[cotjockey]

If we get the order after 1700, we ask the doctor to order that it can be initiated the next day...if it needs to be initiated right away, we call the pharmacist at home. It doesn't look good if we have to chart that a medication is unavailable, but it is much better than not putting something on the MAR right away.

We all know that it is inappropriate to sign the MAR before the med is given...it is also inappropriate to wait and sign everything at the end of the shift. I will never understand why we don't just try to do things right all the time so we aren't fumbling to do things right when state is there.

[CapeCodMermaid]

I've worked at several places with several different pharmacies and they all say there are two correct ways of doing the med pass: Pour, Give, Chart OR Pour, Chart, Give. As long as you are consistent you're okay. I used to pop the pills into the cup,initial as I popped, then give the meds. If the person refused, I'd circle the initial and write the reason for refusal on the back. If some of the meds had parameters, I'd pop them in a separate cup. I've seen nurses initial everything after the pass was done and I've seen them initial everything before they started the pass....yikes.
As for writing the meds on the MAR, we write them when we get the order. If we know it's an unusual medication we'll add "start when available" to the order.

[loriangel14]

I just graduated last year and we were taught to initial as we pour each med. If a med is refused we put an R in the MAR and circle it. We also document refusal of meds.

[husker_rn]

We document them on the MAR before we can note that the order; noting indicates everything is done and handled. Thta's our fcility's slant on it.

[OldMareLPN]

Great, great, great.

Dot when you pull the med, initial when you gave the med.

Perfect.

[cotjockey]

I have no issue at all with initialing when you pour...I do have a major issue with sitting down and signing everything at the begining or end of the shift. We use a bubble pack system and we have a lot of problems with blanks on the MAR, so the DON started having us initial the bubble packs too...takes twice as long and is a pain in the neck.

[CapeCodMermaid]

You'd better check with your pharmacy consultant. I seem to remember some reg about writing on the pill cards. At one place where we had lots of blanks on the MAR, we'd have to swap books with another nurse and check each other's books for blanks.

[Nascar nurse]

My surveyors expect to see pour, pass, chart. Considered falsifying records if charted before actually administered. They said it is the MAR - meaning "adminisration" record not the MPR "poured" record. Turned into another big stinking nightmare. URG!

[sfn2008]

How many people in these LTC's actually NEED a nurse to do the med pass? How many patients in the hospital NEED a professional to do a task that they do for themselves at home (and very well I might add). What do you think the percentage is of patients that actually need nurses to hand them their routine meds?

OK, I am thinking outside the box again. But.. hey.. we have a nursing shortage for a reason... technology is out there making the Super Market check out fast and efficient.. but who is out there trying to keep nurses at the bedside?

Passing medication is not what makes me a Registered Nurse. RN's go to College to learn critical THINKING skills.. and yet our day is filled with tasks that many of our patients can actually handle better than we can.

Are there any places in the world that THINK OUTSIDE THE BOX?

[CapeCodMermaid]

Originally Posted by sfn2008

How many people in these LTC's actually NEED a nurse to do the med pass? How many patients in the hospital NEED a professional to do a task that they do for themselves at home (and very well I might add). What do you think the percentage is of patients that actually need nurses to hand them their routine meds?

OK, I am thinking outside the box again. But.. hey.. we have a nursing shortage for a reason... technology is out there making the Super Market check out fast and efficient.. but who is out there trying to keep nurses at the bedside?

Passing medication is not what makes me a Registered Nurse. RN's go to College to learn critical THINKING skills.. and yet our day is filled with tasks that many of our patients can actually handle better than we can.

Are there any places in the world that THINK OUTSIDE THE BOX?

I run a 135 SNF. At any given time, there are fewer than 15 people in the building who score a 0 on the cognitive section of the MDS. The majority of them take more than 10 medications a day--many of them new medications which have parameters associated with them. These people would not be able to take their medications safely.
I'm not disagreeing with you in theory....that's why many states allow for med techs. Massachusetts does NOT. And with the raising awareness of the potential for catastrophic results from medication errors, I don't think we will have them any time soon.
And, given the fact that many of these patients see the doctor only once every 60 days and then for only a brief time, I would say this gives the NURSE plenty of opportunity to use her critical thinking skills and not just blindly pass out the medications.
Maybe in the future, we'll all have bar codes on our foreheads and we can scan ourselves and have the correct medications come down a tube. But for now, and since the last time I used one of those bar code scanner at the supermarket that mistakenly indicated my 1/4 pound of snap peas cost $102.00, I'll stick to having nurses pass meds.