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

  1. 2
    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 clinicals in a nursing home before but i was only looking after two residents. now i have 25-30 residents.

    according to state, i have an hour before 9 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. im aware of the factors that affect med pass. i.e., emergencies such as falls or incidents, a resident take more than 5min to take meds, family calls, doctor wants 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 4 times in the 3 weeks i've been on my own medcart. im stressing out cuz im worried about not giving meds on time and we all kno 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 with in 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 12pm meds. but heart meds and things like plavix and insulin need to stay at their designated times right?
    i have 6 accucheck ppl and two who need insulin at specific times. maybe i should remember what time breakfast and lunch is 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 repition but not by memory yet. i know it takes time but i wanna get my routine down now. there are not enough hours in a day lol
    RadTEKemtRN2B and pinkiepieRN like this.
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  4. 16 Comments so far...

  5. 0
    Wow, I'd like to see responses to this! I'm about 4 weeks into LTC and thank goodness I'm still on orientation because it takes me forever to pass meds to only 16 residents! Like, I start off fine but the last 4 patients seem to take forever, no matter how I prioritize it. I've tried the "easy" residents (walky talky) first and I've also tried the crushed in apple-sauce residents first, with almost the same results!

    Something that just dawned on me today was to make sure all of your meds are in alphabetical order in the cart, so you can just go straight down the kardex and straight across the drawer. Also, make sure your cart is stocked before your shift starts (if night shift doesn't do it for you).
  6. 2
    One month is hardly any length of time to become speedy!!!! It takes time, esp because EVERYTHING is new and is also time-consuming (phone calls, MD interax, families, emergencies, etc, and esp eye gtts and GTubes). And all the BP parameters you have to do.... And what does the stock Colace bottle and stock EC baby aspirin box look like? It takes time, even for us ancient ones!

    One thing concerns me about your post - your comment about giving meds by memory? You're giving meds acccd'g to the MAR. I'm guessing you just worded your post funny. Just don't get into a habit just giving meds by memory. Things change and then there'll be errors. I know there are nurses who probably do give meds by memory. Bad habit.

    Remember your training's good technique. And there's no award or prize for 'Fastest Med Pass Nurse'. No plaque to hang on a wall!

    You'll be OK - but since you did ask for tips >>>>>> Make sure your med cart is super-well stocked, you know all your supplies!
    That's where I lose time, like I need Glucerna or tissues, lancets, preps, etc. PP reminded me that I also lined up my med cards, not alphabetically, but by the order on the MAR. Granted someone else may pop back THEIR med cards into my sequence, but by and large, they would be pretty much in order.
    Pat2012 and VivaLasViejas like this.
  7. 1
    Certain meds do have to be given at certain times but if you have a lone vitamin I would see about changing the time on it. We can change the times provided the doctor didn't give specific orders like give at bedtime, etc. I regularly go through meds as I'm passing to see what could be moved to a more convenient med pass time and then go thru the proper procedure (which sometimes does involve asking the doc and getting an order).
    amoLucia likes this.
  8. 0
    Quote from dolcebellaluna
    Like, I start off fine but the last 4 patients seem to take forever, no matter how I prioritize it. I've tried the "easy" residents (walky talky) first and I've also tried the crushed in apple-sauce residents first, with almost the same results!


    Something that just dawned on me today was to make sure all of your meds are in alphabetical order in the cart, so you can just go straight down the kardex and straight across the drawer. Also, make sure your cart is stocked before your shift starts (if night shift doesn't do it for you).

    Dude, same here! I know you're supposed to leave work at the door and vice versa but when I get home I can't help but think who should i give meeds out to first and in what order? ANYTHING can happen during med pass. one of the LPNs told me to act like one of those things will happen during med pass. And maybe that'll help speed things up. idk..


    Quote from amoLucia
    One month is hardly any length of time to become speedy!!!! It takes time, esp because EVERYTHING is new and is also time-consuming (phone calls, MD interax, families, emergencies, etc, and esp eye gtts and GTubes). And all the BP parameters you have to do.... And what does the stock Colace bottle and stock EC baby aspirin box look like? It takes time, even for us ancient ones!


    One thing concerns me about your post - your comment about giving meds by memory? You're giving meds acccd'g to the MAR. I'm guessing you just worded your post funny. Just don't get into a habit just giving meds by memory. Things change and then there'll be errors. I know there are nurses who probably do give meds by memory. Bad habit.


    Remember your training's good technique. And there's no award or prize for 'Fastest Med Pass Nurse'. No plaque to hang on a wall!


    You'll be OK - but since you did ask for tips >>>>>> Make sure your med cart is super-well stocked, you know all your supplies!
    That's where I lose time, like I need Glucerna or tissues, lancets, preps, etc. PP reminded me that I also lined up my med cards, not alphabetically, but by the order on the MAR. Granted someone else may pop back THEIR med cards into my sequence, but by and large, they would be pretty much in order.

    Okay, so it's not uncommon for med pass to take forever. Got it. I'm not trying to be the fastest med pass nurse lol. I'm just having trouble finding my judgement on when to take a break off the floor. it seems crazy for me to never have time for a break in the 3 weeks i've been on my own cart. But i guess that's a nurse's life story right? like how nurse's will be lucky if they find time to pee..
    another thing i have trouble finding time for is charting on the ones who need it q shift. I have three. we chart by exception at my facility. it doesn't seem bad but the other day PT wrote in like 7 new orders that i needed to transcribe.
    my staff manager keeps reminding me YOU CAN'T DO EVERYTHING ON YOUR SHIFT. somethings you have to pass on.
    im the kind of person who will bend over backwards for my patients. i feel bad passing on my tasks during MY shift to the next nurse. 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.


    And passing meeds by memory. yep okay. bad me. won't do it.


    Quote from IaCountryGirl
    Certain meds do have to be given at certain times but if you have a lone vitamin I would see about changing the time on it. We can change the times provided the doctor didn't give specific orders like give at bedtime, etc. I regularly go through meds as I'm passing to see what could be moved to a more convenient med pass time and then go thru the proper procedure (which sometimes does involve asking the doc and getting an order).

    basically i just want to try and finish med pass so i can find time to do important RN things, discharge/admit/readmit residents, charting, etc. and also LEAVE ON TIME. i've stayed 4 hours after my shift one time to finish charting. my work doesn't like paying me OT lol.
    but thanks for the help guys!! (:
    i hope this weekend will be better.
  9. 0
    LTC has a wicked learning learning curve, as you are quickly finding out! Suggestions made above about making sure your cart is stocked will definitely help. It will save a lot of wasted time looking for supplies and stocking as you go. Also as you learn your residents routines it will be easier to prioritize who gets meds when simply based on who is in their room and easily accessible. It will really slow you down having to track residents down to give them them their meds. The suggestion of changing med times for those single meds also makes good sense, just make sure there is not a good reason for that med to given separately i.e a possible adverse interaction with another med. I know you probably don't want to hear this but...if you decide to stay in LTC get used to a med pass taking more than the 2 hours allowed; if it is done right it is about impossible to pass meds to 20+ people in 2 hours, especially with all the interruptions. On the plus side, don't stress that too much as I have been in LTC for over 15 years and haven't ever heard of a nurse getting in trouble for going over 2 hours for a med pass or state citing the facility for the same. Good luck and please let us know how it is going!
  10. 2
    You will definitely get the hang of it. I don't work LTC(never did) but I remember when I first started at the job I am at now(I started out in oncology) thinking that it would be time for afternoon meds by the time I finished giving out the morning meds! I don't have to tell you oncology patients tend to be on A LOT of medications and our hem/onc unit is very big, people were constantly getting admitted and discharged and while I didn't have 15+ patients to give meds out to it still took up a lot of my time. Once I would get used to my patients routine they would be discharged(or very sadly, they would die). Plus on the oncology unit pain is a big issue, so I was constantly being called away to give patient so and so their PRN Dilaudid or Morphine...OR patient so and so's PCA was empty and needed to be re-filled..and well you get the picture. When I first started out I couldn't even think of a time that I wouldn't get the hang of it...and guess what...I got the hang of it. Just like when I was first starting out I never thought I would get the hang of starting an IV...now some of my co-workers come to ME if they have a patient who's a hard stick and they can't get the IV started.

    I used to get the easy patients out of the way first. The patients that were cooperative, just needed their morning GSCF shot, their dose of oxycontin etc. Some nurses do it the opposite way and do the patients that take up the most time first. Everyone is different. But just remember, you will get the hang of it, of course it's going to take you some time at first. Try to remember your patients habits...I had a patient that would ONLY take his meds with red Gatorade...that's it..nothing else..not orange Gatorade, no water, not ginger ale..but red Gatorade. So you can be sure I remembered his red Gatorade BEFORE I started...having to run and get it while it seems like it would just take an extra minute...all those extra minutes turned into extra hours and fast!
    RadTEKemtRN2B and newrnltc like this.
  11. 3
    You save time when you finally get all you residents special likes memorized. Like Mr. Jones hates taking pills but if you offer it with OJ he is a lot more willing to take them or Mrs. Williams likes her meds right after breakfast otherwise she tends to get a grumpy stomach before she eats and then won't eat anything at all. After awhile you just get it down. I have a couple do not do's that some people may tell you saves time. Don't sort out meds in a med cup ahead of time, even if you initial the cup with the residents name it always is a catalyst to a mistake. Always check the MAR even if you have had the same resident with the same meds for 5 years. Unless your on duty 24/7 you never know when a med may change. And if someone's advice seems wonky follow your gut because chances are its not a good idea.


    I always stayed on track with flow sheets I made at work and leave at work to not violate any privacy laws. Eventually I was able to complete morning meds for 30ish patients in the time frame given.
    SJVCatholicGirl, newrnltc, and amoLucia like this.
  12. 1
    Never memorize meds but double check to see if orders were changed. And yes know your patients habits especially in LTC, sometimes reasoning or logical discussion (i.e. you need this for your infection) will not help. If you know so and so doesn't take his meds unless he's in a certain chair, with a certain snack and the sun at a certain location in the sky do not bother trying to get him to take it because you will delay everyone else's meds. Make a note and go back to him. As time goes on you will get to know your residents, love most of them like family and you will be much more efficient. Sometimes following the text book: crushing each pill in a separate cup and mixing it with a separate spoonful of applesauce is too idealistic.. also it can get applesauce spit in your face (personal exp lol). Use your nursing judgement. There is no cutting corners but increasing efficiency is always possible. Every minute you shave off adds up and before you know it you saved an hour! I was also able to pass meds to 30-40 res within the designated times. It's definitely possible!
    Last edit by newrnltc on Jun 15, '13 : Reason: spelling
    SJVCatholicGirl likes this.
  13. 2
    Insane. I had this same type of job but with max 18 patients, I made a med error (ya think!!) and was thrown under the bus (not fired but I quit soon after). Insane. Not safe. Do you feel safe? It is not fair to those residents that the ratios are so bad. I feared for ny license every shift. I really admire any nurse that can make it work.
    RadTEKemtRN2B and MAtoBSN like this.


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