When Medication Regulations Collide With Common Sense
When medication administration was exclusively manual, nurses simply verified a medication as given or noted the actual time the patient received it, with rare entries indicating a justified delay. Typically, medication-error audits excluded being outside the time window described in policy; instead, they focused on the more critical elements of the wrong patient, wrong medication, wrong dose, and wrong route.
With the advent of automated dispensing cabinets, electronic charting, and barcode medication administration, electronic time stamps are recording administration times—whether or not these times accurately reflect actual administration time or manipulated entries. The data then become available both internally and for external review.
Nurses are fully capable of making common-sense clinical decisions about administering medications. In most cases, they know when administration is time-sensitive and when, in contrast, they can use discretion in altering the administration time to accommodate patient activities and rest (as well as the nurse's workload). By common sense, I don't mean to imply these are simplistic decisions, because critical thinking and judgment about the patient's condition guide the nurse's decisions. But there are also simple decisions, such as giving the patient time to finish activities (bathing, toileting, and therapy, for instance) or adjusting for an unexpected event with a patient assigned to the nurse.
Evolution of Medication Administration
When medication administration was exclusively manual, nurses simply verified a medication as given or noted the actual time the patient received it, with rare entries indicating a justified delay. Typically, medication-error audits excluded being outside the time window described in policy; instead, they focused on the more critical elements of the wrong patient, wrong medication, wrong dose, and wrong route.
With the advent of automated dispensing cabinets, electronic charting, and barcode medication administration, electronic time stamps are recording administration times—whether or not these times accurately reflect actual administration time or manipulated entries. The data then become available both internally and for external review.
Nurses are fully capable of making common-sense clinical decisions about administering medications. In most cases, they know when administration is time-sensitive and when, in contrast, they can use discretion in altering the administration time to accommodate patient activities and rest (as well as the nurse's workload). By common sense, I don't mean to imply these are simplistic decisions, because critical thinking and judgment about the patient's condition guide the nurse's decisions. But there are also simple decisions, such as giving the patient time to finish activities (bathing, toileting, and therapy, for instance) or adjusting for an unexpected event with a patient assigned to the nurse.
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