Do you Pre-Pour? Is it legal?

CHATSDALE · Nov 12, 2008

i know that nights are hard in this respect because your busiest time comes at the end of a shift because of glucochecks, meds, charting etc but this is a bad habit to get into..start as early as possible but try and not get into the habit of cutting corner..it will get to you sooner or later

NurseKatie08, MSN · Nov 12, 2008

Hello everyone -
I'm a new grad, and just got my first nsg job in a LTC facility. I've been there 6 weeks; I'm working overnights. At this point, I still have a 'mentor' (I'm using the term loosely here) - she is someone I can go to with a question, but basically, I have my own side of the unit, am responsible for a med cart, and am passing meds for 22 patients. At night, our only scheduled med pass is 6am, which is when, imo, you are at your most tired (shift ends at 7:30) and you are trying to get everything done so you can count narcs at 7 with the new shift and report off, etc etc.
After the first night, I asked the mentor if it's okay to 'pre-pour' the meds. I was thinking that you know, I have all this down time between pretty much 0100 and 0400 in which to get ready for the 0600 pass. She replied, "Absolutely - I can't tell you to do that, but we all do, and it helps quite a bit. Although, if a supervisor comes in, throw them out and start over."
Of course I gathered from this that it's against policy. However - why? Is it against JCAHO rules? And do any of you do it?

I'm also a new grad. I gather that it's against the rules because you should be pouring the meds by looking at the MAR or eMAR, doing your three checks, and giving them to the res/pt etc. If you pre-pour and lock the meds back up in your cart, who knows what will happen to them. I don't pre-pour, no matter how crunched for time I am, because it wigs me out. I don't like the thought of giving one of my pts something that has been out of my sight. (Yes, I also do stand right there and watch them take their pills.) Only thing I have ever done was save a Zyprexa that I had popped for a pt with agitation who turned out to be sleeping at the time (I didn't dare wake him and increase his agitation--as the saying goes, let sleeping dogs lie.). I held on to it so as not to waste the med bc it was getting low, and didn't end up giving it, so I told the oncoming nurse & disposed of it at the end of the shift, because I didn't expect her to feel comfortable giving something she hadn't popped herself.

I've seen people pre-pour, but wouldn't do it myself.

SuesquatchRN, BSN, RN · Nov 12, 2008

I was taught at my first LTC night shift job to pre-pour AM meds. I was also taught other very bad habits that I then had to break, including pouring from memory.

If any agency were to come in and find meds pre-poured in your cart the facility would get cited. It's a big no-no and I would not start getting into bad habits.

Best practice is best practice, even if it takes a little more time.

Good luck. HTH.

:)

LogCabinMom · Nov 12, 2008

Thanks, everybody. I've had my doubts about this place from the beginning, and this is just one more nail in the coffin. I'm applying for other jobs.

CoffeeRTC, BSN, RN · Nov 12, 2008

LogCabin....you will find that everywhere. 22 pts is an excellent ratio for an 11-7 shift...heck, any shift in LTC. Just keep that in mind,

If that is the only issue with the place.

TheCommuter, BSN, RN · Nov 12, 2008

Pre-pouring is certainly not legal. However, it is a commonly utilized shortcut in nursing homes where the patient loads are extremely heavy, the staffing is too lean, and the supplies are missing. I have had up to 70 patients by myself on night shift (10pm to 6am), and only 8 hours to accomplish my numerous tasks. Did I use shortcuts? You betcha!

Long Term Care Columnist / Guide · Nov 12, 2008

Pre-pouring is a bad habit and will get your facility cited. Worse yet, it raises the risk of med errors because at some point you WILL get flustered, hurried, distracted etc., and you WILL grab the wrong cup of pills and give them to the wrong resident. I've done it. Now that I'm back in LTC, I'm slower than many of the nurses and CMAs who pre-pour, but I'd rather be slow and do things correctly!

Just my two pence worth.

TheCommuter, BSN, RN · Nov 12, 2008

I have my own side of the unit, am responsible for a med cart, and am passing meds for 22 patients.

22 patients during night shift is a light load in the nursing home setting, and a ratio that many LTC nurses can only dream about. To be perfectly honest, I'd keep this job and ride the wave to see where it leads.

Flare, ASN, BSN · Nov 12, 2008

About the closest i will get to pre-pouring is to separate the meds in the individual patient drawers and simply check that the meds are there and move them closer to the front of the drawer or maybe put them all still wrapped in a paper med cup. But I still check them when it's time to administer - it's more so to make sure i don't have any missing meds than for convenience sake, though.

LogCabinMom · Nov 12, 2008

Ok, so then - do any of you have any tips on how to do your med pass more quickly? I do realize I'll get faster with time, but I am also one of those who tries to be extremely thorough. I do the 5 rights for everyone.

I've been wondering if I should go through the mar at the beginning of the shift and make notes on who gets what at what times - kind of making a schedule for myself. OR, should I just go through the MAR at the scheduled med time from start to finish?

BradleyRN · Nov 12, 2008

In LTC, you have to do things you wouldnt ordinarily do. Sure presetting meds is against state regulations, but if you have just under 40 pts, by not presetting them you will go way over the two hour allotted time to give them. No matter how you slice it, some rules are going to be broken, and truly we have done this to ourselves by accepting assignments that are too big. So the question becomes, which rules do we break? By presetting the meds, you do all your bending at once, instead of bending at every room, and that certainly saves your back a whole lot, as well as allowing you to save an hour on your med pass. On the other hand, dont preset and your med pass may wind up over 3 hours long. Either way you have violated the regulations, but with the latter some of your patients had to wait 3 hours to get their meds. Thus, by using your downtime to prepare for your med pass, you benefit both you and your patients.

Nonetheless, no one should preset meds before they know all their patients and their meds. Once you are seasoned a bit, put the patient's initials (or names) on the cups, and stack them in your med cart. However, if you are lucky enough to have a med pass that can be completed on time, then there is no need to preset.

In LTC, nurses are forced to break so many rules that i could spend the whole day listing them. Any nurse who has more than 30 patients and thinks they are following the rules, please step forward and i will help you end that illusion.

Shame on LTC. And shame on us for letting them get away with it.:)