Nursing Home: Tips on how to be faster in med pass?

[itsdebraanne]

I'm a new *new* nurse, fresh out of school. Just passed my boards in march. This is also my first job. Ever.

I work the 7a-3p shift in a nursing home. We have a front and back hall. I'm in the back hall. It's not as busy as the front. I've done clinical in a nursing home before, but I was only looking after two residents. Now I have 25-30 residents.

According to the state, I have an hour before nine and an hour after to pass meds. But in all honesty, I give out my first meds of the morning at 7:30, and I don't finish til about 130. I have about 25-30 residents with meds ranging from 1 to 15 pills. I'm aware of the factors that affect med pass. I.e., emergencies such as falls or incidents, a resident taking more than 5min to take meds, a family call, a doctor wanting updates, new orders to be added or d/c'd. But for the month I've worked there, I still can't get all my meds out before 1200. I've only taken a lunch break four times in the three weeks I've been on my own medical. I'm stressing out cuz I'm worried about not giving meds on time, and we all know the stress on an empty stomach is a no-no.

I've learned some tips from nurses who've worked in my hall on how to be faster in med pass; start with the people nearest the nurses' station. Then start within the back and work your way forward. one of them also told me, which is probably not good. She told me that if they have one little pill in the afternoon, say like a vitamin, it wouldn't hurt to give it with morning meds. So it kinda cuts down my 12 pm meds. But heart meds and things like Plavix and insulin need to stay at their designated times, right?

I have six Accu-Chek PPL and two who need insulin at specific times. Maybe I should remember what time breakfast and lunch are served so I can know where to put my insulins.

Sorry, this is long, and IDK how you can help me if you're not where I work, but if you have any tips, that'd be great.

I just wish they'd let me stay on the floor after shift change so I can learn my resident's meds. During med pass, that's the only thing on my mind: pass meds, pass meds, pass meds. I have learned from repetition but not from memory yet. I know it takes time, but I wanna get my routine down now. There are not enough hours in a day, LOL.

[LPenaRN]

I don't want to be negative, but I'm going to be truthful. Since there is no nurse/patient ratio in long-term care, they will give you a patient load that is outlandish and unsafe. The number of patients they give you typically can not be cared for in a safe manner in an 8-hour period. I typically had 38 patients and always worked at least 2 hours overtime, and that was passing meds quickly. A few of the other nurses typically stayed even later. It's just too much to do in 8 hrs. in a safe manner with the three checks, constant interruptions, and having to crush 50% of the patient's meds and mix them with applesauce. I didn't stay at that job long because I felt that my license was at risk. I also felt that I had gone to school for a long time, and I felt that I didn't go to school to give the kind of care that I was forced to give. I wanted to give far better care than I was able to give. I didn't have time for the extras that I felt these old and fragile patients deserved. While I was leaving, I noticed that they were converting one of the offices into another patient room to accommodate three more patients. I was already maxed out at 38, and now I was going to be expected to take on three more! I knew it was never going to get better. The only way it's going to get better is with better laws protecting patients. Nurses have told me they had as many as 50 patients! They do have the help of CNAs, naturally. But even still, that is a lot of medications to pass in 8 hrs., and I insist this can not be done in a safe manner. I will not put my license at risk because you know sure enough that if an error did occur and God forbid something bad happened to a patient. As a result, the nurse is gonna get thrown under the bus and possibly get her license restricted or suspended. And the facility will continue to do business as usual. (Or after a bad enough reputation, change their name of business and then continue on) But it will be the nurse, the patients, and the patient's family that will suffer. It's absolutely criminal that this is not regulated better. Even the DON's know that this is not safe practice. I had to quit because I felt it was against the oath I took when I became a nurse. I hope this changes, not just for the horrible working conditions this creates but for the horrible living conditions this creates for the people who live in long-term care. They deserve far better.

[aflack41]

"I could go on about an LPN who didn't accept the task I gave her. I'm an RN, so, um, nope, I'll keep this comment short."

What does this comment mean? Um, You are aware that LPNs do not work for RNs, right? I was going to give you some tips until I read that part. Good luck; you have a lot more to learn than a faster med pass.

[RadTEK2RN]

Wow. Being new to nursing but not new to healthcare (an X-ray tech for 20+ yrs), I decided to try LTC and work in a rehab/nursing home. I have to say I love the residents. Most are kind, pleasant and have precious stories that only their nurses and aides hear. Med pass is also impossible where I work. But I do the best I can and stay safe. I figure it's better to be fired for taking too long to pass meds (really? Who is going to fire you for that? They literally beg RNs and LPNs to work there on their marquees!) than to be fired for a med error. I keep praying there will be answers that will work to help residents, the facilities, and nurses. In the meantime, it does help to write down their meds on a brain sheet, so I get more familiar with them and the time they are due.

[Nola009]

Sometimes I had medications spaced an hour apart, and yes, I gave them together. I wouldn't give a beta blocker or even a lipid-lowering agent at a vastly different time, and of course, no doubling up. Insulins need to be on schedule as possible, for obvious reasons. I am new, too, but I have already had a 'seasoned' nurse tell me that her med passes are often (usually) outside of the one hr. window. I think that it's like that in almost every nursing home, unfortunately. I'd say you are doing the best you can and will get more efficient with time. We all know that 'things happen' (calls, falls, codes, other emergencies) sometimes.

[sunshyne17]

Interesting - my situation is similar. I, too, work in LTC in the south hall with 25 residents ?

Hmm. knowing the preference of your residence meds and what is due when helps. I finished my med pass early yesterday, 7a-3p. I know who wants them crushed in what, who needs Accu-Chek at 11, etc., and the chart in between. Yes, this is my first nursing job- been at this place for..a month ?

I don't give my meds early to save time in the afternoon, but I know those that do.

- I start as soon as I get the report (7 or 7:05 - we have to be 10 minutes early).

- I give meds to whoever is in the dining room first because they are right there.

- Grab the meds from the fridge while I am up there, then head down

- Move the cart to the center of the hall, then use that as a base.

- I give to the people I don't have to wait for vitals (although my trainer laughed when I said this).

- Then I give to people whose vitals need to be monitored.

By this time, it is between a quarter of 10 and 1015. Then I take a "break," but I am really charting while snacking. Take out my insulins, and then at 1100, start checking my blood sugars. Then the next med pass is coming due, so I start doing those simultaneously once 1200 rolls around.

The hard thing I have is squeezing in time for an assessment. I always have to go back and listen to lung or bowel sounds when I'm charting. I don't want to just write what the previous person did w/o checking.

I got laughed at for that too!

[musiQsoulbrother]

Interesting topic of discussion. I will leave my own tips now, and hopefully, it will help someone.

I work at an LTC with about 28 residents. My med pass starts at 9 am and should end before 12, which is lunchtime. Most times, I am minutes before 12 (on a bad day when I am being interrupted a lot)

with me, it's all about finishing on time and going home; this includes a med pass.

How to finish med pass quicker

• Get to Work 30 minutes early.
• Take a look at the schedule rooster and take note of who you will be working with, the can's that are working with you, and when at your unit. Make sure I get the report and know who I am writing to; make a separate note so you can visit that during my break time (yea work while you eat, LOL)

2. We get to work early so I can pre-check the residents that need vitals for meds, get a (working B/P machine) and check the resident b/p while I do my rounds to get that out the way, or according to your facility policy, you must make sure your CNA's have your vitals ready on time.

3. I count my narcs while they are still in the bag; I hold them in there with one hand, pull them out, observe them, and write on them. ( this makes it faster for me, it might help you, too, IDC)

4. G tubes can be a little tricky; some are backed up, and some residents are uncooperative, so you must figure out a working system for you; you should be able to press the hold flow button, give meds and be back before the machine starts beeping. Message me if you need more info on this one [phone]

5. MOST IMPORTANT; the med pass

• With The med pass, like previously mentioned, stock before you start, it cuts down on time wasted. So make sure you are well stocked with whatever you may be running out of.
• On the first drawer of the cart, I clear up the center space in the front center, enough space to fit a resident's batch of blister packs.
• This way, when you need to look through it for a resident's medication, it is all faced in front of you, you just flip through it with one hand, and when you get to the right med, you turn it faced down sideways.
• Put your water to the far right or left and your cups to the opposite end.
• Place your MAR in the center, or if you are lucky, you are using computer documentation (we are not so lucky yet!)
• Open the MAR
• Find a resident
• Read the medication needed.
• Flip through blister packs with one hand, and when you get to the med, you turn that blister pack faced down sideways.
• Or if it is a stock med, you should find it (it is usually in the first drawer too),
• After you have found and placed all the needed meds on the table or turned sideways down, then you can start preparing the medications for that resident.
• Afterward, you then sign the blister pack; if it's a new blister pack, you must include the date and your initial; if it's not, just write the data.
• After giving the med to the resident, return and sign your MAR for giving them.

It seems a little confusing, but that's my system of a med pass in a nutshell; it's effective. But with anything in life, there is variance, things that we cannot control. We try to avoid distractions unless it is an emergency.

To avoid med errors

• Make sure you sign the Narc book as soon as you pop the narc. (very important), don't wait until after.
• AFTER preparing a resident's medications from the blister pack, as we return the batch of blister packs into the cart, TURN IN BACK SIDE FACING us, so we can only see the white; this way, we can minimize the margin of error by a lot.

During your break

At the cafeteria, sit back with your 24 reports and start writing on them for the residents that are on it; also, write on the nursing report as soon as you can, and flag them until you get your vitals to fill on it.

That's my little 2 cents. I hope someone got something from it. Best of luck, y'all, we nurses are at a great disadvantage, and it isn't getting any easier; gotta get back in school and upgrade that license. And no, I do not feel safe.

Sincerely,

Samuel from Brooklyn

[RPnurse]

I am a new nurse too. I work with an agency, and I get assigned to at least three different LTC. My struggle is recognizing the residents when I have to work day or evening shifts. I usually have a minimum of 32 residents on day or evening shifts and 60 (2 units) to 92 (3 units, on different floors) residents. The good side about working at night is that I don't need to give meds to all of them, the bad side is when there are residents that I have to monitor their vitals every 2 hours, and these residents are not in the same unit or same floor. Even working at night, I barely have time to go to the washroom or even drink water sometimes. I ended up getting confused about which floor I was in or which unit when there were three units assigned to an RPN at night. Different facilities have different ways of organizing their med carts, some alphabetically, some by room number. I depend on the PSWs to tell me who is who. So far, I have been working at two different facilities for a month and still not able to recognize ALL of them. I can only recognize max five residents. I tried giving meds to those I am 100% sure I know, but it still doesn't work, and so far, I still finish giving morning meds at almost 12 noon. I don't rely on the pictures of the residents on their MAR because, usually, it's not updated. I tried giving meds by room number and was still late on meds. I read all the comments here, and I will try them, and hopefully, there is a way I can cut down my time on giving meds, esp in the morning when each resident has tons of meds.

[Bhannah94]

This was so helpful to read! I'm at a facility where I had 40 hours of training in 4 days and was just on my own for the first time tonight. Having to get 53 residents' pills done in a 5-hour shift is crazy! (A charge nurse helps with some when she can!) I felt terrible when I came home - as I stayed 1 hour more & felt like I missed something. But I needed this reminder that it'll be okay! I made a cheat sheet with how people like their pills if they're on thickened liquids and what they get (oral meds, eye drops, etc.) so I don't miss anything & get done as fast as I can. I felt so overwhelmed and embarrassed leaving late - now I know it'll be okay! I also feel bad as this is my first nursing job ever & I have lots of questions on how to do things. My school never even taught me to give injections! Time will make me more familiar with everything. (On another note - I feel bad for the residents because everyone is so busy & burnt that they don't visit).

[kbvn3210]

I am going through exactly what you're going through, except it takes me even longer to pass meds. I had bad experiences with two of my preceptors. The third is much better, and I've learned so much, but she is pressing me to get faster. She passed meds by memory. She has 30 patients and passes their meds in two to two and a half hours. I saw her make a mistake, and I thought, my lord, how many mistakes has she made in the two years she's been there? After watching her process, I realized she followed the med card, not the Mar. I don't know if that's the safest practice. I'm thinking about looking for another job with less patients. You seem to be handling things much better than I am. Don't ever feel bad about your time. It's unsafe and unethical to expect one nurse to give 30 patients medication and care in two hours. There should be a federal law limiting the number of patients one nurse can have.

[Jeliptical22]

Hi there!! I stumbled upon this post tonight as I am in the same exact boat as you. The only difference is that I start my first day on the cart tomorrow. I am worried sick over it. I only had four days of orientation, and I have 20-plus patients tomorrow. About half are Diabetic. I have a peg and IV and have not done many. They showed me, but I am still fuzzy with it. I am definitely psyching myself out. I am a brand new RN as well and feel so lost, like I didn't learn much in school. I keep thinking of the little tricks they showed me, but still, I realize that it is going to take a while to speed up and get used to my patients. They have me working on the rehab side, which is not permanent residents. I have only worked that side once. Please tell me you have gotten more confident and better at doing this job. Any words of advice would be greatly appreciated. I feel so lost and praying it all runs smoothly. I am just going to pretend to be confident!

[katie0303]

I'm a new nurse the good part about it is that I have 13 years at the same facility. I am a nurse, so I am familiar with the patients. I do the BGM first, then the blood pressure. Give them their insulin when you know they are getting ready to eat. Don't get stressed out. You will get faster with time.

[katie0303]

I do exactly what you are saying. It takes me almost 30 minutes to stock my cart. I have to find some of my supplies, and my cart is not in order when I get back the next day. I have 30 patients I give meds to. And I double-check the meds I give, so it takes me a while to do my med pass.