Methods of Dispensing Medications

Responsibility:

The pharmacist is legally responsible for dispensing medications. This responsibility includes labeling and relabeling damaged labels. Licensed nurses cannot legally label medications.

The most common method of dispensing medications in modern hospitals is a combination of a unit dose and individual supply system. The pharmacist dispenses a 24 hours supply to a drawer labeled for an individual patient.  Most of the medications are packaged as individual doses. This system is not absolutely an unit dose system because the individual packages are not always the exact dose ordered by the physician.

Some hospitals have self-medication systems. The medication is dispensed to the patient’s room and the patient takes his/her own medication. Unless this is practiced on your nursing unit, you should always assume the patient may NOT have medications in the room unless there is a physician’s order for this.  Home medications should be sent home or to the hospital safe for storage. This practice avoids “double dosing”.

Common “Routine Times” for Medication Administration:

Most often the physician does not specify an exact time for medication administration. The order only includes bid, tid, qid, q6h, q4h, daily, ac, pc, or hs. Individual nursing units or hospitals establish routine times for medication administration.

  Examples:

bid = 0800, 2000

tid =  0900, 1300, 2100

qid = 0900. 1300, 1700, 2100

q6h = 0600, 1200, 1800, 2400

ac & hs = 0730, 1130, 1630, 2100

pc & hs = 0900, 1300, 1800, 2100

ac & pc medications may have to be adjusted from the exact scheduled time to fit the time the meal trays actually arrive on the unit.

qd = 0900 or 1700

Daily coumadin is often given at 1700

bid diuretics are given at 0900 and 1700

Types of Drug Orders

Single dose:

STAT – give immediately; a physician has a responsibility for not overusing STAT as an order. Stop what you are doing and give the medication.

ASAP or Now – as soon as possible. This means finish what you are doing and then give the medication promptly.

Specified time. May be used for a scheduled surgery or other procedure when the medication needs to  

take effect before the procedure starts.

On call from OR –- Usually when the OR case is scheduled

to “to follow” another case. The anesthesiologist will call the nursing unit to request administration of the preoperative medications

Multiple Dose:

Most scheduled medications are to be given indefinitely.  That is, the order stands until the physician discontinues it.  Some orders have written limitations for duration.

Q4h X 4 days

Q6h X 10 doses

Give Medrol dose pack

Others, by hospital policy, have automatic stop dates.  The MAR has a column to indicate automatic stop dates.  Narcotics and antibiotics are the most common types of orders with automatic stop dates.  You should inquire on your individual unit about the policy concerning Automatic Stop Dates.  On some units, the doctors order has precedent over hospital policy and the drug is not stopped until the physician has been notified.

PRN

A prn order gives the nurse leeway to administer the medication when the patient needs or wants it.  Safe administration of prn medications requires that the nurse exercise judgment within the parameters of the physician’s orders. 

ERRORS:

In the event of errors of administration:

  • MAINTAIN YOU INTERGRITY

  • Assess the patient
  • Report the error / notify your instructor
  • Initiate an incident report (with your instructor’s help)

Incident Reports

These are not part of employee personnel files, are not used for punitive purposes against employees or nursing students.

These are the hospitals method of tracking errors and incidents for the purpose of analyzing the system and implementing measures to prevent errors and incidents from occurring.

The report should contain:

  • Description of events (factual, not opinion, not conclusion, not legally incriminating--- Just the facts.)
  • Patient assessment
  • Actions taken
  • Notification of physician
  • Physician’s assessment

SAFETY MEASURES:

  1. Report concerns about your patient’s medication orders to your instructor or the RN on the unit.  The pharmacist and /or physician may need to be consulted when drug dosages or frequency of administration seem inappropriate.
  2. Determine if the patient is allergic to any drugs.
  3. Be knowledgeable about all drugs given
  4. Verify an order with the physician if it is unreadable.
  5. Double check the drug dosage if the patient questions it.
  6. Protect the patient from harm by using the six right every time you give a medication.