Why
Don’t They Give Me My Medicine on Time?
By: Jane Backer, DNS, RN
Associate Professor,
Individuals
with Parkinson’s disease (PD) and their families know the importance =
of
taking Parkinson’s drugs on time.&nb=
sp;
Unfortunately, when the person with PD is hospitalized or admitted t=
o an
extended care facility, the person often has difficulty receiving his/her
medication on time. There are several reasons for why this may occur. The n=
urse
may not know to administer the medication at the exact time ordered. Nurses
generally have an hour window of time for administering medications. For example, if a medication is to=
be
given at 9 AM, the medicine could be administered anytime between 8:30 and =
9:30
AM. This is considered “=
;on
time” by the nurse. It’s highly possible the nurse’s care=
is
guided by this rule without knowledge of the need for patients with PD to
receive their medicines at the =
exact
time indicated.
Informing
the nurses about the need to administer the medicines at the exact time ord=
ered
seems simple so why do we continue to experience difficulty with getting the
medicines on time? Nurs=
es
provide care 24 hours a day and 7 days a week so the chance that you will h=
ave
the same nurse day after day and shift after shift is highly unlikely. Additionally, staffing problems may
occur so nurses may be brought in from another unit in the facility or an
outside agency. All of these
factors make it difficult to ensure that the nurse administering care to the
person with PD is informed of the need to administer the medications at the
exact time ordered and not sometime during the usual hour time frame. Another major reason for not getti=
ng
medications at the exact time ordered is the nurse’s workload. The expectation that the nurse wil=
l administer
the medicine on time is unrealistic if the nurse lacks the necessary resour=
ce
to meet the expectation, such as time.&nbs=
p;
Acutely ill patients may take priority for the nurse’s attenti=
on. The number of patients the nurse is
caring for may also
act as a barrier to
administration of medicines at the exact time ordered. This is especially a problem in ex=
tended
care facilities where a certified nursing assistant may be the person
responsible for administering medications to as many as 40 patients.
What can I=
do
to prevent or decrease the problem of receiving my medicines at the exact t=
ime
ordered?
=
1.&n=
bsp;
On admissio=
n to a
hospital ask to speak to the registered nurse in charge of the unit or the
Clinical Nurse Specialist, if available. Express your concern about getting
your medicines at the exact time ordered and ask the nurse to develop a plan
that will facilitate the person with PD receiving the medications at those
times. Remember the nurse considers “on time” to mean any time
during the 1 hour time frame. Be sure you emphasize the exact time ordered. If
you are admitted to a nursing home, ask to speak to the Director of Nursing=
and
primary care provider (which is often a Nurse Practitioner working with an =
MD).
Both of these individuals can assist with developing a plan and then reinfo=
rce
the need to follow the plan with the staff.
=
2.&n=
bsp;
A family me=
mber
can visit occasionally at the planned medication times. If the drugs are not
administered at the appointed times, a nice but firm complaint can be commu=
nicated
to the appropriate persons.
Typically weekends are the most challenging times to ensure that
patients with PD receive their medicines on time. The staff changes on the weekend a=
nd
frequently staff workload increases, both of which can contribute to the
problem, therefore it is important to communicate to the weekend staff the =
need
to administer the medication at the exact time ordered. Remember the nurse generally follo=
ws the
hour window of time when administering medicines.
=
1.&n=
bsp;
In most
healthcare facilities medicines are given at 9am, 1pm, 5pm, & 9 pm and =
as
noted previously, the person administering the medicines follows the policy=
of
giving the medicines sometime during the hour time frame. Sometimes there are so many medici=
nes to
administer and/or frequent interruptions, the medicines are administered ev=
en
later so it is possible that a person with PD could receive a 9 am medicine=
at
10 am but be sitting at breakfast expected to eat at 8 am. The 9 am medication time is genera=
lly
the busiest time of the day. Since patients with diabetes are typically giv=
en
their insulin prior to meals, you could suggest that the person with PD be
placed on a schedule similar to patients with diabetes rather than the 9 am
schedule. This would increase=
the
likelihood that he/she would be able to eat his/her meal.
=
2.&n=
bsp;
Ask the nur=
se to
highlight the medicines and administration times to draw attention to the
specific time. Another sugges=
tion
is to write on the patient’s medication record in large letters the n=
eed
to administer the medication at the exact
time ordered.
=
3.&n=
bsp;
Ask for an =
order
to administer Sinemet “as needed” or prn. Then if the medicine is off schedu=
le,
the “as needed” medicine can be given to ensure the person with=
PD
is able to function.
=
4.&n=
bsp;
Ask for a r=
oom
location that makes it easier for the nurse to administer the medicines on
time. For example, you do not want to be at the end of the hall if the nurse
begins administering medicines at the opposite end or has to travel a long
distance every time she delivers the medicines.
=
5.&n=
bsp;
If the pers=
on
with PD is alert and able to manage his/her medications, ask the nurse to
obtain permission for the patient to keep the medicines at the bedside and
administer his/her own medications.
This is probably the best solution but often is not possible because=
of
patient limitations.
I wish I could say th=
at there
is an easy answer to the problem of patients with PD getting their medicati=
ons
at the exact time ordered. The
previous suggestions addressing the problem may or may not be successful.