When I have a med pass to do I do one thing first...set my mind into thinking that each individual pass will be a separate event that I concentrate on...that way I am not distracted by thinking of how many I have to do, or that person that gets mad if you are a minute late! That helps! Best to have a clear mind focused on one thing at a time in these cases!
Okay...it is different in all places actually...typically how the meds are dispenced to you. Bubble packs, Rx bottles per pt, Pixis, Pharmacy bringing dailys, and sometimes even bulk bottles for PRN's or common meds used by several pts (typically I see this in LTC). BUT, no matter the method...there is a way to do this safely!
I do my 5 rights (actually there are anywhere from 6-8 dependant on your school of training), and I get my meds and SIGN the MAR as I put them into the cup! I do this so I know what is in that cup incase something distracts me or something comes up...as it always does during med pass...LOL! If someone doesn't take it, or it is dropped, I still have to circle the initial and explain so signing at this point is the way to go (I had someone argue with me on that...I won!). Go through each pill carefully and once it is signed for focus on the next till you are done! Concentrating on each pill for each individual pass is the best way to go...time consuming at first...but I do it quickly now...
For Pixis, I get the pill out, put a small dot in the corner of the MAR square for my initials so I know I got it out of Pixis. Then when I actually pop the pills into the cup I sign. That saves on time for me if I can't find a med in pixis, or forget my place on the MAR...a dot means I already got it out
...the sign and pop is a double check in essence to make sure I did it right!
My rule, if it wasn't popped out or given...never sign. Go back over your MAR during the day to make sure you didn't miss anything, and with this habbit, if there is a missing spot...you will know you didn't give it instead of wondering!
For those that like to do the whole pass and sign later...when I was training med pass I would sneek in and remove a bubble pack...and sure enough...the person passed without it and signed later for it...BIG BAD! Sign as you pop, that way if something is missing you know! (or my fav...spill the cup before you are done...easier to look on the mar that guess that pill!).