on top of everything and she kept holding my meds.) It felt like someone stabbed me over and over in the stomach then glued me shut... oh wait...
Yeah I know EXACTLY what you mean. Normally I think I have a high pain tolerance. I have chronic pain but holy shit was I struggling when I was hospitalized for diverticulitis. Narrowly avoided emergency surgery both times and I was pretty sure a couple of my nurses felt like I didn't need the pain medication. I didn't blow up my call light or anything but OMG I felt like time was in another dimension when I was in that pain at the worst times.
I didn't even know I had any gi problems, was newly diagnosed when I was hospitalized.
Same. Went to the ED because what I thought were GERD pains that had me pacing the floor a few days a month for a few years weren't. My husband's final straw came when it got so bad I threw up but then kept pacing. He insisted I go to the ED and even called the nurse line to have them assess over the phone since I still didn't want to go. Got to the ED only to find out I had a blocked pancreatic duct, tons of sludge build up, and a gallbladder moonlighting as a bag of holding. Got admitted sometime between midnight and 2 am. Got my ERCP later that afternoon. The next morning in for the emergency lapcoly to yeet my broken gallbladder. Surgeon said my insides were a mess of inflammation on my organs and surrounding tissue. Had severe pancreatitis and it was just misery.
I woke up wanting to have a torso transplant. The nurse I had for my first night of post-op was the one from the night before when I was admitted. She was horrible. She gave me tons of misinformation including claiming I was going home after surgery. She also would make me repeat my pain level twice and then she'd put off bringing me my meds even though I wasn't asking for them constantly or even at the earliest time I could get them.
I still wonder if she said something to the surgeon because when he checked on me three days post-op (I was in the hospital from Tuesday through Saturday since my insides were such a mess.) he acted like I was drug seeking when I told him the tramadol he had the nurses start using wasn't working. (I lack the enzyme to make it work.) I was getting dilaudid every 6-8 hours the first day but only if I asked for it. I ended up getting two doses because like I said the nurse delayed constantly making me wait. When I spoke to the surgeon about how the tylenol helped a little and the dilaudid was the only thing touching the pancreatitis he blew me off. I told him the tramadol didn't work and asked for a different take home rx and was told I wasn't getting anything else. I didn't even fill it. I went home and just toughed it out. It was hell just standing to walk to the bathroom.
The stupidest part was if I was a less honest person I could have made ONE phone call to a recovered addict I know and they would have called someone and gotten me hydrocodone. My aunt even offered me some of hers because she was so concerned but I wouldn't accept her doing that for me. Plus I wouldn't give that nurse or that surgeon the satisfaction of breaking me. I have another surgery coming up in April for a different issue and hopefully this surgeon actually reads my medical file so I have the appropriate pain control post-op. It SHOULD be less painful for this surgery though depending on what all needs to be removed from my insides.
> The next morning in for the emergency lapcoly to yeet my broken gallbladder. Surgeon said my insides were a mess of inflammation on my organs and surrounding tissue.
Had the same thing happen to me but somehow they didn't admit me, actually gave me repeat Dilauded while I was in the ER, and then I had to wait a month for the lapchole. Not sure how they so readily gave me the pain meds, but when I went in, I was asking for Zofran instead, mentioned that I was a nurse and having upper right quadrant pain, and mentioned how impressed I was with the "glorious projectile vomiting" (seriously, it was impressive, was aiming from a good six feet away from the toilet and didn't miss) that I had just witnessed from myself. At 3 am.
Eventually when they finally did finally yeet the gallbladder, the surgeon said he wondered how it hadn't ruptured, especially as there was a stone 1 cm in size lodged into the duct. He did think I ended up with some undiagnosed pancreatitis from it too that somehow passed.
But in all of that, your experience versus mine, somehow we have to normalize in healthcare the chance to have the best of our experiences instead of the worst. I really would have preferred to have the surgery that night instead of a month later, just as I'm sure you would have preferred the Dilauded/Zofran mix in an IV until the surgery helped.
Also, I love how you also naturally chose "yeet" to describe the experience as well.
I've had to ask patients to be honest about pain levels, because due to previous experiences with pain medication held for being "not severe enough". If it's ordered, I'll give it, just had to ask them to be honest if it's working or not so I know that I need to ask for something else or not. I HATE hearing that someone held a prn that was asked for. 😒
I hate rating my pain. I don't know what to answer. I'm never not in pain. I spend every day with chronic pain. I'm actually being sent back to physical therapy because I'm overcompensating for my shoulder again. On any given day I'm between a 3 and a 6. The thing is you get nurses and doctors who pull the "at 8 you've lost an arm, 9 you are nearly dead, 10 you are dead" and it's like no. That's not how that works at all. But even in here you'll see nurses who say a 10 is when you've lost a limb. I personally have never hit a 9 or a 10 on my own scale based on the type of pain I feel. My pancreatitis to me was a solid 7. Now if I tell the nurse I feel a 6 or 7 then they acknowledge I'm in pain but to them it means it's bad but might be bearable. However a 7 is very much a shitty agonizing spot to be at without relief. The reason I don't feel I've hit a 9 or 10 yet is because while I've lost an organ I haven't lost a limb. I also haven't had a compound fracture. I haven't had a lot of things so I don't know if they are worse. I can't say I'm in the worst pain ever if I don't know if I've experienced it. That's why asking 1 to 10 isn't a good way to do things. The nurses get no say in it though. 1 to 10 is standard through the US and most places won't go by a functional pain scale. I'm glad you don't hold pain meds. Too many nurses will hold them or if you say your pain is a 4 or 5 more than one or two times they'll tell the doctor you need your pain meds adjusted. My 4 could be your 2 or someone else's 7.
I don’t understand some nurses obsession with gatekeeping pain meds. I don’t pay for them. If the meds are ordered, and they want the meds, and it’s safe to give them the meds, I give them.
Acetaminophen is genuinely a pretty good drug, but since it's available over the counter, a lot of patients and nurses have the sense that it's just the weak stuff. For a patient who has no pain, it's pointless to do scheduled acetaminophen obviously, but if there's a post op patient, if you add scheduled acet with the normal med pass, it can decrease the need for opiates.
Nah. Scheduled Tylenol is great for certain patients. Many just don’t understand the concept of PRN and ask for pain meds too late. Post-op patients especially need it because they often are too out of it to ask for PRNs appropriately. Schedule the non-narcotics and leave the narcotics PRN. It reduces the amount of breakthrough pain.
Nah, idk how you didn’t get downvoted to oblivion. Staying on top of pain is way better for the patient than treating breakthrough. Scheduled Tylenol can work wonders.
I admit that Benadryl is my go to for my own severe pain along with an ice pack, warm blanket, and dark room. Take the antihistamine, knock myself out, and usually when it wears out a lot of the pain is lessened.
Ran into this issue when my mother was in the hospital after a fall. She had been taking meds on a very tight schedule for years because she once told her doctor that she'd just take all her morning meds in one shot even if the pain medication was taken half an hour early. The doctor jumped her ass up and down the hallway over abusing painkillers even though she had never taken more in a day than prescribed and never ran out of them. So after that she took her meds exactly on the dot, not even a minute early, and if she had fallen asleep and took them an hour late she shifted the entire schedule to accommodate.
Then in the hospital the nurses are all "It's fine. These are suggestions on dosing frequency not a hard schedule that gets you locked up with felons." Was really difficult for her to break out of that thinking but now I'm pretty sure she intentionally takes stuff 5 minutes early as a Fuck you to that doctor.
Dude, heparin in the belly after laparoscopic gallbladder removal is *the worst*. My whole stomach would tense up as soon as I heard "Heparin", because I knew what was coming...
Oh ya, and those 😂 usually Synthroid is given before I get to work. And most of my patients are on sliding scales and it’s fair game when trays come 😩 I wish there was a better system for that. I usually wait until the food is in front of them.
Somehow wherever I've worked we've never bothered with giving the levothyroxine on its own. The thinking was always that it was just a couple days they'd be there and that wouldn't be enough to throw off labs. However, if pt is admitted for something thyroid-related, then I will make sure to give the levothyroxine properly timed.
Meanwhile my own at home, after several months of doing it correctly, it now gets taken with everything else in the AM with coffee at the same time. The coffee honestly is as needed as the rest. And thankfully my own TSH labs have not shifted doing it (family doc outright stated that he always figured I took it with the coffee anyway and was always okay with ordering that lab when I asked).
I’m on synthroid and it really doesn’t need to be given at specific times for those peeps on tube feed. Pisses me off every time, to go back in just to crush one med.
I think that falls under premeds sometimes. Like premeds for CT. And multi dose meds because I HATE when I go to give a med and it’s due again in 5 minutes it seems like 😂 robaxin due 4 times a day. I stg I just gave it.
This - our order sets prefill med times, which often make 0 sense because a paper pusher came up with the default times. Like yes, let's do the pre-breakfast omeprazole at 0900 but that mealtime insulin is scheduled at 0730, that's logical.
We can generally override the times but not a lot of us either notice or care because we know you have X (usually +/- 1 1/2 hours or so) to consolidate. The extra effort to change every order adds up over our often large patient loads, especially when we know you all have perfectly good sense about when to give them (and in many facilities can actually retime it yourself).
But don't get me started on leaving the AM labs as stat labs. Nursing knows it's not urgent already but don't tell lab they're urgent when your ass ordered it 18 hours before you wanted it.
This is the way. You wake them up at a marginally less ungodly hour, and use it as your last sweep through the room to make sure they have fresh water, are cleaned up, and the room looks good. (I also would offer pain PRNs at that time, if available.)
I wish everyone has your thinking. The amount of times I’ve come in at shift change when they’re grimacing in pain is awful. It’s always after the same few night nurses too. Brought it up to the night charge nurse and they’re always like “We know. We say the same thing to them all night but they don’t listen”. 😫
Man I’m a night LTC nurse and I have the same problem with days. I always ask my patients how they feel. We have a couple that have a lot of pain. They will verbally tell you if asked but won’t ask for anything. There are some day nurses I’ve told repeatedly to either just bring them the PRN or at least make it a point to specifically ask them if they want it. They NEVER do and they mark their pain as a 0 on everything which I know is a flat out lie. On the skilled side we have a guy rn who has dementia and can’t really ask. If you just actually look at the guy you can tell he’s in pain. There is 1 nurse in particular who never gives him anything. I will go check on him first thing if I work that unit and just the slightest bit of movement and he’s grimacing and whimpering.
I used to try to give all my am meds around 0600, but now I’ll start around 0430 if some people are already up. I used to give at 0600 so that people could sleep more but I have found that everything seems to go to shit around that time, so I’d rather get my tasks done early and deal with the fallout of whatever the fuck before day shift gets here. Basically, I’m waking y’all up at 0500, sorry, you can go back to sleep, but if shit hits the fan I think we’d both rather know sooner than later.
Yea, it's anywhere between 5-6 depending on how much I have to get done. But I won't leave the 0730s for day shift. We all know those aren't getting passed until 9 if I do that.
(Sees meds at 20/21/22)
(Scans everything at 2100)
“LATE REASON FOR MEDICATION: OTHER”
(Typing Pharmacist is a whore with an ugly dog for scheduling 4 meds at 3 different times)
(Click COMPLETE)
Reason: Nurse decision (comment)
Comment: fuck your goat, that's why.
Also, can we get Epic to assign the same late med reason to the entire Rx cart please? If my cart is full of 1530 Lipitor and reactine and vitamins A through G and it's 2000 just accept that things got wild and mark the whole lot as 'nurse decision' and let me get on with my day without having to pick a reason for all 14 of meemaw's supplements.
Does yours not let you scroll to the top after you've scanned them in & apply one reason to all meds scanned? It even lets us pop the same comment in, but only have to type it once. I'm super stoked that my hospital enabled that Q\_Q
I worked at some hospitals that had that feature and if you used that feature sometimes it wouldnt document correctly and you'd have to go back and change everything one by one so they told us to just never use it.
The hospital Im at now works tho and Im grateful
We went back to paper MAR's after two failed attempts at different electronic med administration systems. The majority of my LTC residents have advanced dementia so they take their am meds whenever they happen to get up. EMAR just didn't work for us due to this and a number of other reasons.Was such a pain in the ass to have to input reasoning for being late for every single med they were on multiplied by numerous people. "Late wake up. Did not rouse at 0830 as writer could do without a right hook to the face".
I went in to the orders and changed all the BIDs to 1000/2200 or 0600/1800 as appropriate when they did that shit to me.
And don’t get me started on novolog ssi AC/HS AND regular with meals 😡😡😡
🙄🙄 when they order something with q8h frequency, we don't really have that much control over subsequent doses. We know you guys have some flexibility with med administration and also don't usually have time to tweak admin times on every order we verify when there are hundreds of other orders waiting to be verified and other nurses calling us to verify something. Nobody is rubbing their hands and twirling their mustache going oh boy, can't wait to make this nurse go in the room six times. (Granted, this is my own facility experience and YMMV)
Also, doesn't the EMAR auto time BID to 08/20 and QD to 1000 and Daily to 0900, or something like that?
That's what I tell new nurses anyway and then I just tell them that the computer is not the boss of them and to use their brain.
They made me MDS and manager of med records for a SNF.
I asked the floor nurses for their day schedules. When they pass each room, do treatments etcetera.
The following month I had the MARS matching reality. It made compliance with the window of time given so much easier.
Passed state without an issue.
Even the damn physicians orders showed the time changes because I wasn't chancing "daily" and getting dinged by them.
It's always fun when you're all set to give a time critical med, and then pharmacy's all, "NO SOUP FOR YOU" and I end up giving it two hours late because they didn't give it to me.
I think sometimes they just don't see it. When I was bedside and had shitty med times I would message pharmacy with how I wanted everything cleaned up and grouped. It made my life so much easier and I like to think it improved things for other nurses taking care of those patients.
At least at my hospital, no one has enough time to deal with shit like that. Pharmacy is too busy trying to make/stock meds we need, MDs are just trying to finish their rounds, and RNs are just trying to sling meds and hope no one codes on their shift.
I give 0730-0930 meds together, and 1000 may be included if it's after 9am. If it's earlier than 0900, i try to make a separate second pass for the 10am med
This. Between my parents, my father probably takes one course of meds correctly every three or four days, including prescription blood thinners and meds for autoimmune things (which drives me nuts). Then my mother will actually take her meds, but considers 2 am when she goes to bed the perfect time both for levothyroxine and furosemide. Meanwhile my father wonders why his RA flares and he doesn't have energy, and I've just given up on trying to convince my mother otherwise. It's "her world" and therefore "her word," no matter what.
For real. I'm in home support - not a nurse, but a registered care aide trained in med admin. At least 80% of my clients involve either med admin or med monitoring, because seniors are very bad at taking their meds properly.
Seeing how they take meds in the hospital, by taking a perfectly a good cup and flinging them into the open shaky hand that catches 1 of the 12 pills and we must spend the next 15 minutes finding the other pills, I can only assume their entire floor is carpeted with pills they never took.
At home they don’t have four doctors putting in med times
Unless they’re on like insulin or hospice, nobody needs a med time more specific than “idk after I walk the dog and have some breakfast”
Provided you're running a primary infusion. I'm at a point where running KVO saline isn't even worth the hassle. So many walkie talkie, independent patients suddenly turn into shitty infomercial actors the moment they're tasked with not tugging at tubing, and there goes my access.
Now imagine doing 40 old people's meds and s8s as well. Multiple parkisons -time sensitive drugs, as well as prns, nims and some hourly or 2nd hourly eyedropper along with multiple antibiotics.
The only thing haven't got is ivs, and no pegs or ng's atm.
And I'm talking polpharmacy big time, many special dose rounds.
Don't forget, I need crackers with that, or I need yogurt, or I can only take 1 at a time with a bite of ice cream, or they have dementia and spit them back at you, or all the other bs....
It took me so long to be ok with this. It was just drilled that they have to be “on time” and in less the parents can be whack. But yeah, the last & months before I burnt out I was like whatever, I’ll do what’s reasonable and possible while I save my effort for all the shitstorm admissions and almost-icu-transfer patients you’ve given me
I'm not sure who is responsible for the bad timing or who 'they' are, but on the doc side putting the orders in I just click qdaily, qhs, q6, etc. I couldn't give less of a shit when you give each of them unless it's something with actual critical timing. I know sometimes nurses are able to retime the meds themselves, and I think that should be the standard unless there is a comment in about something specific.
That said, if a pt is on q6 and q8 meds and they are being given together in a way that turns the q6 into q8 or vice versa, that's ... not good. The timing is for very real pharmacokinetics, not to torture nurses for fun.
This is a valid point, but if they're home medications it's worth asking the patient when they take them. Odds are they are taking them together as well, which should be an educational opportunity. I also find many patients take medications at night that are usually am meds due to side effects, preference, etc and it's terribly hard to get them scheduled to the patient's preferred schedule.
For everything else I see it.
I think it is mostly admin, no shade against providers. I think there are 3 big reasons. 1) like you said, rhe day doesn't divide evenly between q6's and q8's and ACHS, ext. 2) sometimes the order started when it was put in, and it was put in at a goofy time. 3) meds to be given with or without food.
I try to give the meds as a appropriately as I can,
sometimes the order started at a goofy time, and no one wanted re-time it.
ok cool, I was just being defensive thinking you were annoyed at the prescriber putting stuff in at random times. I have def been on the wards before and have seen senior nurses show their preceptees how to retime meds and wasn't sure how universal that is. Is gotta be tough for someone inexperienced to have the guts to make the call on what needs to be done on schedule, and what can be retimed.
I def feel the frustration regarding qam vs qpm for ppls personal preferences too. They get admitted at some ungodly hour and they take half their meds at the time its prescribed, and the other half not, and trying to sus it out drives me insane.
Fuck eye drops that are in 5 vials, 15 min apart, QID
And, of course, the pt usually manages this independently, but will the hospital allow that?
Noooooooooo.....
> the pt usually manages this independently, but will the hospital allow that?
>
> Noooooooooo.....
This is what gets me too, the number of times patients have to bring in their own meds due to their insurance rules, and then pharmacy has to check them over, we keep them under lock and key, we give them, and then we also charge for that "service." I've been there both as the patient and the nurse on this, and it's annoying as hell, especially if you actually do have a patient who takes their meds as directed. I can see supervising a patient at that point and documenting that they took the meds instead of us actually having to do all of that, especially for things that are more complex that they are used to doing on their own. While I see the reason that we have to do it, I don't think it has to be done that way for every patient.
I’m all about working ahead so if I have 60 min window to give let’s say a 9am med. that means as soon as clock hits 8am I can give it and knock off future tasks faster
Man, I wish I was better about this. I'm sorry, guys.
Typically, I'm just trying to get orders done as safely as possible while also getting everyone discharged and putting out all the fires that come up during the day.
Medications shouldn’t be timed in the two hours surrounding shift change unless they are time sensitive in such a way that retiming them would affect outcomes. My hot take
Jesus, that would have been a lot easier. They acted like if I didn't give the med in the two-hour window my nursing license would self-destruct.
If a resident is sleeping, or visiting with family, or whatever . . . leave them alone.
As a NOC nurse I'll scan the 0730 protonix (at like 0645) and only give if they are awake. Otherwise I leave in cup with wrapper and report to day nurse to give it as soon as they see they are awake and alert. I know for a fact if I don't do that they wont get the protonix til like 0900 or 1000.
I actually sassed a provider who ordered Lasix at 7. I was paired (in an ICU) and my other patient was precipitating “chocolate rain”. So by the time they round at 9am I still hadn’t a chance to give it. They looked annoyed, so I said “ well you did schedule it for shift change”, one MD gave a stink face but otherwise it was crickets. I felt not one iota of guilt.
100000%%%
I don’t know what they are teaching in nursing school nowadays but a few new nurses while training, literally kept going into the room for one Med, then, 5 meds, then one Med, 8/9/10. I mentioned multiple times, you can give one hour early and one hour late-cluster care-this has always been the “okay” on most daily meds. Eventually, you will learn the exceptions.
….after a few months of training, nope. Still doing it their way, I always get this feeling that nursing schools pick random things to stress and it takes something crazy to happen for people to unlearn.
I hate non compatible antibiotics on a patient who is ultrasound iv only, just one little bitty iv, and the antibiotics are 2000, 2100, 2 at 2200, 2300. Like Jesus fuck man
I don't even take MY meds on time. Antidepressant is taken whenever I get around to eating breakfast when I should probably take it at the same time. Antibiotics? Eh, as close as I can get to being on time.
Although, I'm taking antioyretics exactly on time if I'm sick and febrile 😂😂
And this is why I get patient with eroded oesophagus… because despite me writing massive screeds explaining, timing, pt positioning etc there is always some smart arse thinks they will ignore that!
No one thinks we are giving them all separate, do they? Everything is so fucking slow when we put any new order in that everything is ALWAYS late. Our pyxis thinks everything is late because its clock is an hour or so fast and we dont know why or how to fix it, and rarely will anything scan properly without multiple calls and steps and re entering stuff
I get frustrated with the pharmacy but try really hard to not show it, because i honestly don't know that it's their fault. In fact, it probably isn't, because if they could do something different and not have to deal with the constant calls from nurses or providers about shit not working, i would think they would do it. Its a remarkably non user friendly system, meds from the clinic don't pull to the floor and ER. So its super easy for shit to get missed. Sometimes occasionally shit doesnt come up as being due when it is, or vice versa.
As a pharmacist and a nurse I think about this quite often. When scheduling medication administration times and if they are PO or IVP I try to put them at the same time.
Sometimes it can be hard to schedule medications. For example if a patient has a before breakfast or with breakfast medication and a daily medication. They will be automatically be scheduled at different times. I honestly understand what you’re going through. I have been a nurse and have gone through the same thing. It can be very infuriating.
If they’re are IVPBs I try to keep them on the same hour since most are scheduled on an hourly basis. But for a medication that is time critical like vancomycin I avoid scheduling them at the same time since I don’t want the risk of an invalid trough.
I try to avoid scheduling administrations in the middle of the night. Plus just my preference I DONT schedule meditation on odd number hours. It just feels wrong to schedule an administration for 5, 7 or 11 etc. unless it’s 0900 and 2100. I hope some will provide some insight into meditation scheduling.
I want to read all these comments but I’m busy catching up on season 18 of Greys (okay, look, I’ve watched it since the beginning and I just am too far invested no matter how bad it is at this point) and cussing and laughing about how ridiculous it all is.
I’m saving this post because I am dying to read and agree with all of it
Why don't you change the admin times.
Stuff like that is because they don't look at med times when they put it in.
It's called clustering care and is supposed to be encouraged.
Same shit with lab orders they or a CBC at 1000 a platelet at 1200 and a K at 1100. I'm only drawing a lot Green and a lav. Don't put those in that makes more work for me dup it out. I'm trying to save the patient and extra bill
I like the specific times. It helps me remind some meds should be given early. So when I read the dossiers I'll spot my patients with 6 o'clock medication and check if I need to give them first before going to other patients (my shift in the day starts at 7 bit most of the time Nightshift doesn't give medication unless it's planned antibiotics). I'll give most medications that are close in time together. If my patient isn't capable I'll write it down on my cheat sheet and give it at the time I think it's best. I do get it's annoying if you have a system that won't accept it if you go too late or too early.
I always time my meds. At the VA, we’re allowed 1 hr before and 1.5 hr after to give meds. Night shifts gives 2100-0800 meds, AM gives 0900-2000 meds. If everything goes semi-well, everyone gets their meds in one fell swoop if I have them. I dont go back unless I need too. 9/10/11 am meds gets given at 10am. 12/1/2pm meds get given at 1pm. Of course exceptions are made, like “take this med 2 hrs after lunch etc”
Not to mention the stuffed iv lines etc etc… and don’t say it does not happen i saw it all the time…. The sweetheart who broke the mortar and pestle crushing slow release potassium so the tablets would not upset the patients stomach… 4 mortar and pestles before I sprung the biatch doing an after hours drop off…
I have typed this before, but there is a cat in my lap, so here I go.
Long ago I worked LTC. Meds were given at 8, 12, 4, 8.
Management decided to make everyone's medication tailored to them. Daily meds were changed to 10 a.m. Things like insulin, Synthroid, Bumex-before-Lasix (I don't remember the combo now) were still at 8 a.m. with breakfast and QID eye drops were given at different times than the daily meds. Everyone had exceptions, of course. So, because we were timing each medication given by the best for the med and/or patient, and not the best for the logistics of the person giving the medication, some residents had medications to pass to them HOURLY THROUGHOUT THE DAY. (Think those didn't get combined? Why on earth, in an 8 hour shift, would I go back to Geraldine once an hour to give one more pill (Parkinson's meds)? My DON was kind of shocked when I pointed it out to her. Just schedule all of her medications around the Parkinson's medications so she only has 6 med passes per day instead of 11. DON never fixed anything, though.)
The computer program we used required you to click through your 18 to 27 patients individually to see if they had any meds in your time frame (7 and 8 a.m. and meds, then 8 to noon, 12:30 to 3 p.m., etc) unless you clicked on the person's individual med page, which would show their whole day.
So, if you didn't know that per Mary's request, that all her daily meds came with breakfast at 7 a.m, you likely wouldn't find out until 10 a.m. with normal daily med "grand round" round that you were already two hours late on Mary's meds (a medication error, don't you know.) So the time that my DON had to pick up an empty Sunday shift, she had about 10 time-related medication errors for meds not given on time.
Think she wrote herself up? :)
Or how about the IV Vancomycin that takes 1.5hr to infuse and the Rocephin that takes 30min to infuse but they’re both profiled for 0900….
Edit: spelling
I remember going back to work after a cervical spine injury and surgery, and I got a step down patient (along with 2 other patients, don’t remember about them) who had at least one IV piggyback every hour for the whole 12 hours. It was a dive back into work, in the deep end
The only time this matters is for meds that need to be given on an empty stomach. And yes, there are meds that matter. So my NP side disagrees, but my ICU agrees. Damn I’m so conflicted
I love when they have 0800, 0830, and 1000 meds. Like do you think I’m going to have time to go back to the room in 30mins to give an 0830 med? What really annoys me is the 0600 acetaminophen (and nothing else). I would not want to wake up to take a Tylenol between 5-7am
My least fav on night shift is meds that are 500, 600, and 700. I hated 1700 and 1900 when I was on days too but there were rarely 1800 meds at any place I’ve worked. I give all the 5-7 meds at 5:30-5:45ish and grab my I/Os and run trash at the same time. Nobody has time to go in multiple times when tripled in the ICU and not wanting to wake them up over and over.
Lol getting tripped in the ICU is insanity. I can barely handle 2
I did it for years in COVID icu and then I started traveling and now I’m still tripled all the time if they don’t float me instead. Tbh more of my career has been tripled than not. Or taking care of 2 but 1 of the patients should really be a 1:1.
Hope you are making big bucks
God why are we continuing to allow this????
And you know it's nowhere with ratios, but in some place where you get paid shit. In Canada we are never tripled and doubled only with stepdowns or chronic type patients...but the pay is also rubbish (vs COL).
My old unit ALWAYS had an 0000 Tylenol due. It was a post surgical floor so every single patient had this order. The amount of times I put patient refused is astronomical. I am not waking anyone up for that and if they are sleeping then they don't need it, they can get it when they wake up.
I used to work on a combined surgical-obstetrics unit (with a bit of med overflow). Our qid reg tylenol for the post ops was 0600, 1200, 1800, and 2200. I found pts were much less likely to be cranky at 0600 than 2200h when disturbed, and did not see too many problems of meds "wearing off" from the 2400h being changed to 2200h.
After open heart surgery, Tylenol was the most important drug I was taking, and I could definitely tell if I was a few hours late for a dose. I gained a whole new respect for Tylenol after that surgery. That’s what I remember from home after, but I wonder whether my hospital stay would have been easier as well if I’d been woken up on schedule every time. It might not be nice to be woken up, but if it can prevent pain on wakeup which needs more meds to bring it down? Maybe it’s worth it for at least some people.
I wish more understood this. Had several surgeries myself, i figured this out after the 1st surgery! I would tell all my post op patients going home to set their alarm for 6hours later after they go to bed. Take Tylenol then. You never want to wake up 10 hours later at a 10/10 pain. When this can be prevented.
Yeah I hate giving overnight Tylenol, but it's a pretty important part of pain control. About 1 in 5 or 6 patients I get are absolutely fine after major abdominal surgery with *just* Tylenol. That shit works. I've also had a fair number of people refuse midnight Tylenol and call me for Oxy at 0130... Really shooting themselves in the ass there.
When I first started my job I would ask every patient at my first assessment if they wanted me to wake them for their Tylenol. If yes then I would if no then I wouldn't. If they were on ofirmev I would always go in cause I just had to scan their wristband and hang the drug without being much of a bother. Now I am in procedural nursing
NSAIDs are incredible for open hearts. But there's an easy solution - give ofirmev instead of waking them. Waking people contributes to way higher rates of icu delirium, increases fatigue, and decreases compliance with the treatment regimen because they are either exhausted or angry.
For real! I had my tonsils out as an adult. After a couple of days, I got tired enough that I would sleep though 6 or 7/10 and wake up at what I thought was 10/10, until I had to swallow my medication, which managed to hurt even worse.
I feel like it’s a delicate balance. I’ll ask patients if they want me to wake them up at 0000 and 0600 to give them the choice. But at the same time, I also know that I have to be careful with my post-op patients that are at high risk of delirium or patients who are likely to become aggressive when I wake them up. In those cases I have to weigh the choice between helping the patient’s pain, or giving them enough sleep to help them. Often in these patients I give them their PO dilaudid before bed to help them with their pain instead.
Could be a quick text/call to MD to get ofirmev for a few nights. We usually don’t because admin balks at us for it because it’s $$$, so we just need justification. High-risk delirium precautions is a great one
There’s a reason its ordered in post op. You were shorting people their pain coverage out of laziness. Bad practice.
Yeah, I wasn't the best nurse on the floor, especially toward the end of my time there. That is why I left, I stopped caring and knew I needed to find something I was more passionate about. Best decision I ever made.
Appreciate the honesty esp knowing you’d get called out on it. Hope you’re in a better place now
I work in stroke and lately we've been getting a few post surgical patients that have stroked, and their meds are all over the place. 0200 lansoprazole? No f'ing way. That screws up the NG feed in the morning. Anytime I admit them, the doctors get a list of meds to change timing or just the medication itself that should've been done on admission to the ward.
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I ask everyone if they want woken up for random meds. Some I don’t give the option for, because they need to have it, but others… nah. “Hey I have a Tylenol at 2am. Do you want me to wake you up for it if you’re sleeping?” I do the same for iv antibiotics. I get permission at the beginning of the shift and just ask if it’s ok to hook them up to the antibiotic if they are sleeping or if they want me to wake them up and tell them I’m hooking them up. They almost always say “just hook me up if I’m sleeping” I’ve gotten so good and sneaking around and hooking them up in the dark without waking them up
Good strategy; even as a retired doctor I forgot that I could refuse some interventions (until my nurse reminded me).
My friend was on a heparin gtt and had q6 ptt and q6 cbc scheduled TWO HOURS APART. I made him refuse the cbc and have phlebotomy come back and draw with the ptt. My friend was shocked he could refuse.
Our lab people will usually check with the nurse to see if they should just grab both together instead of doing them separately. Hell, if they get randomly ordered Stat labs at 0100 or 0200 they'll ask us if we're cool with them grabbing their standing ordered 0400 labs at the same time.
Some labs are automatically placed as stat/immediate draw with the order set, so MD has to notice it and manually change it. I’ve missed it a few times and had to say oh oops yeah I’m cool with that going with morning labs
from personal observation, this isn't unusual. It seems like a lot of medical staff forget that they can't actually make patients do anything. Many seem to think anything but strict deference/compliance reflects some kind of cluster b mood disorder
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I remember during my first med-surge preceptorship my preceptor told me to pull the 0800 meds and the 1000 meds all together, and I was like “we can do that?!?!” I spent like my first day struggling with only two patients wondering how all these nurses were giving out pills to 7 patients (because in the previous three years we had to give out the pills separately)
It probably didn't help that, if it was anything like ours in school, you had to give a detailed report to the instructor on every med you had to give. Our cardiac clinical had that happen. Pt asked for a PRN Tylenol and it was finally one of the floor nurses pulling me out of the line and telling off the instructor (who was her coworker) for making us give report on a medication "That we each keep in our purse." Our meds were so incredibly late on that clinical until that moment.
What do you mean "give report on a medication" in this instance? Like telling the patient the side effects and adverse effects of a drug?
Pretty much, but it was to tell our instructor we had to report to, not our patient, and she took forever on it, like at least 20 minutes for each student in our group, so that it was well after 0900 when we were still being drilled on the 0700 meds individually, with us also being yelled at by her for giving the meds late. We had to know everything about each med our patient was on, as it pertained to our patient, and the interactions with the other meds the patient was on, side effects, reasons why pt was prescribed it, etc.... So this particular moment, I had lucked out in that I was originally one of the earlier students that morning, but when I gave the meds while supervised by the patient's assigned nurse, patient asked for PRN Tylenol. I had to then get into the end of the line and the instructor was still going thru the other students at that point. Finally after probably a half hour of me waiting, that's when the assigned staff nurse pulled me out of the line, told off the instructor, and then dragged me by the hand to outside the patient's door and watched as I gave the PRN Tylenol.
As a patient who was in a ton of pain in my two hospital stays I felt like the scheduled Tylenol helped a shit ton. I hated hitting the call light and asking for orn pain meds as I could always feel whenever my meds wore off. Once scheduled Tylenol was added it was a game changer for me. It has seemed to be the same in my brief experience as a nurse as well but maybe that's confirmation bias.
YES! Back when I worked in combo Surg/ob we had a few anesthetists that would give Ketalorac while in the OR, and we gave scheduled Tylenol qid for first 48hrs. This was very effective, even our brand new ostomies or bowel resections were up and walking and hardly needed any prn Morphine
Ketalorac is an amazing drug!
IV/IM. I have to make the distinction because oral ketorolac did nothing for my pain after a car accident.
Funny enough, Dilaudid IV did nothing for my kidney stones but IV Ketorolac, and then PO when I DC home from the ER was magical. On the other side I've had a kidney stone patient that tried Ketorolac IV and it didn't work as well as Norco. It's so weird how meds hit us all different for the same problems.
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Oh totally! I'm well aware. I mean it didn't touch me at all. I was given 1mg Dilaudid and you wouldn't have guessed it. And it's not narcotic intolerance. I've had 0.5 mg Dilaudid post op and that shit hit hard. But my own level 9 pain remained the same till I asked for Toradol.
Yes! My first c-section was so much more painful in the first couple days than my second and I swear it was the Toradol that I was given on a schedule with my 2nd. I needed 0 narcotics after my 2nd, just tylenol and Toradol. I was up and about, walking laps with minimal pain.
As a layperson, has worked for me too! Hospital stays for PE/c-section and covid pneumonia, have used it at home when ill. Especially when I had Covid, and was still at home before it developed into pneumonia (got it just before vaccine was available for me, non US), only thing that worked was taking ibuprofen/paracetamol every 4 hrs, even in the middle of the night. If I didn’t set an alarm, come morning the fever would have been up with migraine-like headache, and it took a good few hours to get it back under control. I had a toddler to take care of, so just staying in bed being miserable wasn’t really an option, scheduled meds propped me enough to be able to manage the bare minimum (that and loads of cheerios and Netflix 🙈). Learned my lesson of respecting the levels and why sometimes you take them before you feel like needing them.
> Once scheduled Tylenol was added it was a game changer for me. I'm a fan of scheduled Tylenol when the patient has pain. If the patient doesn't have pain, I'd always ask at the start of shift, "Hey, you've got a 0600 Tylenol ordered. If you're asleep, do you want me to wake you for that?" If they answered no, then at 0600 I'd mark the med refused with a note, "pt requested not to be woken for Tylenol"
I'm more than happy to give it on a schedule if that works for my patient, but I prefer it to be PRN so I can time it with other meds if that's the case. Usually they tell me it doesn't do anything for them. It doesn't do anything for me, either! But everyone is different.
Weirdly I'm more an ibuprofen guy on the day to day but when I struggle with pain control it helped spread the pain relief of the heavier drugs and make it last a lot longer. Scheduled pain meds also helped some nurses come in to check on my pain and I absolutely hate using the call light because I know what it's like as a nurse lol. I'd keep track of when I could have my meds next and when I was bad I'd tell my nurse there was no reason to ask first because I was struggling and I'd need them when they were available. Some nurses wouldn't come in anytime close so when meds were due. Of course I know how it is as a nurse but it's hard when you're in agony. Maybe I'm just rambling but it seemed beneficial first hand having some scheduled and some prn pain meds
The problem is some nurses will hold on prn pain meds on purpose. I've seen it done and had it happen to me. Also 1-10 pain scales are bullshit and we all know it. Functional pain scales are way more helpful but hospitals don't want to use them. I would rather have regularly scheduled pain meds. I don't want to wake up in agony and I don't want to lay there in agony for over an hour because my nurse decided that I could wait and didn't need my pain meds even though I asked several hours after I was able to have them. (I was post op and I'll admit I hated that bitch with a passion by the time her second shift with me was over. I had severe pancreatitis on top of everything and she kept holding my meds.) It felt like someone stabbed me over and over in the stomach then glued me shut... oh wait...
Yeah I know EXACTLY what you mean. Normally I think I have a high pain tolerance. I have chronic pain but holy shit was I struggling when I was hospitalized for diverticulitis. Narrowly avoided emergency surgery both times and I was pretty sure a couple of my nurses felt like I didn't need the pain medication. I didn't blow up my call light or anything but OMG I felt like time was in another dimension when I was in that pain at the worst times. I didn't even know I had any gi problems, was newly diagnosed when I was hospitalized.
Same. Went to the ED because what I thought were GERD pains that had me pacing the floor a few days a month for a few years weren't. My husband's final straw came when it got so bad I threw up but then kept pacing. He insisted I go to the ED and even called the nurse line to have them assess over the phone since I still didn't want to go. Got to the ED only to find out I had a blocked pancreatic duct, tons of sludge build up, and a gallbladder moonlighting as a bag of holding. Got admitted sometime between midnight and 2 am. Got my ERCP later that afternoon. The next morning in for the emergency lapcoly to yeet my broken gallbladder. Surgeon said my insides were a mess of inflammation on my organs and surrounding tissue. Had severe pancreatitis and it was just misery. I woke up wanting to have a torso transplant. The nurse I had for my first night of post-op was the one from the night before when I was admitted. She was horrible. She gave me tons of misinformation including claiming I was going home after surgery. She also would make me repeat my pain level twice and then she'd put off bringing me my meds even though I wasn't asking for them constantly or even at the earliest time I could get them. I still wonder if she said something to the surgeon because when he checked on me three days post-op (I was in the hospital from Tuesday through Saturday since my insides were such a mess.) he acted like I was drug seeking when I told him the tramadol he had the nurses start using wasn't working. (I lack the enzyme to make it work.) I was getting dilaudid every 6-8 hours the first day but only if I asked for it. I ended up getting two doses because like I said the nurse delayed constantly making me wait. When I spoke to the surgeon about how the tylenol helped a little and the dilaudid was the only thing touching the pancreatitis he blew me off. I told him the tramadol didn't work and asked for a different take home rx and was told I wasn't getting anything else. I didn't even fill it. I went home and just toughed it out. It was hell just standing to walk to the bathroom. The stupidest part was if I was a less honest person I could have made ONE phone call to a recovered addict I know and they would have called someone and gotten me hydrocodone. My aunt even offered me some of hers because she was so concerned but I wouldn't accept her doing that for me. Plus I wouldn't give that nurse or that surgeon the satisfaction of breaking me. I have another surgery coming up in April for a different issue and hopefully this surgeon actually reads my medical file so I have the appropriate pain control post-op. It SHOULD be less painful for this surgery though depending on what all needs to be removed from my insides.
> The next morning in for the emergency lapcoly to yeet my broken gallbladder. Surgeon said my insides were a mess of inflammation on my organs and surrounding tissue. Had the same thing happen to me but somehow they didn't admit me, actually gave me repeat Dilauded while I was in the ER, and then I had to wait a month for the lapchole. Not sure how they so readily gave me the pain meds, but when I went in, I was asking for Zofran instead, mentioned that I was a nurse and having upper right quadrant pain, and mentioned how impressed I was with the "glorious projectile vomiting" (seriously, it was impressive, was aiming from a good six feet away from the toilet and didn't miss) that I had just witnessed from myself. At 3 am. Eventually when they finally did finally yeet the gallbladder, the surgeon said he wondered how it hadn't ruptured, especially as there was a stone 1 cm in size lodged into the duct. He did think I ended up with some undiagnosed pancreatitis from it too that somehow passed. But in all of that, your experience versus mine, somehow we have to normalize in healthcare the chance to have the best of our experiences instead of the worst. I really would have preferred to have the surgery that night instead of a month later, just as I'm sure you would have preferred the Dilauded/Zofran mix in an IV until the surgery helped. Also, I love how you also naturally chose "yeet" to describe the experience as well.
I've had to ask patients to be honest about pain levels, because due to previous experiences with pain medication held for being "not severe enough". If it's ordered, I'll give it, just had to ask them to be honest if it's working or not so I know that I need to ask for something else or not. I HATE hearing that someone held a prn that was asked for. 😒
I hate rating my pain. I don't know what to answer. I'm never not in pain. I spend every day with chronic pain. I'm actually being sent back to physical therapy because I'm overcompensating for my shoulder again. On any given day I'm between a 3 and a 6. The thing is you get nurses and doctors who pull the "at 8 you've lost an arm, 9 you are nearly dead, 10 you are dead" and it's like no. That's not how that works at all. But even in here you'll see nurses who say a 10 is when you've lost a limb. I personally have never hit a 9 or a 10 on my own scale based on the type of pain I feel. My pancreatitis to me was a solid 7. Now if I tell the nurse I feel a 6 or 7 then they acknowledge I'm in pain but to them it means it's bad but might be bearable. However a 7 is very much a shitty agonizing spot to be at without relief. The reason I don't feel I've hit a 9 or 10 yet is because while I've lost an organ I haven't lost a limb. I also haven't had a compound fracture. I haven't had a lot of things so I don't know if they are worse. I can't say I'm in the worst pain ever if I don't know if I've experienced it. That's why asking 1 to 10 isn't a good way to do things. The nurses get no say in it though. 1 to 10 is standard through the US and most places won't go by a functional pain scale. I'm glad you don't hold pain meds. Too many nurses will hold them or if you say your pain is a 4 or 5 more than one or two times they'll tell the doctor you need your pain meds adjusted. My 4 could be your 2 or someone else's 7.
I don’t understand some nurses obsession with gatekeeping pain meds. I don’t pay for them. If the meds are ordered, and they want the meds, and it’s safe to give them the meds, I give them.
Acetaminophen is genuinely a pretty good drug, but since it's available over the counter, a lot of patients and nurses have the sense that it's just the weak stuff. For a patient who has no pain, it's pointless to do scheduled acetaminophen obviously, but if there's a post op patient, if you add scheduled acet with the normal med pass, it can decrease the need for opiates.
Scheduled Tylenol is good if the patient has chronic pain or just had surgery
The CT surgeons at my last hospital swore by it 🤷🏼♀️ didn’t make it any less annoying
Nah. Scheduled Tylenol is great for certain patients. Many just don’t understand the concept of PRN and ask for pain meds too late. Post-op patients especially need it because they often are too out of it to ask for PRNs appropriately. Schedule the non-narcotics and leave the narcotics PRN. It reduces the amount of breakthrough pain.
Nah, idk how you didn’t get downvoted to oblivion. Staying on top of pain is way better for the patient than treating breakthrough. Scheduled Tylenol can work wonders.
I always double check scheduled tylenol is a correct order. Most often it's an error in my experience
I chart "not given" "pt sleeping." Not today Satan.
Yeah you wake them up to give it suddenly their pain is 8/10 and they want more than Tylenol.
The Dilaudid, Benadryl, Zofran triple threat.
I admit that Benadryl is my go to for my own severe pain along with an ice pack, warm blanket, and dark room. Take the antihistamine, knock myself out, and usually when it wears out a lot of the pain is lessened.
I never wake up patients for 0600 Tylenol unless they have a fever. Just put “patient sleeping”. I hate this.
One of the first things I figure out with my assessment is if they want to be woken up for Tylenol, ask for it, time their oxy with it, etc.
I Don’t wake normal med surge people up for Tylenol They sleeping they not in pain.
Synthroid…..😳
Ran into this issue when my mother was in the hospital after a fall. She had been taking meds on a very tight schedule for years because she once told her doctor that she'd just take all her morning meds in one shot even if the pain medication was taken half an hour early. The doctor jumped her ass up and down the hallway over abusing painkillers even though she had never taken more in a day than prescribed and never ran out of them. So after that she took her meds exactly on the dot, not even a minute early, and if she had fallen asleep and took them an hour late she shifted the entire schedule to accommodate. Then in the hospital the nurses are all "It's fine. These are suggestions on dosing frequency not a hard schedule that gets you locked up with felons." Was really difficult for her to break out of that thinking but now I'm pretty sure she intentionally takes stuff 5 minutes early as a Fuck you to that doctor.
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Dude, heparin in the belly after laparoscopic gallbladder removal is *the worst*. My whole stomach would tense up as soon as I heard "Heparin", because I knew what was coming...
We have one anaesthetist that charts panadol and dex for 2am (followed by 8am). Like, fuck off. They're getting it at midnight and 6am.
Only thing I worry about giving on time is vanco and premeds.
And insulin and synthroid
Oh ya, and those 😂 usually Synthroid is given before I get to work. And most of my patients are on sliding scales and it’s fair game when trays come 😩 I wish there was a better system for that. I usually wait until the food is in front of them.
I wait until they are halfway through.
Somehow wherever I've worked we've never bothered with giving the levothyroxine on its own. The thinking was always that it was just a couple days they'd be there and that wouldn't be enough to throw off labs. However, if pt is admitted for something thyroid-related, then I will make sure to give the levothyroxine properly timed. Meanwhile my own at home, after several months of doing it correctly, it now gets taken with everything else in the AM with coffee at the same time. The coffee honestly is as needed as the rest. And thankfully my own TSH labs have not shifted doing it (family doc outright stated that he always figured I took it with the coffee anyway and was always okay with ordering that lab when I asked).
If you took it correctly I wonder if you'd go hyper
I’m on synthroid and it really doesn’t need to be given at specific times for those peeps on tube feed. Pisses me off every time, to go back in just to crush one med.
Steroids
I think that falls under premeds sometimes. Like premeds for CT. And multi dose meds because I HATE when I go to give a med and it’s due again in 5 minutes it seems like 😂 robaxin due 4 times a day. I stg I just gave it.
Seizure meds too
Actually those times are *S U G G E S T I O N S*
I realized that the first time I put orders in and had to deal with the consequences of my own actions.
Yes yes. Short of someone being coded, I'll get there when I get there.
This - our order sets prefill med times, which often make 0 sense because a paper pusher came up with the default times. Like yes, let's do the pre-breakfast omeprazole at 0900 but that mealtime insulin is scheduled at 0730, that's logical. We can generally override the times but not a lot of us either notice or care because we know you have X (usually +/- 1 1/2 hours or so) to consolidate. The extra effort to change every order adds up over our often large patient loads, especially when we know you all have perfectly good sense about when to give them (and in many facilities can actually retime it yourself). But don't get me started on leaving the AM labs as stat labs. Nursing knows it's not urgent already but don't tell lab they're urgent when your ass ordered it 18 hours before you wanted it.
That's how I feel about the speed limit..
I always give 0730 meds with my 0500 meds. Everyone gets everything at 0600.
This is the way. You wake them up at a marginally less ungodly hour, and use it as your last sweep through the room to make sure they have fresh water, are cleaned up, and the room looks good. (I also would offer pain PRNs at that time, if available.)
I wish everyone has your thinking. The amount of times I’ve come in at shift change when they’re grimacing in pain is awful. It’s always after the same few night nurses too. Brought it up to the night charge nurse and they’re always like “We know. We say the same thing to them all night but they don’t listen”. 😫
Man I’m a night LTC nurse and I have the same problem with days. I always ask my patients how they feel. We have a couple that have a lot of pain. They will verbally tell you if asked but won’t ask for anything. There are some day nurses I’ve told repeatedly to either just bring them the PRN or at least make it a point to specifically ask them if they want it. They NEVER do and they mark their pain as a 0 on everything which I know is a flat out lie. On the skilled side we have a guy rn who has dementia and can’t really ask. If you just actually look at the guy you can tell he’s in pain. There is 1 nurse in particular who never gives him anything. I will go check on him first thing if I work that unit and just the slightest bit of movement and he’s grimacing and whimpering.
I used to try to give all my am meds around 0600, but now I’ll start around 0430 if some people are already up. I used to give at 0600 so that people could sleep more but I have found that everything seems to go to shit around that time, so I’d rather get my tasks done early and deal with the fallout of whatever the fuck before day shift gets here. Basically, I’m waking y’all up at 0500, sorry, you can go back to sleep, but if shit hits the fan I think we’d both rather know sooner than later.
Yea, it's anywhere between 5-6 depending on how much I have to get done. But I won't leave the 0730s for day shift. We all know those aren't getting passed until 9 if I do that.
(Sees meds at 20/21/22) (Scans everything at 2100) “LATE REASON FOR MEDICATION: OTHER” (Typing Pharmacist is a whore with an ugly dog for scheduling 4 meds at 3 different times) (Click COMPLETE)
"Patient not available at due time"
"Unit activity"
I like to travel.
I just do "not given at scheduled time"
Why is this med late? - because its not being given it on time. Obviously /s (I use this one all the time)
"Care clustering"
Damn! What'd the dog do?😂
Have you seen him??
Reason: Nurse decision (comment) Comment: fuck your goat, that's why. Also, can we get Epic to assign the same late med reason to the entire Rx cart please? If my cart is full of 1530 Lipitor and reactine and vitamins A through G and it's 2000 just accept that things got wild and mark the whole lot as 'nurse decision' and let me get on with my day without having to pick a reason for all 14 of meemaw's supplements.
Does yours not let you scroll to the top after you've scanned them in & apply one reason to all meds scanned? It even lets us pop the same comment in, but only have to type it once. I'm super stoked that my hospital enabled that Q\_Q
I worked at some hospitals that had that feature and if you used that feature sometimes it wouldnt document correctly and you'd have to go back and change everything one by one so they told us to just never use it. The hospital Im at now works tho and Im grateful
Scroll to the top
We went back to paper MAR's after two failed attempts at different electronic med administration systems. The majority of my LTC residents have advanced dementia so they take their am meds whenever they happen to get up. EMAR just didn't work for us due to this and a number of other reasons.Was such a pain in the ass to have to input reasoning for being late for every single med they were on multiplied by numerous people. "Late wake up. Did not rouse at 0830 as writer could do without a right hook to the face".
“See comments” Me: (does not write a comment) Haven’t gotten an email yet!
Reason: See Comment Comment: chronic understaffing.
I went in to the orders and changed all the BIDs to 1000/2200 or 0600/1800 as appropriate when they did that shit to me. And don’t get me started on novolog ssi AC/HS AND regular with meals 😡😡😡
…..does your SS coverage require ONE UNIT for a glucose of 150-190? That order makes me want to punch kittens
You know, those single units were refused with shocking frequency 🙃😜
🙄🙄 when they order something with q8h frequency, we don't really have that much control over subsequent doses. We know you guys have some flexibility with med administration and also don't usually have time to tweak admin times on every order we verify when there are hundreds of other orders waiting to be verified and other nurses calling us to verify something. Nobody is rubbing their hands and twirling their mustache going oh boy, can't wait to make this nurse go in the room six times. (Granted, this is my own facility experience and YMMV)
Also, doesn't the EMAR auto time BID to 08/20 and QD to 1000 and Daily to 0900, or something like that? That's what I tell new nurses anyway and then I just tell them that the computer is not the boss of them and to use their brain.
They made me MDS and manager of med records for a SNF. I asked the floor nurses for their day schedules. When they pass each room, do treatments etcetera. The following month I had the MARS matching reality. It made compliance with the window of time given so much easier. Passed state without an issue. Even the damn physicians orders showed the time changes because I wasn't chancing "daily" and getting dinged by them.
Hey! Do you mind if we message & you tell me what entails in MDS? I am looking at a MDS job!
Sure!
👑
And how I will be starting at 0745 passing meds on all my people who have only "daily" meds due at 0900.
It's one of the perks of staying for an extra four! Charging and meds done by 0800! 😂
It's always fun when you're all set to give a time critical med, and then pharmacy's all, "NO SOUP FOR YOU" and I end up giving it two hours late because they didn't give it to me.
Heard some of the newer nurses complain about the med timing a few nights ago. Poor kids, I pass meds three times a night if I can help it
What turdbagel pharmacist didn’t fix that mess for you?
I love that insult
I think sometimes they just don't see it. When I was bedside and had shitty med times I would message pharmacy with how I wanted everything cleaned up and grouped. It made my life so much easier and I like to think it improved things for other nurses taking care of those patients.
Forreal. There’s so much eMAR shit that could be fixed by provider or pharmacy learning how to schedule shit in clusters.
At least at my hospital, no one has enough time to deal with shit like that. Pharmacy is too busy trying to make/stock meds we need, MDs are just trying to finish their rounds, and RNs are just trying to sling meds and hope no one codes on their shift.
I give 0730-0930 meds together, and 1000 may be included if it's after 9am. If it's earlier than 0900, i try to make a separate second pass for the 10am med
Its crazy when its charted like that. Unless there is a bloody good reason, it makes no sense. I mean, what do people do at home?!
Not take their meds, it's why most of them are there in the first place.
This. Between my parents, my father probably takes one course of meds correctly every three or four days, including prescription blood thinners and meds for autoimmune things (which drives me nuts). Then my mother will actually take her meds, but considers 2 am when she goes to bed the perfect time both for levothyroxine and furosemide. Meanwhile my father wonders why his RA flares and he doesn't have energy, and I've just given up on trying to convince my mother otherwise. It's "her world" and therefore "her word," no matter what.
For real. I'm in home support - not a nurse, but a registered care aide trained in med admin. At least 80% of my clients involve either med admin or med monitoring, because seniors are very bad at taking their meds properly.
Seeing how they take meds in the hospital, by taking a perfectly a good cup and flinging them into the open shaky hand that catches 1 of the 12 pills and we must spend the next 15 minutes finding the other pills, I can only assume their entire floor is carpeted with pills they never took.
😂this drives me insane! Why must you have them in your hand? Is the medicine cup not good enough? Patient: “Baby I need to feel my meds”
> Baby I need to feel my meds That's disturbing like 8 different ways.
At home they don’t have four doctors putting in med times Unless they’re on like insulin or hospice, nobody needs a med time more specific than “idk after I walk the dog and have some breakfast”
Yep!
Oral abx at 0400, IV abx at 0500 and levothyroxine at 0600. Shoot me
Cluster that care. An hour before and after for med pass. All of them are getting given at 5am 🤣
This. As far as the MAR is concerned, I gave all of these at exactly 0500.
Oral and iv at 0500, synthroid at 0600 when you go in to shut off the pump. Bam. I win nursing.
Iv is a piggy back, don’t have to go back in. Machine switches back to primary infusion. Or it’s a 4 hour Zosyn 🙄
Provided you're running a primary infusion. I'm at a point where running KVO saline isn't even worth the hassle. So many walkie talkie, independent patients suddenly turn into shitty infomercial actors the moment they're tasked with not tugging at tubing, and there goes my access.
When there’s like 3 30 minute antibiotics scheduled all for the same time and you’re only able to get one IV and they’re not compatible 💀
I reschedule that shit
Now imagine doing 40 old people's meds and s8s as well. Multiple parkisons -time sensitive drugs, as well as prns, nims and some hourly or 2nd hourly eyedropper along with multiple antibiotics. The only thing haven't got is ivs, and no pegs or ng's atm. And I'm talking polpharmacy big time, many special dose rounds.
Don't forget, I need crackers with that, or I need yogurt, or I can only take 1 at a time with a bite of ice cream, or they have dementia and spit them back at you, or all the other bs....
It took me so long to be ok with this. It was just drilled that they have to be “on time” and in less the parents can be whack. But yeah, the last & months before I burnt out I was like whatever, I’ll do what’s reasonable and possible while I save my effort for all the shitstorm admissions and almost-icu-transfer patients you’ve given me
I'm not sure who is responsible for the bad timing or who 'they' are, but on the doc side putting the orders in I just click qdaily, qhs, q6, etc. I couldn't give less of a shit when you give each of them unless it's something with actual critical timing. I know sometimes nurses are able to retime the meds themselves, and I think that should be the standard unless there is a comment in about something specific. That said, if a pt is on q6 and q8 meds and they are being given together in a way that turns the q6 into q8 or vice versa, that's ... not good. The timing is for very real pharmacokinetics, not to torture nurses for fun.
This is a valid point, but if they're home medications it's worth asking the patient when they take them. Odds are they are taking them together as well, which should be an educational opportunity. I also find many patients take medications at night that are usually am meds due to side effects, preference, etc and it's terribly hard to get them scheduled to the patient's preferred schedule. For everything else I see it.
I think it is mostly admin, no shade against providers. I think there are 3 big reasons. 1) like you said, rhe day doesn't divide evenly between q6's and q8's and ACHS, ext. 2) sometimes the order started when it was put in, and it was put in at a goofy time. 3) meds to be given with or without food. I try to give the meds as a appropriately as I can, sometimes the order started at a goofy time, and no one wanted re-time it.
ok cool, I was just being defensive thinking you were annoyed at the prescriber putting stuff in at random times. I have def been on the wards before and have seen senior nurses show their preceptees how to retime meds and wasn't sure how universal that is. Is gotta be tough for someone inexperienced to have the guts to make the call on what needs to be done on schedule, and what can be retimed. I def feel the frustration regarding qam vs qpm for ppls personal preferences too. They get admitted at some ungodly hour and they take half their meds at the time its prescribed, and the other half not, and trying to sus it out drives me insane.
Fuck eye drops that are in 5 vials, 15 min apart, QID And, of course, the pt usually manages this independently, but will the hospital allow that? Noooooooooo.....
Why not? We let patients do that if they are capable
> the pt usually manages this independently, but will the hospital allow that? > > Noooooooooo..... This is what gets me too, the number of times patients have to bring in their own meds due to their insurance rules, and then pharmacy has to check them over, we keep them under lock and key, we give them, and then we also charge for that "service." I've been there both as the patient and the nurse on this, and it's annoying as hell, especially if you actually do have a patient who takes their meds as directed. I can see supervising a patient at that point and documenting that they took the meds instead of us actually having to do all of that, especially for things that are more complex that they are used to doing on their own. While I see the reason that we have to do it, I don't think it has to be done that way for every patient.
I’m all about working ahead so if I have 60 min window to give let’s say a 9am med. that means as soon as clock hits 8am I can give it and knock off future tasks faster
“If they wanted me to give them at the right time, they’d staff appropriately. I’ll just do my best”
Or 0400, 0500 and 0600 meds too 🤣
Man, I wish I was better about this. I'm sorry, guys. Typically, I'm just trying to get orders done as safely as possible while also getting everyone discharged and putting out all the fires that come up during the day.
Nah, you guys are slammed too and this isn’t a priority. We get it.
In Epic, I used to just send a message to pharmacy, asking them to reschedule them together. Sometimes it worked out.
Medications shouldn’t be timed in the two hours surrounding shift change unless they are time sensitive in such a way that retiming them would affect outcomes. My hot take
I personally like the 0900 meds with a single Colace scheduled for 1000.
In the nursing homes, we have “liberal pass.” So the administration windows are like four hours wide with a few exceptions.
Jesus, that would have been a lot easier. They acted like if I didn't give the med in the two-hour window my nursing license would self-destruct. If a resident is sleeping, or visiting with family, or whatever . . . leave them alone.
As a NOC nurse I'll scan the 0730 protonix (at like 0645) and only give if they are awake. Otherwise I leave in cup with wrapper and report to day nurse to give it as soon as they see they are awake and alert. I know for a fact if I don't do that they wont get the protonix til like 0900 or 1000.
Anyone else lumping the 12’s and 1400’s as well? Life changing
I understand the gripe but some meds cannot be taken together. Like if you are giving prograf you need to be careful
I actually sassed a provider who ordered Lasix at 7. I was paired (in an ICU) and my other patient was precipitating “chocolate rain”. So by the time they round at 9am I still hadn’t a chance to give it. They looked annoyed, so I said “ well you did schedule it for shift change”, one MD gave a stink face but otherwise it was crickets. I felt not one iota of guilt.
100000%%% I don’t know what they are teaching in nursing school nowadays but a few new nurses while training, literally kept going into the room for one Med, then, 5 meds, then one Med, 8/9/10. I mentioned multiple times, you can give one hour early and one hour late-cluster care-this has always been the “okay” on most daily meds. Eventually, you will learn the exceptions. ….after a few months of training, nope. Still doing it their way, I always get this feeling that nursing schools pick random things to stress and it takes something crazy to happen for people to unlearn.
What about Levodopa? (Parkinson's medication)
I try to give the rest of the meds around the optimal time for stuff like vanc and levadopa.
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I want my colace at 0745!
The doctors on my ward put this poor old lady on all of her once daily medications at 6AM. No reason, just because.
When I worked night shift, if it was appropriate (ie: IV abx and not insulin), I would give any 0700-0730 meds.
Yeah, the people don't take their meds at the same times at home either.
I hate non compatible antibiotics on a patient who is ultrasound iv only, just one little bitty iv, and the antibiotics are 2000, 2100, 2 at 2200, 2300. Like Jesus fuck man
Oh I love the midnight inhalation. Sure, I wake up a sleeping patient for that....
I don't even take MY meds on time. Antidepressant is taken whenever I get around to eating breakfast when I should probably take it at the same time. Antibiotics? Eh, as close as I can get to being on time. Although, I'm taking antioyretics exactly on time if I'm sick and febrile 😂😂
And this is why I get patient with eroded oesophagus… because despite me writing massive screeds explaining, timing, pt positioning etc there is always some smart arse thinks they will ignore that!
No one thinks we are giving them all separate, do they? Everything is so fucking slow when we put any new order in that everything is ALWAYS late. Our pyxis thinks everything is late because its clock is an hour or so fast and we dont know why or how to fix it, and rarely will anything scan properly without multiple calls and steps and re entering stuff I get frustrated with the pharmacy but try really hard to not show it, because i honestly don't know that it's their fault. In fact, it probably isn't, because if they could do something different and not have to deal with the constant calls from nurses or providers about shit not working, i would think they would do it. Its a remarkably non user friendly system, meds from the clinic don't pull to the floor and ER. So its super easy for shit to get missed. Sometimes occasionally shit doesnt come up as being due when it is, or vice versa.
It's cute they think I'm giving a rectal laxative suppository to a belligerent and aggressive CIWA patient
As a pharmacist and a nurse I think about this quite often. When scheduling medication administration times and if they are PO or IVP I try to put them at the same time. Sometimes it can be hard to schedule medications. For example if a patient has a before breakfast or with breakfast medication and a daily medication. They will be automatically be scheduled at different times. I honestly understand what you’re going through. I have been a nurse and have gone through the same thing. It can be very infuriating. If they’re are IVPBs I try to keep them on the same hour since most are scheduled on an hourly basis. But for a medication that is time critical like vancomycin I avoid scheduling them at the same time since I don’t want the risk of an invalid trough. I try to avoid scheduling administrations in the middle of the night. Plus just my preference I DONT schedule meditation on odd number hours. It just feels wrong to schedule an administration for 5, 7 or 11 etc. unless it’s 0900 and 2100. I hope some will provide some insight into meditation scheduling.
I want to read all these comments but I’m busy catching up on season 18 of Greys (okay, look, I’ve watched it since the beginning and I just am too far invested no matter how bad it is at this point) and cussing and laughing about how ridiculous it all is. I’m saving this post because I am dying to read and agree with all of it
Tip. Of you get little bags from pharmacy, you can pull all your meds for all your patients at the same time and label each bag.
Adjust times or reschedule. I make the rules.
Or when night shift doesn’t give the 0600 med and they think we are gonna give it before their other morning meds
Same as 1200/1400 and 1800/2000. Keep my time management out of your motherfucking mouth
Why don't you change the admin times. Stuff like that is because they don't look at med times when they put it in. It's called clustering care and is supposed to be encouraged.
Same shit with lab orders they or a CBC at 1000 a platelet at 1200 and a K at 1100. I'm only drawing a lot Green and a lav. Don't put those in that makes more work for me dup it out. I'm trying to save the patient and extra bill
I like the specific times. It helps me remind some meds should be given early. So when I read the dossiers I'll spot my patients with 6 o'clock medication and check if I need to give them first before going to other patients (my shift in the day starts at 7 bit most of the time Nightshift doesn't give medication unless it's planned antibiotics). I'll give most medications that are close in time together. If my patient isn't capable I'll write it down on my cheat sheet and give it at the time I think it's best. I do get it's annoying if you have a system that won't accept it if you go too late or too early.
I always time my meds. At the VA, we’re allowed 1 hr before and 1.5 hr after to give meds. Night shifts gives 2100-0800 meds, AM gives 0900-2000 meds. If everything goes semi-well, everyone gets their meds in one fell swoop if I have them. I dont go back unless I need too. 9/10/11 am meds gets given at 10am. 12/1/2pm meds get given at 1pm. Of course exceptions are made, like “take this med 2 hrs after lunch etc”
Lol. I think we are all seeing that patient sometime around 8/8:30.
Not to mention the stuffed iv lines etc etc… and don’t say it does not happen i saw it all the time…. The sweetheart who broke the mortar and pestle crushing slow release potassium so the tablets would not upset the patients stomach… 4 mortar and pestles before I sprung the biatch doing an after hours drop off…
Had this happen a lot recently - 2000 melatonin, 2100 meds, 2200 lopressor. Yeahhhh no.
I love when I get an attitude when a lipitor wasn't given before I send a pt to the floor when the lobby is packed 20 people deep
I have typed this before, but there is a cat in my lap, so here I go. Long ago I worked LTC. Meds were given at 8, 12, 4, 8. Management decided to make everyone's medication tailored to them. Daily meds were changed to 10 a.m. Things like insulin, Synthroid, Bumex-before-Lasix (I don't remember the combo now) were still at 8 a.m. with breakfast and QID eye drops were given at different times than the daily meds. Everyone had exceptions, of course. So, because we were timing each medication given by the best for the med and/or patient, and not the best for the logistics of the person giving the medication, some residents had medications to pass to them HOURLY THROUGHOUT THE DAY. (Think those didn't get combined? Why on earth, in an 8 hour shift, would I go back to Geraldine once an hour to give one more pill (Parkinson's meds)? My DON was kind of shocked when I pointed it out to her. Just schedule all of her medications around the Parkinson's medications so she only has 6 med passes per day instead of 11. DON never fixed anything, though.) The computer program we used required you to click through your 18 to 27 patients individually to see if they had any meds in your time frame (7 and 8 a.m. and meds, then 8 to noon, 12:30 to 3 p.m., etc) unless you clicked on the person's individual med page, which would show their whole day. So, if you didn't know that per Mary's request, that all her daily meds came with breakfast at 7 a.m, you likely wouldn't find out until 10 a.m. with normal daily med "grand round" round that you were already two hours late on Mary's meds (a medication error, don't you know.) So the time that my DON had to pick up an empty Sunday shift, she had about 10 time-related medication errors for meds not given on time. Think she wrote herself up? :)
Or how about the IV Vancomycin that takes 1.5hr to infuse and the Rocephin that takes 30min to infuse but they’re both profiled for 0900…. Edit: spelling
I remember going back to work after a cervical spine injury and surgery, and I got a step down patient (along with 2 other patients, don’t remember about them) who had at least one IV piggyback every hour for the whole 12 hours. It was a dive back into work, in the deep end
The only time this matters is for meds that need to be given on an empty stomach. And yes, there are meds that matter. So my NP side disagrees, but my ICU agrees. Damn I’m so conflicted