CO 13.421 - STANDARD MEDICATION ADMINSTRATION TIMES
PURPOSE
To establish consistent system-wide standards for medication administration within defined time frames (see tables at end of policy).
SCOPE
All Baystate Health Inpatients and Emergency Departments.
DEFINITIONS
1)Medications eligible for scheduled dosing times: Medications eligible for scheduled dosing times are those prescribed on a repeated cycle of frequency, such as once a day, BID (twice a day), TID (three times a day), hourly intervals (every 1, 2, 3 or more hours), etc. The goal of this scheduling is to achieve and maintain therapeutic blood levels of the prescribed medication over a period of time.
a)Time critical scheduled medications: those for which an early or late administration of greater than 30 minutes might cause harm or have significant negative impact on the intended therapeutic or pharmacological effects. Accordingly, scheduled medications identified under the hospital’s policies and procedures as time-critical must be administered within thirty minutes before or after their scheduled dosing time, for a total window of 1 hour.
b)Non-time critical scheduled medications: medications for which a longer or shorter interval of time since the prior dose does not significantly change the medication’s therapeutic effect or otherwise cause harm.
2)Medications NOT eligible for scheduled dosing times: medications that follow clinical practice guidelines or medication orders or individual doses that require more exact or precise timing of administration, based on diagnosis type, treatment requirements, or therapeutic goals.
Refer to medication administration schematic at end of policy.
PROCEDURE
1)Time critical scheduled medications include:
a)Antibiotics;
b)Anticoagulants;
c)Insulin;
d)Anticonvulsants;
e)Immunosuppressive agents;
f)Pain medication;
g)Medications prescribed for administration within a specified period of time of the medication order;
h)Medications that must be administered apart from other medications for optimal therapeutic effect; or
i)Medications prescribed more frequently than every 4 hours.
2)Non-time critical scheduled medications:
a)Medications prescribed for daily, weekly or monthly administration may be within 2 hours before or after the scheduled dosing time, for a total window that does not exceed 4 hours.
b)Medications prescribed more frequently than daily but no more frequently than every 4 hours may be administered within 1 hour before or after the scheduled dosing time, for a total window that does not exceed 2 hours.
3)Medications NOT eligible for scheduled dosing times include:
a)Stat doses (immediate);
b)First time or loading doses (initial large dose of a drug given to bring blood, tissue or fluid levels to an effective concentration quickly);
c)One-time doses; doses specifically timed for procedures;
d)Time-sequenced doses; doses timed for serum drug levels;
e)Investigational drugs;
f)Clinical Practice Guidelines (CPG)
g)Drugs prescribed on an as needed basis (prn doses).
4)Missed or late administration of medications includes:
a)Missed medications: The circumstances for missed administrations can vary greatly. They include, but are not limited to, a patient is in NPO status, the patient is off the unit, or the patient is not able to take medication. In these circumstances the missed medication administration should be reviewed with the provider and/or pharmacy to determine the next time of administration. The nurse must document in the electronic medication administration record (e-MAR) the reason for the missed administration.
b)Late Administration of medications:If a medication is administered outside the appropriate window, the nurse administering the medication must enter a reason for the late administration in the electronic medication administration record (e-MAR).
5)PRN (as needed) medications shall be administered at the intervals or within the parameters prescribed. The first dose shall be administered at the time “prn” parameters are met.
6)Standing orders: medications not given at the standardized administration times includes:
a)Cyclosporine
b)Digoxin
c)Levothyroxine
d)Mycophenolate mofetil & sodium
e)Sirolimus
f)Tacrolimus
g)Warfarin
References: CMS:
CIS Medication Frequencies/Standard Administration Times/Time Zone Period
Frequency / Administration Time2 times a day / 0800, 2000
2 times a day before breakfast & dinner / 0700, 1700
2 times a day with meals / 0800, 1700
3 times a day / 0800, 1400, 2000
3 times a day after meals / 0900, 1300, 1800
3 times a day after meals & bedtime / 0900, 1300, 1800, 2200
3 times a day before meals / 0700, 1100, 1600
3 times a day before meals & bedtime / 0700, 1100, 1600, 2200
3 times a day with meals / 0800, 1200, 1700
4 times a day / 0800, 1200, 1600, 2000
5 times a day / 0800, 1200, 1500, 1800, 2200
Daily / 0800
Daily at bedtime / 2200
Daily before breakfast / 0700
Daily before dinner / 1600
Daily before lunch / 1100
Daily in AM / 0800
Every Friday / 0800
Every Monday / 0800
Every Monday & Thursday / 0800
Every Monday, Wednesday & Friday / 0800
Every other day / 0800
Every Saturday / 0800
Every Saturday & Sunday / 0800
Every Sunday / 0800
Every third day / 0800
Every Thursday / 0800
Every Tuesday / 0800
Every Tuesday & Friday / 0800
Every Tuesday & Thursday / 0800
Every Tuesday, Thursday & Saturday / 0800
Every Wednesday / 0800
Every week / 0800
Monday through Friday / 0800
Acceptable Time Zones for Administration of Non-Time Critical Meds
Meds prescribed daily or longer intervals (i.e. every other day, weekly)
- Given within 2 hours before or after prescribed time
Prescribed time / Acceptable time zone to administer medication
0600 / 0300 / 0400 / 0500 / 0600 / 0700 / 0800 / 0900
0700 / 0400 / 0500 / 0600 / 0700 / 0800 / 0900 / 1000
0800 / 0500 / 0600 / 0700 / 0800 / 0900 / 1000 / 1100
0900 / 0600 / 0700 / 0800 / 0900 / 1000 / 1100 / 1200
1000 / 0700 / 0800 / 0900 / 1000 / 1100 / 1200 / 1300
1100 / 0800 / 0900 / 1000 / 1100 / 1200 / 1300 / 1400
1200 / 0900 / 1000 / 1100 / 1200 / 1300 / 1400 / 1500
1300 / 1000 / 1100 / 1200 / 1300 / 1400 / 1500 / 1600
1400 / 1100 / 1200 / 1300 / 1400 / 1500 / 1600 / 1700
1500 / 1200 / 1300 / 1400 / 1500 / 1600 / 1700 / 1800
1600 / 1300 / 1400 / 1500 / 1600 / 1700 / 1800 / 1900
1700 / 1400 / 1500 / 1600 / 1700 / 1800 / 1900 / 2000
1800 / 1500 / 1600 / 1700 / 1800 / 1900 / 2000 / 2100
1900 / 1600 / 1700 / 1800 / 1900 / 2000 / 2100 / 2200
2000 / 1700 / 1800 / 1900 / 2000 / 2100 / 2200 / 2300
2100 / 1800 / 1900 / 2000 / 2100 / 2200 / 2300 / 2400
2200 / 1900 / 2000 / 2100 / 2200 / 2300 / 2400 / 0100
Meds prescribed more freq than daily but no more frequently than every 4 hours
- Given within 1 hour before or after scheduled dosing time
Scheduled
dose time / Acceptable time zone to administer medication
2400 / 2100 / 2200 / 2300 / 2400 / 0100 / 0200 / 0300
0100 / 2200 / 2300 / 2400 / 0100 / 0200 / 0300 / 0400
0200 / 2300 / 2400 / 0100 / 0200 / 0300 / 0400 / 0500
0300 / 2400 / 0100 / 0200 / 0300 / 0400 / 0500 / 0600
0400 / 0100 / 0200 / 0300 / 0400 / 0500 / 0600 / 0700
0500 / 0200 / 0300 / 0400 / 0500 / 0600 / 0700 / 0800
0600 / 0300 / 0400 / 0500 / 0600 / 0700 / 0800 / 0900
0700 / 0400 / 0500 / 0600 / 0700 / 0800 / 0900 / 1000
0800 / 0500 / 0600 / 0700 / 0800 / 0900 / 1000 / 1100
0900 / 0600 / 0700 / 0800 / 0900 / 1000 / 1100 / 1200
1000 / 0700 / 0800 / 0900 / 1000 / 1100 / 1200 / 1300
1100 / 0800 / 0900 / 1000 / 1100 / 1200 / 1300 / 1400
1200 / 0900 / 1000 / 1100 / 1200 / 1300 / 1400 / 1500
1300 / 1000 / 1100 / 1200 / 1300 / 1400 / 1500 / 1600
1400 / 1100 / 1200 / 1300 / 1400 / 1500 / 1600 / 1700
1500 / 1200 / 1300 / 1400 / 1500 / 1600 / 1700 / 1800
1600 / 1300 / 1400 / 1500 / 1600 / 1700 / 1800 / 1900
1700 / 1400 / 1500 / 1600 / 1700 / 1800 / 1900 / 2000
1800 / 1500 / 1600 / 1700 / 1800 / 1900 / 2000 / 2100
1900 / 1600 / 1700 / 1800 / 1900 / 2000 / 2100 / 2200
2000 / 1700 / 1800 / 1900 / 2000 / 2100 / 2200 / 2300
2100 / 1800 / 1900 / 2000 / 2100 / 2200 / 2300 / 2400
2200 / 1900 / 2000 / 2100 / 2200 / 2300 / 2400 / 0100
2300 / 2000 / 2100 / 2200 / 2300 / 2400 / 0100 / 0200
Time-Critical meds: Antibiotics, anticoagulants, insulins, anticonvulsants, immunosuppressive agent, pain meds, meds for admin within a specified period of time of the order, meds that must be administered apart or optimal therapeutic effect, meds prescribed more freq than every 4 hours
- Must be given 30 min before or after scheduled dosing time