Download CDHA MM 05-020 Medication Administration Times

MEDICATION MANUAL
Policy & Procedure
TITLE:
Effective Date:
Medication Administration
Times
October 2010
NUMBER:
MM 05-020
Page
1 of 8
Applies To:
Holders of CDHA Medication Manual
POLICY
1. Unless otherwise specified by the physician’s written order, medication administration
times are to be consistent with schedule and procedure as outlined in this policy.
1.1. If there is a requirement to consistently administer particular medications on a
different schedule, the Health Services Manager or delegate is to discuss the issue
with the Pharmacy Department.
Exception: In intensive care units, Registered Nurses are to use clinical judgment when
scheduling medication times for patients.
2. Standard once-daily, bid, tid, qid, q4h and q6h medications, etc. are to be administered
within one (1) hour before or after the scheduled administration time. Medications
prescribed q2h and q3h may be given within 30 minutes before or after the scheduled
administration time.
2.1. Anything greater than these acceptable deviations are to be considered a
medication error.
3. Nurses use clinical judgment in deciding when to withhold medications for some side
effects (e.g. Low BP, high BP, intoxication, recent overdose, or some physical illnesses)
but are to document and notify the physician as soon as possible before the next dose
is due.
PROCEDURE
1. When establishing administration times, consider patient requests with respect to
how they want to take their medications or how they take them at home.
This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled and
should be checked against the electronic file version prior to use.
Medication Administration Times MM 05-020
Page 2 of 8
1.1. If the patient’s request or home practices are not congruent with safe medication
practices, assess the need for and provide education as appropriate regarding safe
administration of a specific medication.
2. When administration times are different than the policy, inform pharmacy.
2.1. For areas using pharmacy generated MARs, the nurse completes a MAR action
sheet indicating the specific administration times for the medication.
3. Document every medication given on the Medication Administration Record. If
additional information is required, document on the health record (Progress Notes),
with the reason it was withheld or refused.
4. For antibiotics, antiarrhythmics, theophylline and sustained release or controlled release
products ordered bid, tid or qid administer on the q12h, q8h and q6h schedules
respectively.
5. For insulin and oral hypoglycemics administer no more than one-half hour before
meals.
Exceptions: Patients that are NPO and those that are supported by Total Parenteral
Nutrition therapy as ordered by the physician. In these cases check physician’s orders.
6. When multiple intravenous medications are ordered for one patient to be administered
at the same scheduled time, administer the drugs in the same sequence at each dosing
time. Number medication record entries in sequence.
E.g. #1
gentamycin q8h (0600, 1400, 2200)
#2
metronidazole
q12h (1000, 2200)
#3
ampicillin
q6h (0600, 1200, 1800, 2400)
7. Specify “stat” only for doses that must be administered immediately (e.g. haloperidol
5mg IM stat then 5mg IM/po q4h prn). These may be single doses or the first dose of a
series for which urgent initiation is necessary.
7.1. Use discretion in determining the time between the stat dose and the next regularly
scheduled dose. When the stat dose is given beyond the halfway point of the
dosage interval, the next scheduled dose may be omitted.
Example: A q6h drug order with a stat given at 0930h, omit the noon dose, the next
dose will be at 1800h.
Refer to Procedure #8 for special rules on intravenous antibiotics.
8. When a drug is to be given one time only, the physician writes the order as such to
avoid the urgency imposed when “stat” is written (e.g. warfarin 10mg one dose only).
9. Initiate intravenous antibiotic orders as soon as possible.
9.1. For those ordered q4h, q6h or q8h subsequent doses, administer on the standard
schedule following the half way point procedure outlined in Procedure #5.1.
9.2. For those ordered q12h or greater, do not adjust the subsequent doses to fit the
standard schedule, but give by the clock as ordered.
9.3. Inform pharmacy of the first dose time on these orders by writing it on the
“Physician’s Orders” form.
10. In some cases, a particular medication is best given at a specific time of day or with
respect to empty stomach, meals, etc.
This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled and
should be checked against the electronic file version prior to use.
Medication Administration Times MM 05-020
Page 3 of 8
Example:
Atorvastatin (Lipitor®) once daily is best given with the evening meal
Alendronate (Fosamax®) once daily is best given when first getting up in the morning
and before taking food.
10.1.
In such cases, special requirements/auxiliary labeling may override the
scheduled times as per the policy.
RELATED CDHA DOCUMENTS
Appendices:
Medication Times Schedules:
Appendix A – QEII (except VMB) and Hants *
Appendix B – Dartmouth General, Mental Health, Offenders Health Services *
Appendix C – Tri-Facilities (Musquodoboit Valley, Twin Oaks and Eastern Shore)
Appendix D – VMB & Haliburton Place
Appendix E – Nova Scotia Rehabilitation Centre
* Exception: Does not apply to intensive care units
***
This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled and
should be checked against the electronic file version prior to use.
Medication Administration Times MM 05-020
Page 4 of 8
APPENDIX A
MEDICATION TIMES SCHEDULE
QEII (except VMB) and Hants Community Hospital
* Exception: Intensive Care Units
When establishing administration times, consider patient requests with respect to how they want to take
their medications or how they take them at home. If the patient’s request or home practices are not
congruent with safe medication practices, assess the need for and provide education as appropriate
regarding safe administration of a specific medication.
DOSING SCHEDULE
TIME TO BE GIVEN
Once Daily
0800 OR 1000
Bid
Tid
Qid
q2h
0800 – 2000 OR 1000- 2200
0800- 1600- 2200
0800- 1200- 1700- 2200
0600 -0800 - 1000 - 1200 - 1400 and so on
until 0600
0300 - 0600 - 0900 - 1200 - 1500 - 1800 - 2100
- 2400
q3h
q4h
q6h
q8h
q12h
hs
hs prn (sedation)
Prn
Ac
Pc
with meals or milk
0600 - 1000 - 1400 - 1800 - 2200 – 0200
0600 - 1200 - 1800 - 2400
0600 - 1400 - 2200
1000- 2200
2200 or 1 hour before bedtime unless
otherwise specified
At bedtime prn (after one hour trial sleeping);
may be given up to 0300 only
as specified by Physician (no time scheduled)
½ hour to 1 hour before meals
immediately to ½ hour following the meal
administer according to unit meals times or
with food or milk if other than at meal time
POINTS OF
EMPHASIS/EXCEPTIONS
Oral anticoagulants at 1800
The interval between doses
as well as the maximum
number of doses to be
administered in a given
period of time (e.g. Q4h prn
to a maximum of 4
doses/24 hour period)
see procedure #7 re insulin
This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled and
should be checked against the electronic file version prior to use.
Medication Administration Times MM 05-020
Page 5 of 8
APPENDIX B
MEDICATION TIMES SCHEDULE
Dartmouth General, Mental Health, Offenders Health Services
When establishing administration times, consider patient requests with respect to how they want to take
their medications or how they take them at home. If the patient’s request or home practices are not
congruent with safe medication practices, assess the need for and provide education as appropriate
regarding safe administration of a specific medication.
DOSING SCHEDULE
TIME TO BE GIVEN
Once Daily
0900*
Bid
0900 – 1800*
Tid
0900 - 1300 – 1800*
Qid
0900 - 1300 - 1800 – 2200*
q2h
0600 -0800 - 1000 - 1200 - 1400 and so on
until 0600
0300 - 0600 - 0900 - 1200 - 1500 - 1800 - 2100
- 2400
q3h
Prn
0600 - 1000 - 1400 - 1800 - 2200 – 0200
0600 - 1200 - 1800 - 2400
0600 - 1400 - 2200
0900 – 2100
2200 or 1 hour before bedtime unless
otherwise specified
At bedtime prn (after one hour trial sleeping);
may be given up to 0300 only
as specified by Physician (no time scheduled)
Ac
½ hour to 1 hour before meals*
Pc
immediately to ½ hour following the meal *
with meals or milk
administer according to unit meals times or
with food or milk if other than at meal time*
q4h
q6h
q8h
q12h
hs
hs prn (sedation)
POINTS OF
EMPHASIS/EXCEPTIONS
Oral anticoagulants at 1800
*0800 for Willow Hall &
Emerald Hall
*0900 – 2100 at DGH
*0800 – 1700 for Willow
Hall & Emerald Hall
*0800 – 1400 – 2100 at
DGH
*0800 – 1200 – 1700 for
Willow Hall & Emerald Hall
*0800 – 1200 – 1700 - 2100
for Willow Hall, Emerald
Hall & DGH
*2100 for Willow Hall
The interval between doses
as well as the maximum
number of doses to be
administered in a given
period of time (e.g. Q4h prn
to a maximum of 4
doses/24 hour period)
see procedure #7 re insulin
*0700 – 1100 – 1600 at
DGH
*0900 – 1300 – 1800 at
DGH
*0800 – 1200 – 1700 at
DGH
This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled and
should be checked against the electronic file version prior to use.
Medication Administration Times MM 05-020
Page 6 of 8
APPENDIX C
MEDICATION TIMES SCHEDULE –
Tri-Facilities (MVMH, TOMH, ESMH)
When establishing administration times, consider patient requests with respect to how they want to take
their medications or how they take them at home. If the patient’s request or home practices are not
congruent with safe medication practices, assess the need for and provide education as appropriate
regarding safe administration of a specific medication.
DOSING SCHEDULE
TIME TO BE GIVEN
Once Daily
1000*
Bid
Tid
1000 - 2200
0800 - 1200 – 1700*
Qid
q4h
q6h
q8h
q12h
hs
0600* - 1200 – 1800* – 2200
0600 - 1000 - 1400 - 1800 - 2200 – 0200
0600 - 1200 - 1800 - 2400
0600 - 1400 - 2200
1000 - 2200
2200 or 1 hour before bedtime unless
otherwise specified
At bedtime prn (after one hour trial sleeping);
may be given up to 0300 only
as specified by Physician (no time scheduled)
hs prn (sedation)
Prn
Ac
Pc
with meals or milk
½ hour to 1 hour before meals
immediately to ½ hour following the meal
administer according to unit meals times or
with food or milk if other than at meal time
POINTS OF
EMPHASIS/EXCEPTIONS
Oral anticoagulants at 1700
* 0800 or 1000 at TOMH
* 0800 – 1700 at TOMH
* 0600 – 1400 – 2200 at
ESMH
* 0800 & 1700 at TOMH
The interval between doses
as well as the maximum
number of doses to be
administered in a given
period of time (e.g. Q4h prn
to a maximum of 4
doses/24 hour period)
see procedure #7 re insulin
This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled and
should be checked against the electronic file version prior to use.
Medication Administration Times MM 05-020
Page 7 of 8
APPENDIX D
MEDICATION TIMES SCHEDULE
VMB & Haliburton Place
When establishing administration times, consider patient requests with respect to how they want to take
their medications or how they take them at home. If the patient’s request or home practices are not
congruent with safe medication practices, assess the need for and provide education as appropriate
regarding safe administration of a specific medication.
DOSING SCHEDULE
TIME TO BE GIVEN
Once Daily
Bid
0800
0800 - 1700
Tid
Qid
q2h
q3h
0800 - 1200 – 1700
0800 - 1200 - 1700 – 2100 *
0800 - 1000 - 1200 - 1400 and so on until 0800
0300 - 0600 - 0900 - 1200 - 1500 - 1800 - 2100
- 2400
q4h
q6h
q8h
q12h
hs
Prn
0100 - 0500 - 0900 - 1300 - 1700 – 2100
0600 - 1200 - 1800 - 2400
0600 - 1400 - 2200
0800 - 2000
2100 *
as specified by Physician (no time scheduled)
Ac
Pc
with meals or milk
½ hour to 1 hour before meals
immediately to ½ hour following the meal
administer according to unit meals times
POINTS OF
EMPHASIS/EXCEPTIONS
Oral anticoagulants at 1700
Refer to #2 under
“Procedure”
* 2000 at Haliburton Place
* 2000 at Haliburton Place
The interval between doses
as well as the maximum
number of doses to be
administered in a given
period of time (e.g. Q4h prn
to a maximum of 4
doses/24 hour period)
see procedure #7 re insulin
This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled and
should be checked against the electronic file version prior to use.
Medication Administration Times MM 05-020
Page 8 of 8
APPENDIX E
MEDICATION TIMES SCHEDULE
Nova Scotia Rehabilitation Centre (NSRC)
When establishing administration times, consider patient requests with respect to how they want to take
their medications or how they take them at home. If the patient’s request or home practices are not
congruent with safe medication practices, assess the need for and provide education as appropriate
regarding safe administration of a specific medication.
DOSING SCHEDULE
TIME TO BE GIVEN
Once Daily
Bid
0800
0800 - 1700
Tid
Qid
q2h
q3h
0800 - 1200 – 2200
0800 - 1200 - 1700 – 2200
0800 - 1000 - 1200 - 1400 and so on until 0800
0300 - 0600 - 0900 - 1200 - 1500 - 1800 - 2100
- 2400
q4h
q6h
q8h
q12h
hs
Prn
0400 – 0800 – 1200 – 1600 – 2000 - 2400
0600 - 1200 - 1800 - 2400
0800 – 1600 - 2400
0800 - 2000
2200
as specified by Physician (no time scheduled)
Ac
Pc
with meals or milk
½ hour to 1 hour before meals
immediately to ½ hour following the meal
administer according to unit meals times
POINTS OF
EMPHASIS/EXCEPTIONS
Oral anticoagulants at 1700
Refer to #2 under
“Procedure”
The interval between doses
as well as the maximum
number of doses to be
administered in a given
period of time (e.g. Q4h prn
to a maximum of 4
doses/24 hour period)
see procedure #7 re insulin
This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled and
should be checked against the electronic file version prior to use.