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.

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 'stat dose' function within HEPMA.

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

If a medication is marked as non-administered in HEPMA you cannot go back and administer at a later time.

If a patient refuses a dose of medication and you intend to offer at a later point, do not chart as non-administered in HEPMA. The Patient Notes function can used to record refused doses, with information noted for other staff to use if needed - examples of how the Notes can be used can be found in the full guidance.

Options for future offered doses are as follows:

If a second offer of medication is refused, mark as non-administered at this point; but if patient decides later, they do wish to take the dose it will need to be re-prescribed as a STAT dose.

To manage the recording of refusal information you can use the Order Notes function. Add an Order Note titled ‘DRUG NAME REFUSED MEDICATION’ when needed linked to the specific medication. Use the same order note to record all dose refusals and related information. As any amendments to the notes then are marked with the last users’ name, each addition should have the nurse’s name added to easily refer to if needed, rather than having to scan the previous versions to see who added the earlier comments.