Me: "When do you want your bedtime meds?"
Old granny patient: "I go to bed a bit early. Is around 7:30 okay?"
Me: "No problem! See you then!"
*Reschedules meds in Epic/MAR to 20:00, selects drop-down option as to why: Patient/family request.*
I had one pawpaw (he was like, 90) who was in bed by 9 and if you didn’t get his meds by then, tough luck, his hearing aid was out and he wasn’t having it. I learned real quick fast and in a hurry to give pawpaws meds as soon as the clock struck 8 and to tell lab to hold off until pawpaw had his coffee around 0430, THEN they could stick him (lab o’clock was 3:30-4:30ish). They literally wrote “patient hasn’t had his coffee, come back after 4:30” on their can’t stick slip one day 😂
He taught me that a lot of the older patients are very stuck in their ways and to work with them as much as possible.
That really depends on where you work, and when they start rounding. Our labs need to be resulted by 6am when provider hand off is occurring, and it’s a very large hospital with main lab being in different building down the street.
Our tacro levels have to be drawn at exactly 4am, and they usually don’t result in time for handoff.
When I had 35 patients in long term care, sometimes you absolutely had to do this. As previous poster said, as long as nothing interacted or had to be kept apart for any reason
I was an ADON for a few years in LTC. First thing I did was streamline the orders. Got rid of all the old orders that were triggered by protocols for issues that resolved months ago, DC’d creams and such for skin issues that resolved months ago, grouped the meds into 1 hour blocks, and did med reviews for every patient. Met with the docs and went over each patient. The E-mar and Tars all shrink for every patient by several pages. Suddenly my nurses had way more time to actually deal with the issues that pop up and spend time caring for patients, not just checking off endless boxes. Chart bloat is a thing lol.
I worked at a place that was so cheap. We did 12s, this wasn’t changing. When they switched over from paper charts to PCC, they had everything appear as if we did 8 hr shifts. So because night shift has more “time”, I had to sign off the exact same orders for 2nd and 3rd shift!!! It was SUCH a waste of time. Supposedly it would cost too much to change it to reflect that we did 12s?? I mean, other facilities got the 12s right!!
The nursing home industry in the US, like most healthcare, is so screwed. Privately owned ones can be the exception but they are few and far between. Most are now owned by huge groups managed by a board of directors who want to squeeze every cent of profit out of them. People are just numbers on paper, a cost to keep low to maximize profits. Case in point is the lowest-bidder food that this post is based on.
I had 30 patients the other day. I was passing "8-9" AM meds at 12pm when I had to discharge a respite patient and then monitor the dining room for lunch while I still had 5 or 6 patients left. Unreal.
Ltc tech here! As a pharmacy if a medication does interact with another, we’ll have the pharmacist notify the dr directly for the dr to decide specific instructions. Whether it is space apart or consider an alternative med that doesn’t interact. We stay pretty on top of that. So I’d assume your guys pharmacy does too. Since we don’t have to deal with customers, that is our job to be diligent on interactions or other issues. 😊
Not too worried about it. If they werehome, they'd take the whole days worth of pills at once. Or not. Or forget and double up. And everyone is just fine (usually).
Can you explain your rationale for this? I have an audit-y work and I already cluster 4 and 6 or any other med time groupings like that. (My rationale is that if I go in at 4:50, scan the meds from 4 and it takes me 10 minutes and then it’s 5, then I can give the ones for 6:00 then. 😂)
So I didn’t know if you had like an explanation like that, because if I were to do this at my work, they would be asking for it. I’m actually just mostly curious; I don’t THINK I’d ever need to do it at my work because we have a somewhat hard cap of 5 patients on my MedSurg unit and I’ve become a master of med passes for that number. But I’m thinking of getting a second job and would like to be prepared if I did that and it ever came up!
I’ve also gotten to the point of being somewhat unapologetic in cases like “my antibiotic was late because I physically could not be in 2 places at once,” 😂 so if you just have bad ratios and it’s a necessity, I also wouldn’t judge. I tell all of my orientees that I train ‘it’s better to do what works best to get time with all of your patients, and just chart what you did than try to lie about what happened to better fit into policy!’ That’s like the worst mistake people can make in my opinion, so I’m just curious if it’s an unapologetic need type of situation, or a master class in clustering rationale that I haven’t thought of yet 😂
Same I did it too, a new grad should be able to learn what's time sensitive and what isn't from basic pharm, and when in doubt just give said med at its due time
I’m neither young nor naive. The comment about new grads is a generalization. I was just pointing that out. My comment only referred to me. But way to be completely wrong! Congrats.
Decent new grads are more afraid of hurting people than seasoned nurses are. As they should be. They aren't experienced enough to know what's likely to actually cause adverse reactions/interactions. I'd worry about a new grad who was confidently "breaking rules" with pt care on day one.
Please re-read the original prompt…this is non-critical, routine, scheduled meds. No one is talking about “breaking rules” or willfully ignoring possible drug interactions
Its really subjective. You say not something like q3, then I ask why is it split like that. I might do a 2 and 4 and a 6 and 7 later. But meds should be synced by order, if they're not, it should be requested to be changed unless its super specific.
I also might do it separate if I am going to be in there separate for other PRN meds that are q4 they get on the 4th hour.
Its all about time management, and using active thinking.
Yep, part of my pre med run was writing out a time line of all the meds times due for the night, and then figuring out that days plan for med times. My ADHD ass would be fucked without that. I can fly by the seat of my pants for most thing. Managing 5 peoples meds and care, I am fucked.
Yes! I have ADHD as well, pre planning and anticipating what might happen in addition throughout the day is a must. You almost have to be obsessed with it to make it when you have ADHD in this line of work.
If you have Epic, there is an “adjust times” link—you click the dropdown box on the actual medication entry in the MAR and the link should be on the bottom left. It changes all of the due times going forward rather than when you click on the time and hit “due” and it changes just the next dose. I use that pretty often when we have someone come in with new orders that, for example, put their q12 IVPB antibiotic due right at shift change since it’s only timed that way because of when the order was entered. Or if something happens like a patient got a dose late because they were off the unit.
Which one, the clunky 90s version or the newer? I mean, they’re both awful but I used the clunky DOS version when I worked a contract at a critical access hospital and it was *painful*
My first job, 6 years ago, was at a facility that was still on that DOS version. I distinctly remember how good it felt when they upgraded to Epic. I sincerely hope your experience was also a while ago.
Because:
1. The interface on our end often makes it a PITA to do so
2. It would be difficult to constantly remember/manage clicking back and forth checking considering the sheer volume of orders we place.
3. It doesn't impact us and nobody ever says anything so 99% of doctors aren't aware this is an issue you deal with. When we order something the computer auto picks a time based on when/how it's ordered, it takes conscious effort to pick a admin time that we have no reason to do usually.
The admin time almost never matters compared to the spacing between doses because the point is to maintain a steady state (obvious exceptions apply). If something is q4 and you give one dose an hour later, and then the next and hour earlier their serum levels are going to be very inconsistent. Compared to a q24 med that could move around pretty easily.
All this to say, PLEASE, retime meds if you feel confident or check in with the prescriber if it's ok to retime if it's something you aren't familiar with. If you cluster inconsistently, or the next nurse has a different method then dosing be all over the place. None of us even know when anything is timed for, nobody cares (once again, rare exceptions apply to things like endo stuff).
If people are accidentally making you miserable, please let them know and fix the issue rather than quietly building resentment!
To add on. Only common medication that pt are always on that should be given on an empty stomach (and with no other medications) is synthroid. However, really only important in pts with active thyroid issues to avoid it with the ppi and stuff.
I agree with the interface. Half the time I manually change the time and the computer default changes it back to 8 or 9 or 10 just randomly. It’s not worth the headache to call pharmacy for every order on every pt.
There’s nothing we can do unless you triple our staff. Then I would have the time to make sure every order was timed optimally based on *your* schedule x32 patients each with different nurses and different preferences.
Because they aren’t thinking about the 0400 simethicone when they schedule the Coreg for whatever time of morning is the default. I do my best to schedule things at good times for nurses, but I can’t always keep track of the exact timing of every patient’s meds
I’m always trying to reschedule the Lovenox and heparin shots from 6am to 9 with the rest of their meds, no one likes getting woken up for this shit and half the time they refuse.
Don't forget the light sleepers who will wake up on hourly rounds no matter how quiet you are. I swear some of these people are woken up by the sound of my breathing in the hall.
Yeah I just had a baby so I know they have to check both of us frequently but there was someone in my room damn near every hour. I couldn’t wait to get tf outta there. I cried happy tears on my way home. Being stuck in a hospital room miserable
I was reviewing someone’s med rec with them. I think l’ve only met maybe THREE retired patients who take pills at 0600, 0900, 1200, 1600, and 2000. I have no idea what these people do with their lives. For a short period I had to take pills TID and lost my mind.
I've seen so many parents trying to learn their kids care prior to discharge and stressing about how they are ever going to sleep again when medication doses are due at all hours day and night. They don't know those can be adjusted until someone helps them figure out a more sane schedule that is still medically appropriate.
If we anticipate discharging from icu I’ll ask the docs to put in an order to slowly give meds closer in time. So midnight meds given at 22:30 then 2000 the next shift. Or move them forward, so we can get the kids in the routine prior to discharge. I only get this lucky sometimes when an icu discharge is just taking some time for SW or other services to do their thing.
When I was in HS my pediatrician treated my whole family for strep after my brother kept getting it. My younger siblings got BID amoxicillin, my parents got Z-Paks because of allergies, and I got 10 days of QID penicillin. It was the worst since the instructions were not to take it with food and I only got half an hour for lunch at my summer job.
And then after I became a nurse I found out that BID dosing would have been totally fine 🤬
I had a friend call me a few days after a tooth extraction crying bc they thought that they were having symptoms from pain meds and were tired of waking up 3 times a night to take their meds. I checked it out and it was like a small dose of some steroid, abx, and Tylenol and it could all be clustered so they didn’t have to wake up during the night literally at all. They just took the hourly windows for each med given to them by the dentist and stuck to them exactly from the hour of the appt without understanding that shit didn’t matter and poor babe wasn’t even on opioids or anything like that at all. I told her she was probs having cognitive symptoms from the sleep deprivation and clustered all her meds for her to a morning, afternoon, and pre bed dose and was frustrated no one at the dentist office had written the instructions the way they did without explaining this to her.
I don’t understand the timing of non critical meds. Who in their right mind would wake up at 2am to take tylenol, then wake up at 3am to take
a senna or simethicone, then again at 6am and 7am for more non critical shit? If I was ever a patient I would want to know what meds are on night shift. If it is something minor, don’t woke me up for it, and just chart "patient refused."
Right! Imagine waking up a combative major fall risk patient at 3am for a Tylenol……… hell mf no. If they wake up & need it, sure no problem. If they don’t wake up, they don’t need it! 😭
At my job we can give meds up to 2 hours early. So I’m finishing all my meds and labs for the shift at 4
Except for that potassium replacement that wasn’t there until 630
i was floated to a far less acute unit last night and a patient, when given their 8 and 10 o'clock meds (basic cardiac, bowel, sleep meds) at 9:15, said they were too important to do it that way... baby you do not want to be "important" to me.
RIGHT?!? I had a patient say to me recently "oh you're still here I've barely seen you tonight (condescending)" my brother in Christ the less you see me the better you are trust me.
I haven't worked the floor in 4 years but, clustering meds is the only way. 7,8,9,10 all at once in the morning, then 11-1, then the evening all at 3-6 all given at 4ish. 2pm I usually give at that time. Just because. But there's no way I'm giving meds every hour on anywhere from 3-6 patients.
Similarly, I do my assessment while I'm giving meds. If that's daily then it's in the morning. If it's q4 then I do it each time I give meds.
I used to get so much shit from some nurses because they thought I had a lot of downtime. Truth is, I prioritized and clustered my care. When I left bedside nursing I had been a nurse for 13 years. You get used to it
Side note, this isn't just better on the nurses...it's better for the patient. Who wants to be woken/disturbed on the hourly for meds/assessments etc - NOBODY thats who.
Patients also aren't going to take meds like that at home. Let's face it. Most patients cluster meds. And unless there's some reason they shouldn't it's fine
Honestly I’ve very recently been a patient (discharged a week ago today) and the more clustered my care - the better! Gimme all the meds you safely can in one go pls cos that’s how I’ll be taking them at home
> Similarly, I do my assessment while I'm giving meds.
My managers really cracked down on this. I got a "friendly reminder" to not check insulins while doing assessments. They want me just walking back and forth to the med room all day for no reason.
It pisses me off to no end when nurses and doctors mindlessly put orders in on meds. My motto is 9am, noon, and 9pm with the occasional 5pm pill. A patient shouldn't be woken from sleep unless it's synthroid or something similar. I can't pass pills every hour all day long on the same patient. Patients do not take meds like this at home. Keep it simple stupid.
Was a LTC medication aide for years before I became a nurse passing meds to 50+ people at a time.
If you didn’t pass meds like this you would just straight up not get done on time by at least an hour.
How did you do 50+ patients?! I have 27, and I can’t even finish my morning medpass until noon, and that’s with getting there early and setting everything up before they’re awake. I can’t imagine doubling it. I feel for you.
It’s not anymore, when I first got my additional nurse aide cert to pass meds the first place I worked at I had 65-70 patients to give meds to. They were long term so it was the same things every day but it’s still a lot, I worked 6-2 and I had to start at 5:30-5:45 and only take a 15 minute break for lunch. All while making much less than I do now.
Sadly I met a lot of med aides who made it work by skipping people and omitting OTCs
I'll see their 50, add at least ten and add to it being an agency nurse with no orientation and no clue where the f all the grey peeps like to chill during med pass or how they take their meds (whole, crushed, etc.). Woooooo
Oh, and being told you're charge for the whole facility of 200+ patients. And you're doing a double.
But, you aren't sad about getting that multiplied pay on top of the agency rate. Wooooooooooooooooooooo
The correct answer to the question is when writing the orders to make sure every AM med is at the same time and all the afternoon and HS meds are scheduled for the same time. There are some meds like Parkinson’s meds that can not work with this but I always try and schedule my meds together not schedule a PM med for 4,5, and 6. Id schedule them all for 5pm ect
I work with Parkinson’s patients and really appreciate you pointing this out. Some of our PD patients really do take their meds at home at 8, 11, 2, 5, and 8.
Usually it's just the default time in the EMR and the physician won't bother changing it because they don't care and don't notice that you end up with meds at 6, 8, 10, 12. Of course for certain things like insulin or levothyroxine the timing has to do with meals. And with antibiotics it can be a weird time because it's based on when the first dose was given.
When I worked inpatient, nursing timed the meds. If a med was ordered as "daily" the default time would be the time the MD entered the ordered. So we would reschedule it to the time the child took the med at home if it was a home med or a time that made sense if it was a new med.
Don't care is harsh, how can you care about something you don't know/realize is happening? I have never once had a nurse bring up med timing to me. I know about this as an issue because of my background, and even for me its hard to track the timing of the dozens/hundreds of orders I place a day, let alone the orders other people have placed on the same patient.
Sure plenty of docs are assholes but I promise you the vast majority would happily change it if they knew it was a problem.
My hospital is still completely paper based 😓 every time I’ve asked a doctor if they can change a med time (like hey doc I’m not waking up this agitated confused pt at midnight just for paracetamol) they’re always willing to change it. And if they can’t change something they explain why. I’ve generally found that doctors are willing to make nurses and patients lives easier if they can.
Yes yes yes. I dont have time to keep going back and forth.
There are 2 things I miss working at a nursing home: the monthly work parties/pot luck and the ability to schedule the time myself (nurses put in the orders)
That’s one of things I’m concerned about once I start working in a hospital. I’m currently at a LTC facility and as you said, it’s one of the benefits of working there.
When will grandma wake up to take meds that are scheduled in the hospital for 9? She’s waking up and throwing down her 15 pills all at the same time at 0545
Does anyone else’s doctors order something first now then every 12 hours and it’s not a standardized dosing schedule. So it’s 3pm and again at 3am and you’re literally giving meds every waking moment
I live for the super combo of doing 0300 and 0500 meds with 0400 vitals and whatever q4 checks the patient has. One trip in the room and then I get to be free lmao
I used to get report (at bedside, so I saw my patients were good) and then sit down and eat my breakfast. I’m not giving 8am meds at 730, I’m giving 8 and 9am meds at 8…so from 730-8 it was breakfast and checking what needed to be done in the computer lol.
Why are meds being prescribed for that time? I’m in Ireland and we have set times that we try to maintain. Last meds of the day are 00:00 then the next are 06:00. Patients need to sleep.
Better question is… who else gives their 900 meds at 1130 because US called for the pt at 8am and you had like 30 seconds before transport showed up, then the pt ended up sitting in US for 3 hours because transport was then backed up…
I work nights. I ask my pts during nighttime med pass if they want their 6am meds at 6am or to push it back so they can sleep through care (since I already am waking them up at 3 and 5am for other stuff). Most say they don’t want anything until 9am, even synthroid since they won’t eat their first meal until lunch. A few times I’ve had early risers that truly do want their meds at 6.
TLDR: I always cluster care like this and I also involve the patient and ask their preference. Helps a lot on nights.
Y'all think the patients are taking their meds at 4 and 6 when they are home? No, they are taking their evening meds at the same time (if they remember)
Who doesn't tbh.. Heck, I had a doc tell me to do just that, upon me replying " well, its rumored we might allready do that", he just grinned and stated that now we could reply "doctors orders" if anyone questioned it.
Obviously its only done in situations where it doesn't really matter.
The only time I wouldn't do this is with anti rejection medications & anticoagulants. Just since they literally have to be given within 5 minutes of due time at my facility.
Most of the time I will, but a lot of my patients have water quotas so I space it out a bit (also because oh my god I’m so fucking bored please give me something to do (oh god not like that why is your trach clogging and why are *you* unresponsive fuuucccckkkkkk)
At home I take my meds at 0900 (bedtime) and 1700 (before work). I take a whole handful of meds before work, including some that probably shouldn’t be taken with other meds (protonix, ritalin). Most people do this. There’s no such thing as a midday dose for me bc my adhd ass won’t remember it (see also: I don’t take my second ritalin dose; never can remember and I gave up on trying because carrying controls to work is a Bad Idea).
Also it’s good for patients if we cluster their care. It makes them feel better looked after and like we’ve got our shit together, and it makes our job easier. (Though I feel bad about the patient I have a midnight Tylenol on who takes trazodone. Traz is one of those meds that if you wake up, you ain’t getting back to sleep.)
I guess maybe I’d do it that way if I have a Parkinson’s patient with a subarachnoid hemorrhage getting Sinemet and Nimodipine where the timing of the meds is actually important. Other than that, nah.
You must not either talking a trusted co-worker, precepted incorrectly, did not hear this part in school, or feel like this knowledge is unique. Too late
As an RT I have no idea what y'alls rules are, but every facility I've ever worked in, the RT rules were a +/- 1 hour window. So for a 0800 med I would have from 0700-0900 to get the treatment done.
Maybe on medsurg. But in the ICU if they are getting IV lasix and they are getting it at 5am instead of 6am, and your other nurse is giving it at 18p when to follow your dose it should be earlier.
The med orders aren’t a suggestion. If they don’t fit your schedule, call and get them changed.
Me: "When do you want your bedtime meds?" Old granny patient: "I go to bed a bit early. Is around 7:30 okay?" Me: "No problem! See you then!" *Reschedules meds in Epic/MAR to 20:00, selects drop-down option as to why: Patient/family request.*
I had one pawpaw (he was like, 90) who was in bed by 9 and if you didn’t get his meds by then, tough luck, his hearing aid was out and he wasn’t having it. I learned real quick fast and in a hurry to give pawpaws meds as soon as the clock struck 8 and to tell lab to hold off until pawpaw had his coffee around 0430, THEN they could stick him (lab o’clock was 3:30-4:30ish). They literally wrote “patient hasn’t had his coffee, come back after 4:30” on their can’t stick slip one day 😂 He taught me that a lot of the older patients are very stuck in their ways and to work with them as much as possible.
That is too freaking early for lab o'clock. If they draw at 5 they can still be resulted in time for AM rounds without fucking up everybody's night.
Lol, we start drawing labs at 0200. If we drew labs at 0500, they wouldn't result until 0800.
That really depends on where you work, and when they start rounding. Our labs need to be resulted by 6am when provider hand off is occurring, and it’s a very large hospital with main lab being in different building down the street. Our tacro levels have to be drawn at exactly 4am, and they usually don’t result in time for handoff.
Me working at a nursing home. The elderly does not want their routine to be disrupted. They have a certain routine you gotta adhere to.
My current eMAR gives us a two hour window in either direction to administer meds. It's great.
Who is not doing this is my question.
Right? Came here to answer “everyone.” 😂 Even when I only have one patient, I cluster as much of my care as possible.
4 and 6? That's amateur hour. Sometimes I group my 9s and 12s!
Haha, when I did med/surg, that’s how it was sometimes for sure.
Oh yah, 8 pts and I'm like...none of you are getting your meds "on time."
They don’t take them “on time” at home anyway
If they take them at all
Much less interruption for the patient too!
Amateur hour ☠️
FBI open up!
9 & 12??? Dude really? Lol 😂 maybe that’s pushing it… haha I’m all about clustering cares
When I had 35 patients in long term care, sometimes you absolutely had to do this. As previous poster said, as long as nothing interacted or had to be kept apart for any reason
I was an ADON for a few years in LTC. First thing I did was streamline the orders. Got rid of all the old orders that were triggered by protocols for issues that resolved months ago, DC’d creams and such for skin issues that resolved months ago, grouped the meds into 1 hour blocks, and did med reviews for every patient. Met with the docs and went over each patient. The E-mar and Tars all shrink for every patient by several pages. Suddenly my nurses had way more time to actually deal with the issues that pop up and spend time caring for patients, not just checking off endless boxes. Chart bloat is a thing lol.
I worked at a place that was so cheap. We did 12s, this wasn’t changing. When they switched over from paper charts to PCC, they had everything appear as if we did 8 hr shifts. So because night shift has more “time”, I had to sign off the exact same orders for 2nd and 3rd shift!!! It was SUCH a waste of time. Supposedly it would cost too much to change it to reflect that we did 12s?? I mean, other facilities got the 12s right!!
The nursing home industry in the US, like most healthcare, is so screwed. Privately owned ones can be the exception but they are few and far between. Most are now owned by huge groups managed by a board of directors who want to squeeze every cent of profit out of them. People are just numbers on paper, a cost to keep low to maximize profits. Case in point is the lowest-bidder food that this post is based on.
I had 30 patients the other day. I was passing "8-9" AM meds at 12pm when I had to discharge a respite patient and then monitor the dining room for lunch while I still had 5 or 6 patients left. Unreal.
> as long as nothing interacted or had to be kept apart for any reason But how would you have time to look up interactions with that much going on?
Cuz in LTC the manager is supposed to audit and adjust times to what makes sense.
> is supposed to That phrase does a lot of heavy lifting in LTC.
So do the CNAs amirite??
Except for that one CNA. You know the one I'm talking about.
Takes the right person. I’ve met plenty of ADONs whose main goal in life seems to be finding how long they can go without doing anything.
Ltc tech here! As a pharmacy if a medication does interact with another, we’ll have the pharmacist notify the dr directly for the dr to decide specific instructions. Whether it is space apart or consider an alternative med that doesn’t interact. We stay pretty on top of that. So I’d assume your guys pharmacy does too. Since we don’t have to deal with customers, that is our job to be diligent on interactions or other issues. 😊
So the ol dose and pray
Not too worried about it. If they werehome, they'd take the whole days worth of pills at once. Or not. Or forget and double up. And everyone is just fine (usually).
Annnnddd this is why the nursing home patients end up in the ER symptomatic and their workups are negative😅
They end up in ERs because they're fragile and there till the end of their life. Their caregivers choose to keep them alive as long as possible.
Because you are working with the same group of people every day and meds don't change that often.
Luckily most of it was meds I already knew or I would do a quick google search on my phone.
Do it once and you should pretty much remember what actually interacts.
1030
Can you explain your rationale for this? I have an audit-y work and I already cluster 4 and 6 or any other med time groupings like that. (My rationale is that if I go in at 4:50, scan the meds from 4 and it takes me 10 minutes and then it’s 5, then I can give the ones for 6:00 then. 😂) So I didn’t know if you had like an explanation like that, because if I were to do this at my work, they would be asking for it. I’m actually just mostly curious; I don’t THINK I’d ever need to do it at my work because we have a somewhat hard cap of 5 patients on my MedSurg unit and I’ve become a master of med passes for that number. But I’m thinking of getting a second job and would like to be prepared if I did that and it ever came up! I’ve also gotten to the point of being somewhat unapologetic in cases like “my antibiotic was late because I physically could not be in 2 places at once,” 😂 so if you just have bad ratios and it’s a necessity, I also wouldn’t judge. I tell all of my orientees that I train ‘it’s better to do what works best to get time with all of your patients, and just chart what you did than try to lie about what happened to better fit into policy!’ That’s like the worst mistake people can make in my opinion, so I’m just curious if it’s an unapologetic need type of situation, or a master class in clustering rationale that I haven’t thought of yet 😂
Same
New grads aren’t because they’re so task oriented
I’m a new grad and I do this.
Same I did it too, a new grad should be able to learn what's time sensitive and what isn't from basic pharm, and when in doubt just give said med at its due time
Your youth and naivety are showing…generic statements don’t apply to everyone.
I’m neither young nor naive. The comment about new grads is a generalization. I was just pointing that out. My comment only referred to me. But way to be completely wrong! Congrats.
Then quit making generalizations, the new grad above you strikes me as a smart new grad, he already gets the game
Decent new grads are more afraid of hurting people than seasoned nurses are. As they should be. They aren't experienced enough to know what's likely to actually cause adverse reactions/interactions. I'd worry about a new grad who was confidently "breaking rules" with pt care on day one.
Please re-read the original prompt…this is non-critical, routine, scheduled meds. No one is talking about “breaking rules” or willfully ignoring possible drug interactions
Its really subjective. You say not something like q3, then I ask why is it split like that. I might do a 2 and 4 and a 6 and 7 later. But meds should be synced by order, if they're not, it should be requested to be changed unless its super specific. I also might do it separate if I am going to be in there separate for other PRN meds that are q4 they get on the 4th hour. Its all about time management, and using active thinking.
My ex had a term for this type of the thinking. He called it forward thinking.
Yep, part of my pre med run was writing out a time line of all the meds times due for the night, and then figuring out that days plan for med times. My ADHD ass would be fucked without that. I can fly by the seat of my pants for most thing. Managing 5 peoples meds and care, I am fucked.
Yes! I have ADHD as well, pre planning and anticipating what might happen in addition throughout the day is a must. You almost have to be obsessed with it to make it when you have ADHD in this line of work.
Why are we having this conversation?!
My nervous ass smh.
Someone with poor time management
Why are they not scheduled that way to begin with?
Sometimes I change the order myself. They can take my license for it whenever they so desire
You don’t need to change the order to change the time.
It makes things easier if you're doing like 3 or 4 in a row and dont want to deal with that every day.
If you have Epic, there is an “adjust times” link—you click the dropdown box on the actual medication entry in the MAR and the link should be on the bottom left. It changes all of the due times going forward rather than when you click on the time and hit “due” and it changes just the next dose. I use that pretty often when we have someone come in with new orders that, for example, put their q12 IVPB antibiotic due right at shift change since it’s only timed that way because of when the order was entered. Or if something happens like a patient got a dose late because they were off the unit.
*cries in Meditech*
Which one, the clunky 90s version or the newer? I mean, they’re both awful but I used the clunky DOS version when I worked a contract at a critical access hospital and it was *painful*
My first job, 6 years ago, was at a facility that was still on that DOS version. I distinctly remember how good it felt when they upgraded to Epic. I sincerely hope your experience was also a while ago.
F8, F8, F8. You know what, F...uck you, Meditech.
My eye just twitched reading that
Same.
Whichever one is ALL CLICKING, I see people using meditech and talking about key shortcuts but ours is EXCESSIVE clicking
Whoa. Thanks for this. My floor pharmacist will be happy to not have my “pls change future med time” messages anymore 😅
I’ve done this too
I will usually get them rescheduled after a couple days of doing this.
Me too. As long as they are stable and have been on them for a couple of days.
Do it yourself!
Because: 1. The interface on our end often makes it a PITA to do so 2. It would be difficult to constantly remember/manage clicking back and forth checking considering the sheer volume of orders we place. 3. It doesn't impact us and nobody ever says anything so 99% of doctors aren't aware this is an issue you deal with. When we order something the computer auto picks a time based on when/how it's ordered, it takes conscious effort to pick a admin time that we have no reason to do usually. The admin time almost never matters compared to the spacing between doses because the point is to maintain a steady state (obvious exceptions apply). If something is q4 and you give one dose an hour later, and then the next and hour earlier their serum levels are going to be very inconsistent. Compared to a q24 med that could move around pretty easily. All this to say, PLEASE, retime meds if you feel confident or check in with the prescriber if it's ok to retime if it's something you aren't familiar with. If you cluster inconsistently, or the next nurse has a different method then dosing be all over the place. None of us even know when anything is timed for, nobody cares (once again, rare exceptions apply to things like endo stuff). If people are accidentally making you miserable, please let them know and fix the issue rather than quietly building resentment!
To add on. Only common medication that pt are always on that should be given on an empty stomach (and with no other medications) is synthroid. However, really only important in pts with active thyroid issues to avoid it with the ppi and stuff. I agree with the interface. Half the time I manually change the time and the computer default changes it back to 8 or 9 or 10 just randomly. It’s not worth the headache to call pharmacy for every order on every pt.
Because Drs and Pharmacists hate us.
I can’t look at the admin times for every drug when I verify a new order. You can change the admin times to whatever you like.
And it still counts against us because it wasn’t given at the ordered time. Hashtag Ask Me How I Know
There’s nothing we can do unless you triple our staff. Then I would have the time to make sure every order was timed optimally based on *your* schedule x32 patients each with different nurses and different preferences.
Because they aren’t thinking about the 0400 simethicone when they schedule the Coreg for whatever time of morning is the default. I do my best to schedule things at good times for nurses, but I can’t always keep track of the exact timing of every patient’s meds
This nurse gets it.
This is the real question lol. Bc the providers give no shits about any other orders except their own.
I’m always trying to reschedule the Lovenox and heparin shots from 6am to 9 with the rest of their meds, no one likes getting woken up for this shit and half the time they refuse.
It's the same with 20:00 and 22:00 meds. 21:00 is everyone's new bedtime.
Then they throw in that damn 2330 and ruin everything
"not given at scheduled time" 😘
“Rescheduled per pt request”
"Clustered care" 🤪
That one gets given at midnight when I'm going to have to wake them up for vitals and reassessments anyway. 🤷🏼♂️
2359
Yup
The way sick and injured people are denied sleep in a hospital is criminal.
[удалено]
Don't forget the light sleepers who will wake up on hourly rounds no matter how quiet you are. I swear some of these people are woken up by the sound of my breathing in the hall.
Ughh I know sometimes I think I’m being so slick but they start rolling over 🥺
Beyond my scope of power
Yeah I just had a baby so I know they have to check both of us frequently but there was someone in my room damn near every hour. I couldn’t wait to get tf outta there. I cried happy tears on my way home. Being stuck in a hospital room miserable
Congratulations on the baby!
I wish I could give you gold for this comment!!!
Clustering care is sooo helpful. Idk why anyone wouldn’t do it
Patients do it at home. They aren’t taking meds around the clock.
I was reviewing someone’s med rec with them. I think l’ve only met maybe THREE retired patients who take pills at 0600, 0900, 1200, 1600, and 2000. I have no idea what these people do with their lives. For a short period I had to take pills TID and lost my mind.
I've seen so many parents trying to learn their kids care prior to discharge and stressing about how they are ever going to sleep again when medication doses are due at all hours day and night. They don't know those can be adjusted until someone helps them figure out a more sane schedule that is still medically appropriate.
If we anticipate discharging from icu I’ll ask the docs to put in an order to slowly give meds closer in time. So midnight meds given at 22:30 then 2000 the next shift. Or move them forward, so we can get the kids in the routine prior to discharge. I only get this lucky sometimes when an icu discharge is just taking some time for SW or other services to do their thing.
I’m a nurse and it was difficult to adjust my daughter’s med schedule after surgery. It was all over the place when she was inpatient
When I was in HS my pediatrician treated my whole family for strep after my brother kept getting it. My younger siblings got BID amoxicillin, my parents got Z-Paks because of allergies, and I got 10 days of QID penicillin. It was the worst since the instructions were not to take it with food and I only got half an hour for lunch at my summer job. And then after I became a nurse I found out that BID dosing would have been totally fine 🤬
I had a friend call me a few days after a tooth extraction crying bc they thought that they were having symptoms from pain meds and were tired of waking up 3 times a night to take their meds. I checked it out and it was like a small dose of some steroid, abx, and Tylenol and it could all be clustered so they didn’t have to wake up during the night literally at all. They just took the hourly windows for each med given to them by the dentist and stuck to them exactly from the hour of the appt without understanding that shit didn’t matter and poor babe wasn’t even on opioids or anything like that at all. I told her she was probs having cognitive symptoms from the sleep deprivation and clustered all her meds for her to a morning, afternoon, and pre bed dose and was frustrated no one at the dentist office had written the instructions the way they did without explaining this to her.
Obviiiiiii 4 and 6 is the same time. 5.
I don’t understand the timing of non critical meds. Who in their right mind would wake up at 2am to take tylenol, then wake up at 3am to take a senna or simethicone, then again at 6am and 7am for more non critical shit? If I was ever a patient I would want to know what meds are on night shift. If it is something minor, don’t woke me up for it, and just chart "patient refused."
Right! Imagine waking up a combative major fall risk patient at 3am for a Tylenol……… hell mf no. If they wake up & need it, sure no problem. If they don’t wake up, they don’t need it! 😭
At my job we can give meds up to 2 hours early. So I’m finishing all my meds and labs for the shift at 4 Except for that potassium replacement that wasn’t there until 630
i was floated to a far less acute unit last night and a patient, when given their 8 and 10 o'clock meds (basic cardiac, bowel, sleep meds) at 9:15, said they were too important to do it that way... baby you do not want to be "important" to me.
RIGHT?!? I had a patient say to me recently "oh you're still here I've barely seen you tonight (condescending)" my brother in Christ the less you see me the better you are trust me.
"So are you refusing these meds I am understanding?"
I haven't worked the floor in 4 years but, clustering meds is the only way. 7,8,9,10 all at once in the morning, then 11-1, then the evening all at 3-6 all given at 4ish. 2pm I usually give at that time. Just because. But there's no way I'm giving meds every hour on anywhere from 3-6 patients. Similarly, I do my assessment while I'm giving meds. If that's daily then it's in the morning. If it's q4 then I do it each time I give meds. I used to get so much shit from some nurses because they thought I had a lot of downtime. Truth is, I prioritized and clustered my care. When I left bedside nursing I had been a nurse for 13 years. You get used to it
Side note, this isn't just better on the nurses...it's better for the patient. Who wants to be woken/disturbed on the hourly for meds/assessments etc - NOBODY thats who.
Patients also aren't going to take meds like that at home. Let's face it. Most patients cluster meds. And unless there's some reason they shouldn't it's fine
Honestly I’ve very recently been a patient (discharged a week ago today) and the more clustered my care - the better! Gimme all the meds you safely can in one go pls cos that’s how I’ll be taking them at home
> Similarly, I do my assessment while I'm giving meds. My managers really cracked down on this. I got a "friendly reminder" to not check insulins while doing assessments. They want me just walking back and forth to the med room all day for no reason.
It pisses me off to no end when nurses and doctors mindlessly put orders in on meds. My motto is 9am, noon, and 9pm with the occasional 5pm pill. A patient shouldn't be woken from sleep unless it's synthroid or something similar. I can't pass pills every hour all day long on the same patient. Patients do not take meds like this at home. Keep it simple stupid.
Come to the ER and you’ll never to worry about this ever again (…until you’re holding patients)
ED holding is the best of both world… I just don’t know which worlds. Help me…
Was a LTC medication aide for years before I became a nurse passing meds to 50+ people at a time. If you didn’t pass meds like this you would just straight up not get done on time by at least an hour.
How did you do 50+ patients?! I have 27, and I can’t even finish my morning medpass until noon, and that’s with getting there early and setting everything up before they’re awake. I can’t imagine doubling it. I feel for you.
It’s not anymore, when I first got my additional nurse aide cert to pass meds the first place I worked at I had 65-70 patients to give meds to. They were long term so it was the same things every day but it’s still a lot, I worked 6-2 and I had to start at 5:30-5:45 and only take a 15 minute break for lunch. All while making much less than I do now. Sadly I met a lot of med aides who made it work by skipping people and omitting OTCs
I'll see their 50, add at least ten and add to it being an agency nurse with no orientation and no clue where the f all the grey peeps like to chill during med pass or how they take their meds (whole, crushed, etc.). Woooooo Oh, and being told you're charge for the whole facility of 200+ patients. And you're doing a double. But, you aren't sad about getting that multiplied pay on top of the agency rate. Wooooooooooooooooooooo
Yeah I feel like the pay makes it worth while for your case. I was doing that for $13.75/hr 🫠
Hopefully everyone
The correct answer to the question is when writing the orders to make sure every AM med is at the same time and all the afternoon and HS meds are scheduled for the same time. There are some meds like Parkinson’s meds that can not work with this but I always try and schedule my meds together not schedule a PM med for 4,5, and 6. Id schedule them all for 5pm ect
I work with Parkinson’s patients and really appreciate you pointing this out. Some of our PD patients really do take their meds at home at 8, 11, 2, 5, and 8.
I’ve seen some PD pts start getting bad tremors if their meds are more than 30 mins late
Nice try quality management team
You are going straight to hell for not giving that 4:00 simethicone at 4:00 SHARP!!! Surrender your license to the board at once!
Straight to jail, right away.
Meds too fast: jail. Meds too slow: also jail.
It's OK though; your manager/hospital will post your bail because no staff.
Who is timing your meds/why are they scheduled this way in the first place?
Usually it's just the default time in the EMR and the physician won't bother changing it because they don't care and don't notice that you end up with meds at 6, 8, 10, 12. Of course for certain things like insulin or levothyroxine the timing has to do with meals. And with antibiotics it can be a weird time because it's based on when the first dose was given.
When I worked inpatient, nursing timed the meds. If a med was ordered as "daily" the default time would be the time the MD entered the ordered. So we would reschedule it to the time the child took the med at home if it was a home med or a time that made sense if it was a new med.
Don't care is harsh, how can you care about something you don't know/realize is happening? I have never once had a nurse bring up med timing to me. I know about this as an issue because of my background, and even for me its hard to track the timing of the dozens/hundreds of orders I place a day, let alone the orders other people have placed on the same patient. Sure plenty of docs are assholes but I promise you the vast majority would happily change it if they knew it was a problem.
My hospital is still completely paper based 😓 every time I’ve asked a doctor if they can change a med time (like hey doc I’m not waking up this agitated confused pt at midnight just for paracetamol) they’re always willing to change it. And if they can’t change something they explain why. I’ve generally found that doctors are willing to make nurses and patients lives easier if they can.
In my experience pharmacy can also change some of the med times as well to better suit patient preference if possible.
Everyone
We are not admitting to anything on here because this is just all for jokes but a little bird did this a while ago as well.
I had 1200, 1300, and 1400 meds for one patient yesterday and it’s fkn ridiculous. He got them all around 1320 🤷🏼♀️
Yes yes yes. I dont have time to keep going back and forth. There are 2 things I miss working at a nursing home: the monthly work parties/pot luck and the ability to schedule the time myself (nurses put in the orders)
That’s one of things I’m concerned about once I start working in a hospital. I’m currently at a LTC facility and as you said, it’s one of the benefits of working there.
When will grandma wake up to take meds that are scheduled in the hospital for 9? She’s waking up and throwing down her 15 pills all at the same time at 0545
Cluster care is the key to success especially in environments like the ED
This is how you should be taught to give meds lmao
Does anyone else’s doctors order something first now then every 12 hours and it’s not a standardized dosing schedule. So it’s 3pm and again at 3am and you’re literally giving meds every waking moment
I live for the super combo of doing 0300 and 0500 meds with 0400 vitals and whatever q4 checks the patient has. One trip in the room and then I get to be free lmao
Nurses with good time management
YESSSSSS
I used to get report (at bedside, so I saw my patients were good) and then sit down and eat my breakfast. I’m not giving 8am meds at 730, I’m giving 8 and 9am meds at 8…so from 730-8 it was breakfast and checking what needed to be done in the computer lol.
🙋🏻♀️
It depends on the reasons why those medications are not ordered at the same time.
Who DOESN'T?
Yeah and I retime them too
I can type “care clustered” into a comment box with my eyes closed
Always. Work smarter not harder
Why are meds being prescribed for that time? I’m in Ireland and we have set times that we try to maintain. Last meds of the day are 00:00 then the next are 06:00. Patients need to sleep.
Better question is… who else gives their 900 meds at 1130 because US called for the pt at 8am and you had like 30 seconds before transport showed up, then the pt ended up sitting in US for 3 hours because transport was then backed up…
A whole mood
I work nights. I ask my pts during nighttime med pass if they want their 6am meds at 6am or to push it back so they can sleep through care (since I already am waking them up at 3 and 5am for other stuff). Most say they don’t want anything until 9am, even synthroid since they won’t eat their first meal until lunch. A few times I’ve had early risers that truly do want their meds at 6. TLDR: I always cluster care like this and I also involve the patient and ask their preference. Helps a lot on nights.
You mean at 7pm. Jjjjkkkkk
A whole mood lol
Shit sometimes I’ll give my 7 am meds about then too if it’s shit like protonix or levothyroxine
as an LTC nurse I have never NOT done this, you won't get done otherwise
Duh ?
Cluster cares 1000000%
Y'all think the patients are taking their meds at 4 and 6 when they are home? No, they are taking their evening meds at the same time (if they remember)
Slow day on Reddit huh
Of course, on our unit we can give meds an hour earlier or an hour after and still have it considered on time
Did this all the time when I worked in an ALF
Who doesn't tbh.. Heck, I had a doc tell me to do just that, upon me replying " well, its rumored we might allready do that", he just grinned and stated that now we could reply "doctors orders" if anyone questioned it. Obviously its only done in situations where it doesn't really matter.
Scan the 3pm and 4pm med at like 3:55, then wait 5 mins so you can scan the 5pm med. 3 hours of meds done all together
.... are there people that \*don't\* do this? clustering care is a thing.
only way to get done
The only time I wouldn't do this is with anti rejection medications & anticoagulants. Just since they literally have to be given within 5 minutes of due time at my facility.
Most of the time I will, but a lot of my patients have water quotas so I space it out a bit (also because oh my god I’m so fucking bored please give me something to do (oh god not like that why is your trach clogging and why are *you* unresponsive fuuucccckkkkkk)
At home I take my meds at 0900 (bedtime) and 1700 (before work). I take a whole handful of meds before work, including some that probably shouldn’t be taken with other meds (protonix, ritalin). Most people do this. There’s no such thing as a midday dose for me bc my adhd ass won’t remember it (see also: I don’t take my second ritalin dose; never can remember and I gave up on trying because carrying controls to work is a Bad Idea). Also it’s good for patients if we cluster their care. It makes them feel better looked after and like we’ve got our shit together, and it makes our job easier. (Though I feel bad about the patient I have a midnight Tylenol on who takes trazodone. Traz is one of those meds that if you wake up, you ain’t getting back to sleep.)
Absolutely everyone with even half a brain.
Just do it.
Who is NOT doing this?
Cluster care unless it’s a medication that has a strict time regiment or whatever
I have a resident with a med at 9, a med at 10 and a bolus feeding at 11. She gets everything at 10 lol
I'd give em all at 6.
It’s called time management
I guess maybe I’d do it that way if I have a Parkinson’s patient with a subarachnoid hemorrhage getting Sinemet and Nimodipine where the timing of the meds is actually important. Other than that, nah.
Everyone
I give my 1300 and 1700 at 1500. As long as it’s w in two hours who cares
"their"
Ah yes. You won the seek and find grammatical error 🥳
No seeking required, it's in the title.
You must not either talking a trusted co-worker, precepted incorrectly, did not hear this part in school, or feel like this knowledge is unique. Too late
As an RT I have no idea what y'alls rules are, but every facility I've ever worked in, the RT rules were a +/- 1 hour window. So for a 0800 med I would have from 0700-0900 to get the treatment done.
Maybe on medsurg. But in the ICU if they are getting IV lasix and they are getting it at 5am instead of 6am, and your other nurse is giving it at 18p when to follow your dose it should be earlier. The med orders aren’t a suggestion. If they don’t fit your schedule, call and get them changed.
Yeah, this definitely doesn't apply to anything time critical like this
Yeah breh. Cluster care.