Timely administration of medication is one of the challenges identified by nurses discussing the ANA Corrections Nursing Scope and Standards of Practice at the Updates in Correctional Health Care Conference held in May 2012. Medication administration is one of the aspects of practice that distinguish the specialty of correctional nursing.
Many correctional facilities have established a one hour window before or after the designated time for medication to be administered. For example, if 9 am is the time for the morning dose, administration is timely if given anytime between 8 am and 10 am. Medication not given within the designated window is considered a medication error and requires contact with the prescriber to adjust the plan of care.
The Institute for Safe Medication Practices (IMSP) published guidelines in January 2011 for timely administration of scheduled medications in acute care settings. These can be accessed at http://ismp.org/Tools/guidelines/acutecare/tasm.pdf. The IMSP recognized that not all medications require exact timing of doses and suggested a more reasonable approach to timeframes than the “30 minute rule” proposed by the Centers for Medicare and Medicaid Services (CMS).
If you struggle with timeliness of medication administration you may want to consider using the approach recommended by the IMSP summarized here.
Time Critical Medications
- Identify the medications used at your facility that are time critical or should be administered within 30 minutes of the scheduled time. This might include all QID medications, insulin and antidiabetic agents, and medications that must be administered apart from other medications. These might also include medications that are time critical only for certain patients or certain conditions.
- Develop a method to administer time critical medications within the window. It may be that patients are admitted to an inpatient unit or are co-housed so that these medications are administered before other medications. Another option is to establish a time critical medication line that differs from the time for administration of medications that are not time critical.
Discussion: the number of patients on time critical medications should be small given that these are correctional settings and not acute care facilities. If there are a lot of QID orders or other medications that are identified as time critical, nursing
must collaborate with the facility medical director to develop alternatives for appropriate treatment of these patients.
Medications which are not Time-Critical
- Daily, weekly or monthly doses do not have a timeliness window if given on the day it is due. It has long been recommended that the dose be timed to some other event (e.g. after breakfast or the morning med line) to help the patient remember. These patients could be scheduled on a separate med line so that they do not slow down med line for other patients or scheduled among all the med lines. Weekly or monthly doses could be scheduled as clinic appointments rather than on med line.
- Medications administered more frequently than daily but not more frequent than every 4 hours (e.g. BID, TID, q 4 h) should be given within the window of an hour before or after the scheduled time.
Discussion: The majority of patients on medication in a correctional setting should be on daily dosing schedules. It is worth looking at patients on multiple daily schedules and asking prescribers to consider less frequent dosing. Often prescribers are unaware of the challenges nurses have with timely medication administration and are willing to alter orders. Patients also complain about long waits in med line and may be more willing to adhere to less frequent dosages.
Still having problems meeting timeframes for timeliness? More information about medication administration can be found in Chapter 4: Safety for the Nurse and the Patient in the Essentials of Correctional Nursing. Another resource is a newsletter Lorry wrote about managing the risks of medication administration which can be downloaded at http://www.omnisure.com/newsletters/Medication_Newsletter.pdf
We will continue this discussion in a future post. Please let us know by writing in the comments section of this post the challenges you have experienced with timely medication administration?
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