Gving all the meds all at once?

Nurses General Nursing

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I've been working as Nurse in LTC for 2 months now. Woot. I'm just concerned about the ways of other Nurses who gives all the meds for 5pm and 9pm all at once?

Is that bad?

I asked one of the Nurses if it is ok. She said.....

It's ok to give earlier if....

1. Vitamins

2. Eye drops

3. Docusate

4. Senakot

You have to give the other medicine on time if

1. B/P meds

2. Insulin

3. Heart Meds

4. Coumadin

5. Dilantin

6. Vicodin

7. Inhalers

8. Sleeping pills

I was thinking, if you guys do agree or disagree on these. It seems so hard to give all the 5pm meds and then later give all the 9pm meds on time. There are a lot of charting to do and Treatment, it so overwhelming.

They told me about the 1 hour before and 1 after rule on passing meds. They even laugh at me because I was doing the "Book Way" that pass all 5pm meds and then later 9pm meds, so I'm doing what they are doing. I felt I'm doing the wrong way, but everyone is doing it and nothing seems to go wrong. Also, I somehow agree about they told me about that certain drugs are ment to give on time, and some are ok to be late. Most of them are doing it for 17 years now and the patients are ok. Any comments to experience Nurses out there?:o

Specializes in Cardiac Telemetry, ED.

Well, yes, giving 9pm meds at 4 is really outside of the allowable window, and if they're not documenting the actual time given, then that's not okay either.

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Thank you for all your responses. Basically, If the State Board is there, they know the drill. (if you know what I mean)

Some Nurses doesn't even look at the MAR because they have been giving the Meds routinely. For me, I can't memorize them all and I still read them because it's the right way, also there might me a change of Order.

I partially agree on giving the Vitamins early. But I'm careful giving the other meds. Because they are considered deadly.

I have this patient who wants all meds taken all at once because the patient doesn't want to get bothered at 9pm. The patient is suppose to take 200mg of Neurontin at 5pm and 9pm. So basically, the patient is taking 400mg all at once. It was already documented though that she does wants to take them all.

I don't think they will get busted, because it's been going on for quite year now. Like what I said, they know the drill.

Then this means they are falsifying documentation, which is immediate grounds for dismissal AND sanctioning by the BON. Do you really want to be a part of that?

As for not checking the MAR, meds will get missed this way. Yes, the residents are on the same meds day after day, but perhaps the doc orders a new med and the nurse forgets to share that info in report. Therefore the oncoming nurse who has the pt's MAR memorized misses the new med, which could be a crucial one, and the pt is in jeopardy.

Bad idea.

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Another thing about memorizing the MAR: when I was a student there was an RN at the LTC where I did clinicals that had a bad habit of giving all the meds to her pts by memory and not telling us. We would have the MAR to medicate our pts, and most of the time we were able to figure out in time that the pt had already been medicated. No matter how many times her NM talked to her, she would not stop.

One day a resident was overmedicated with both an antihypertensive and an oral antihyperglycemic, and she (the pt) got into some trouble because of it....doc was called, report written, etc. The nurse finally learned her lesson and never did that again.

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I wish I know how to explain to you guys how the area of work in LTC. You might have the idea of it, you might have the experience of it. Then why does it sounds like you guys are soo confident passing meds on the first time round?

Give me some tips.

I asked too many questions during my orientation

1. Who are the FSBS residents

2. Who are in Albuterol routine

3. Who is on glypizide meds

There are other things that I asked. At least, I have an idea on who to give meds first.

These are the things I want to hear from you guys. Things I have to know so that I can be sure to be on time. TIPS TIPS TIPS

You keep asking if I want to be part of it? NO!!!

You keep telling me that Facility should have been closed

You keep telling me that they were doing false documentation

do you guys think I don't know that?

Sorry, but none of you guys know how it feels to work in LTC taking care of 32 residents and expect a new nurse to pass meds on time. Well, some of you do.

If you guys know Therapeutic Communication...then go figure.

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We have a 2-hr window to give meds - 1 hr before they are due up to 1 hr after. So, I give all of my 10 pm and MN meds at 11pm. All of the nurses on my unit do this.

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Whoa there, Nellie, back down!

In your OP you described the situation and stated that you had started doing things the way others told you to, then asked for opinions. You said nothing about knowing it was wrong, or knowing that liability is an issue, or that you didn't want to be a part of it. Not one person here bopped you over the head, all we did was point out things that it didn't seem you got from your OP. So sorry that we tried to help keep you out of trouble.

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Wow..I am having the same issues where I work. I know that others give all morning meds (times ranging from 0730-0900) at the same time while crossing off administration times as if they were given at the correct times. This does allow for more time for charting and, hopefully, avoiding overtime-which is ANOTHER bag of worms- but I do not think that is ethical and I can not give meds this way.

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I f you have a good repore with day nurses,get together with unit manager and change the orders with drs consent when the mars are to be renewed otherwise dothe right thing because its you license, nobodys elses I pass my 5pms starting at 4pm and I pass my 9pms starting at 8pm gotta watch out for those nurses trust yourself beat you own drum pass your meds correctly to heck with what they say its not their license dont allow yourself to become entrapped.

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:nono:I f you have a good repore with day nurses,get together with unit manager and change the orders with drs consent when the mars are to be renewed otherwise dothe right thing because its you license, nobodys elses I pass my 5pms starting at 4pm and I pass my 9pms starting at 8pm gotta watch out for those nurses trust yourself beat you own drum pass your meds correctly to heck with what they say its not their license dont allow yourself to become entrapped.

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I think it is important to learn the book way, but I also think the schools are doing a disservice to the students by not at least hinting that book world does not equal real world a lot of the time.

It sounds like the nurses where you are working have a good system down.

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Whoa there, Nellie, back down!

In your OP you described the situation and stated that you had started doing things the way others told you to, then asked for opinions. You said nothing about knowing it was wrong, or knowing that liability is an issue, or that you didn't want to be a part of it. Not one person here bopped you over the head, all we did was point out things that it didn't seem you got from your OP. So sorry that we tried to help keep you out of trouble.

Sorry..but I'm just upset the way things is going on and I don't konw what to do.

But I'm ok now. I did try passing all meds at 5...then I do 9 today...I found out that there are 10 residents that I'm suppose to give meds at 9. So, I'm ok now. I felt that I'm doing the right thing. And the NOC shift nurse notice that all the residents are sound asleep for the first time. I felt good inside after hearing that.

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If the current schedule doesn't work, get it changed. One of our nurses bribed the medical director and the pharmacy consultant with breakfast and they all sat down and went over the med schedules and made a ton of changes that make med passes easier for the staff and more convenient for the residents. They did things like give higher doses BID instead of lower doses QID, got rid of a lot of vitamins and things like that, and changed med pass regulations so that HS reflects the time the resident goes to bed rather than a standard HS time. It took them almost all day to get it done, but our med passes are much nicer now...for both the residents and staff.

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