Clinical Countdown: Administering Meds On Time

Historically, the standard within nursing has been that medication must be given ½ hour before or ½ hour after the prescribed time in order for a medication to be considered “on time”. As we look at today’s nursing practice environment, this standard is becoming increasingly difficult to maintain, as the challenges and complexities of patients and assignments increase.

The Institute for Safe Medication Practices (ISMP) in concert with other agencies has released new guidelines for organizations to consider regarding the timeliness of medication administration. However, CMS and other organizations have not formally recognized these guidelines so following your internal organizational policy is recommended.

First of all, the policies of an individual organization guide the standards for timeliness. In most cases, the 30 minute rule remains, but a number of medications are considered “time-critical” scheduled medications. Administration of these medications at the exact scheduled time is critical to the efficacy of the medication or for the comfort of the patient. Medications in this category include opioids for chronic pain or palliative care and any medication given more than 4 times daily. Medications that are related to meals (either to be given on an empty stomach or with meals) also fall into this category.

The proposed guidelines provide a more relaxed standard for medications given daily, weekly or monthly- these medications should be given within 2 hours before or after the scheduled time.

Medications given more often than daily, but no more than every 4 hours, are recommended to be given within1 hour of the scheduled time.

These proposed guidelines strengthen medication practices for critical medication but allow relaxation in other areas. This proposed change allows nursing to create practice parameters around the most critical medications for our patients.

The full guidelines can be found at www.ismp.org/tools/guidelines/acutecare/tasm.pdf. As always, follow your organizational policy while these guidelines are interpreted or until similar standards are implemented.