[witchypoo]

where i work the clients also get an average of 19 meds. as i said the beer's rule is mearly a suggestion. i have only one doctor that follows it and unfortunately she only has 4 of my clients. she 23 on my co workers unit and she actually finishes her med pass on time.
I have doctor EGO and he has 12 clients, He has just increased one residents meds to a count of 32 meds, {i think he is working on a pharmacy vacation} on the 9 am med pass. and 3/4 of them are liquid so she has 6oz of meds that you can't mix together and you have to thicken to honey and give her a 1/2 teaspoon at a time and most are bid so it is not like evenings gets a break and i have been trying to get rid of fosamax on this resident she can't sit up with out support, she has to have her meds crushed. she doesn't fit the profile for half the medications, she has an entire half of the bottom draw just for her liquid meds, she really only requires dilantin, colace and lipitor, the rest are supplements and things like prilosec, which she would not need if she was not getting so many meds that upsets her stomach, he has her aricept and namenda, which her alzheimers is beyond because her husband asked about them and now her husband is waiting for a scene like out of awakenings or cocoon, she is like a 6 month old baby, but there is no talking with doctor ego cause you are only a nurse.
I spoke with the medical director yesterday about it and he pulled the chart for a medical review, hopefully now that he is involved things will change. and i won't catch too much grief. but it is routiene for him to review 5 charts from my unit a month and when i am there i stear him to the useless med charts and unsigned and out of compliance charts. the doctors will usually listen to him. He can take away their privalages to practice at our home and 22 others and make life a living hell in 2 of the local hospitals. he is a political md and very well connected and 3 of these doctors are scrambling for admission privalages in the 2 hospitals the medical director has alot of clout in. and they were effected by 2 hospital closures. He also remembers me when i was a snot nosed nurse of 16 running the forensic psych ward at night. and he was the senior resident. he often chides me for not going on since i'm too damn smart to be under some of my supervisiors, and i remind him that i put many things on hold when my son was born. just a fyi my son is severely developmentally delayed.
the director remembered something i once said to him. it was an impossible request and i answered "i'd get to that just as soon as i learned to walk on water" and he looked at me and i then said i'd clairify it for him "as soon as get done with the plagues and parting the red sea." when he was leaving my unit yesterday he told me I'm not making any promises, but i'll try to free you up a little, so start making matoz i'll try to part the red sea.

[JeanineLPN1984]

Talking about the Beers rule, it reminded me in one facility in the early 90's we had a drug holiday on Sundays. The medical director had most of the others doctors agree and the only drugs given out were insulins, dilantins, ABT and absolutely neccesary ones or prn meds( pain etc.). His reasoning was the elderly had impaired renal function and the drugs would work better. The funny thing we did it for a year and a half and I cant remember a time that a patient was harmed because of this.
Anyone else remember this?

[eldragon]

Originally Posted by witchypoo

The beer's rule is a suggestion for doctors to limit meds. that the elderly should have less than 9 meds daily, it is to prevent drug interactions, and that they can do very well with a limited amount of meds. it is a little more complicated than that but that is it in a nut shell.

I have a patient who is a DNR, and he takes 16 meds at 9 am. I just mentioned this to the LPN in charge of infection control and safety and everything (she has 40 years experience,) and she said "So? There's no limit to how many meds he can be given at once. If it bothers you, do half at the beginning of your med-pass and half at the end."

Well, I don't have that kind of time.


I am not getting my 9 ams done by myself during the one hour rule, as it is. But then again, tomorrow starts my 6th day on the job.

But it bothers me to be giving this poor man all these horse pills, when he's sick and has a hard time swallowing, but no swalling problems.

It takes time for him to swallow them, and about 3 glasses of water.

When you consider that 4 or 5 of the pills are vitamins, there is little point in giving them to him at 9 am.

But until I get some time in the place, I'm not going to start making any changes just yet.

After I get comfortable, you betcha I will.

Instead of cutting corners, we should be cutting the prescriptions.

[nurse555]

To the OP welcome to geriatrics. Not all places are like this. A lot depends upon your management team and their focus and views. Some of this might seem kind of excessive it happens a lot but remember who you truly work for and that is the residents because without them you'd have no one to care for. Meds passes are tough even for experienced people who do them often enough to sleepwalk through it. Don't be afraid to speak up because you are the patient's advocate. Believe me this is the only thing that gets me through my day and this is in my opinion the reason for a lot of turnover is the focus on the money and not on the resident.