Pre-pouring or Preparing, That is the Question

EMI23 · Feb 17, 2010

hi, in our institution, we use the same method especially since in most areas we have to pass medication in the tears (cell to cell). In the long run, its less time consuming- i know that in some areas in out institution even if they have pill lines, they will pre-pour in the beginning of the shift so that we could be prepared when the inmates line up. hope this is helpful but if you have any specific questions- ill be glad to answer the best i can.

spongebob6286, BSN, RN · Feb 17, 2010

in our facility we have the IM lined up in front of our carts. some of them were paranoid that you are giving them the wrong meds so we have to show it to them.

EMI23 · Feb 18, 2010

your right, we get allot of that but most of our units are lock up units so even if we let out one tear at a time they there is still danger. I have done both pill pass and pre packing, my post does not have any other option. narcotics are usually crushed and the package is placed in the envelope- as for the other meds if you have a consistent problem with the inmates questioning you then can go through the hassle of writing the pill name and the # of pills, that should not be necessary but it helps...

Guest371144 · Feb 18, 2010

As long as you only give out meds that you yourself prepare, you should be OK. However, you are right to be concerned because there is more opportunity for error, especially if you don't label the packages clearly with name and ID#. You should not administer medications that another nurse has prepared nor prepare more than the immediate med pass. Kudos for your caution....always a good thing!

deyo321 · Feb 20, 2010

We prepare ahead in the office.

1. My time on the floor with an officer is shortened, benefits corrections and nursing.

2. Much less distraction while pulling meds. I have enough to focus on on the floor.

It was unusual for me when I started, because it is so ingrained that you can't do that. But safety dictates. I believe it actually enhances accuracy related to #2 above. Also I see the meds one more time when I pour them in the applesauce, even though they are crushed, I know the colors and amts, etc. that should be there.

nursejudy15209 · Mar 15, 2010

Hi,

I think the idea of pre-pouring meds is realistic and saves time. I have accidentally gone onto a pod and discovered that the book from which I was dispensing, was not filled with evening meds. So, rather than leave and go back to the med room to pour that book, I poured while the line of people waited (not very patiently). This is time consuming, by the way.

We also use envelopes and put the pills inside. As for labeling them, well that simply won't work with over 300 people. I would never get my meds poured if I had to label each and every envelope with name, DOC #, and medication inside. And for some I might need up to 3 envelopes because all the names of medication wouldn't fit on one envelope anyway.

Here's what I do. I pour from looking at the MAR, I check for accuracy as I sign for each med while the inmate does his own check. The water goes into the cup along with the pills. Sometimes I do the pouring, sometimes I hand the pitcher through the opening in the divider and the inmate pours the water. Our particular facility does not use applesauce -- we "float" meds in a cup. Of course they moan and groan that the pill sticks to the bottom of the cup, but they soon figure out that if they want that pill, they just might have to put their finger into the cup to get it "unstuck".

Every now and again another med nurse will help pour meds. I check for accuracy in exactly the same manner as if I were the one doing the pouring. I believe that the inmates know their meds and if they discover a mistake before they start to drink, it can be corrected. Of course there is always someone who says (after they drink the water and meds -- "Hey nurse, you forgot my ********" Now, there is no way to correct that because they have already downed the meds and I can't tell. Maybe they just wanted an extra dose or maybe it was omitted accidentally -- either way it's too late to make any type of corrections. Once the pills pass into their mouths, it's a done deal.

And that's how things are done at the ACJ.

UNCRatDog · Mar 20, 2010

Hi! I work at a county jail. It is impossible at my facility to push around a med-cart and my whole company pre-packages meds. I too questioned this when first hired and actually called my board of nursing and was informed that while the board of nursing does cover correctional facilities that there are also separate governing boards for corrections that do in addition to the state boards of nursing. They told me that it is perfectly legal to pre-package meds in the correctional setting or I wouldn't have done it. We go up into a guard tower...up a few stairs and open a tiny door in the wall. The inmates come up one at a time to the window and the meds are put in their hand from the envelope that we pre-package them in. They have that chance to make sure their meds are right and swallow them at the window. They then open the mouth, pull open the cheeks and lift the tongue so we can make sure they swallowed their meds. My jail is pretty small, but on each envelope we write the block number, inmate name and each medication. For the medication, we write the name, the dosage, and how many pills it should be because the guards pass night meds and that way they know how many pills should be in the pack. Yes, it is legal for guards to pass meds. Our jail is so small the county does not pay for a night nurse. I have a blog that I wrote out our procedures for the day and a very informative jail nursing video if anyone is interested. In addition to jail nursing, I do medical writing and post many helpful nursing and general medical articles there. It's http://ivathecitizenjournalist.blogspot.com. Just scroll down a bit for the jail nursing video and article. Good luck!

Erikadawn RN · Mar 26, 2010

Wow, you get applesauce. We place meds in envelope with building,time,i/m name and we walk from building to building.we were pushing the cart but it fell over on 3 nurses.

christi britt · Mar 31, 2010

Yes, most VA hospitals do this same thing. They have a premade med cart that they take when they make rounds. Of course this cart is locked when not in use. The only concern would be possibly giving the wrong meds or envelope to the wrong pt. This is where computerized verification would be handy. This is a new process that is slowly making its way into the medical setting.

Orca, ADN, ASN, RN · Apr 6, 2010

I have used this method before. Since I was giving out meds to nearly 400 inmates in 16 different units in one pill pass, this was the only practical way to do it. Otherwise, pill call would have lasted about five hours.

t.adamson · Jun 25, 2011

Ooo I like this topic:) It takes about 2 hours to do pill line at a 2200 inmate prison. Is that normal? We have at Least 3 windows. The inmates wait outside:) hehe We don't prepour for regular population/Unless we're on lockdown. But in regards to special needs unit which is at the minimum side we do. But then I just read somewhere on the Dept. of Health website for Washington that it's a violation to prepour? So I'm having my supervisors look over it and some of my co-workers.