Medication outwith prescribed times

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Background

Medication must be given as close as is practical to the specified administration time.

Patients in mental health settings often refuse doses or may be off the ward.

This guidance is intended to support nurses to administer medication in such circumstances.

Principles

The following medications should always be given within 2 hours of the prescribed time (not an exhaustive list)

  • Regular opiate analgesics
  • Insulin
  • Regular Parkinson's medicines. Give a close as possible to the prescribed time as possible, a delay of greater than 30 minutes can result in a significant worsening of symptoms.1
  1. If the delayed medication is due to be administered at the next medicine round, seek medical advice to ensure an appropriate dosage interval is maintained.
  2. If the delayed medication includes paracetamol a minimum dosage interval of 4 hours must be observed. Consequently subsequent doses will need to be withheld or postponed.
  3. With medication administered once per day more leeway is possible but contact medical staff for advice.
  4. If a delayed dose has to be re-prescribed use the 'once only' section of the prescription sheet.

Every patient/clinical situation is different. Consider the risk to patient of delayed/missed doses e.g. treatment failure, withdrawal effects etc. Contact medical/pharmacy staff for advice about delayed or missed medications.

The full guidance can be found here.

References

  1. Prevention of Missed Doses. ADTC Safer Use of Medicines group. NHS GGC March 2012
Flowchart

Editorial Information

Last reviewed: 08 October 2019

Next review: 01 June 2022

Author(s): Safer use of medicines group- mental health.

Version: 1

Approved By: PMG-MH

Reviewer Name(s): Andrew Walker, Suzanne Burke