What is the window for passing medications before it is considered late? And how late before it’s a medication error? (read previous l was Suspended to hear about my first medication error).
We all know that a Colace scheduled at 0900 but given at 0945 shouldn’t be a med error. No possible harm could come from giving a stool softener forty five minutes after it was scheduled. And common sense says Colace is not in the same category as insulin as far as time sensitivity.
However, the CMS window for all meds used to be 30 minutes before or after, for a window of one hour.
Sometimes, with five or more patients, and constant interruptions, that just isn’t possible, for even the most organized nurse on a calm day. Rushing to give meds for fear of making a medication error can lead to shortcuts and unsafe work arounds.
Lab called a nurse I was working with once for a critical lab value. I overheard the nurse say “Not now! I’m passing meds!” While most nurses would not respond that way, she was clearly feeling pressured.
So to rectify the situation, in 2013 CMS lifted it’s thirty minute rule and established new guidelines, dividing scheduled medications into time-critical and non time-critical categories. While CMS defined the categories, it mandated that facilities define which category different medication classes fall in by policy.
A. Scheduled Medications
Scheduled medications are those which are ordered to repeat in a repeated cycle of frequency, such as every day, every eight hours, every four hours.
1. Time-critical scheduled medications
These meds must be given within thirty minutes for a window of one hour, or else it causes harm or is sub-optimal in some way. These are defined by facility, but examples may include:
- Medications prescribed more frequently than every four hours
- Scheduled (not prn) opioid pain medications
2. Non time-critical scheduled medications
Medications where early or delayed administration up to one or two hours will not cause harm or be sub-optimal.
a. These meds must be given within one hour before or after for a two hour window.
Medications which are ordered more frequently than daily, but not more frequently than every four hours. This would include your bid medications.
b. These meds must be given within two hours before or after the scheduled time for a four hour window.
Medications which are ordered daily, weekly, or monthly. This would include your Colace.
B. Non-scheduled medications
By contrast to scheduled medications, non-scheduled medications are not ordered to repeat.
These are defined by facility, but examples may include:
- Stat doses
- One-time doses
- Loading doses
- Prn doses
Furthermore, CMS said that facilities must identify parameters within which nurses are allowed to use professional judgment regarding the rescheduling of missed or late doses, and what actions should be taken when scheduled meds are not given within the window. This includes all reasons, such as patient off the unit, patient refusal, missing meds, or other reasons.
Medication errors that result from missed or late administration must be reported to the provider.
Finally, policies must outline guidelines for the timing of new medications which are initiated between standardized dosing times.
This article links to First Day off of Orientation
As always, know and follow your facility’s policies. Hope this is helpful! Until next time friend,