Gving all the meds all at once? - page 4

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... Read More

  1. by   CoffeeRTC
    My other take on this is that just because one person does it doesn't make it right. The OP is right to question the other nurses practice. Working only on the weekends, I get weird looks all the time when I try to give residents their meds on time or a "huh, no one gives me pills twice ( the 5s and 9s). I would never ever double up on doses. Meds are timed for a reason.

    Just a question for the PP and maybe this should be another post....do you really time your qids for 9, 3, 9, 3? That seems a bit harsh to be waking up folks at 3am? How do you others do it? We do a 6, 12, 6, 12 schedule and only for a few meds that must be given that way. Please remember this is LTC question.
  2. by   Spidey's mom
    Quote from softstorms
    Sometimes Hs meds are different things to diffent pts. What you do is get to know the pt. then ask the Dr. to change the med time. I have found in long term care that most pts. go to bed right after dinner. That would be around 7 pm. If the have a Hs med of colace at 9 pm, then ask the Dr to write it for earlier. Most of the Dr's I work with are more than glad to change times to fit the pts. convenience. This can help you keep within the guidlines.
    Thank you. It is as simple as that.

    We are trained professional nurses - not robots.

    Speak up!!


    steph
  3. by   Jo Dirt
    Quote from lvlissl2ebecca
    I did not mean for that to be taken so literally. Of course I know they are not "My" CNA's and dont work "For me".. but I figured you would catch the meaning behind it. That was a little too hostile of you for my taste.
    I apologize (and I sincerely mean that.) I understood what you meant, I just had a knee jerk reaction because that is something that has always drove me around the bend when I hear it.

    It just sounds demeaning to me to refer to anyone as "my"...aaahhhh!!!


    You are absolutely right, I was way too hostile and I am sorry about that.
  4. by   SuesquatchRN
    We had leeway to set a lot of times ourselves.

    If we had someone who needed to be given meds off-times for specific reasons we documented the heck out of it. For example, I had one man who would refuse and everyone, down to the DON, knew the objective was to get his QD meds into him whenever.

    When changing times, though, be careful of interactions. Somewhat innocuous seeming things can be contraindicated - iron inhibits Synthroid, for example, and the ubiquitous 6 a.m. tummy meds usually deleteriously interact with, well, everything.
  5. by   middlekane
    Quote from lvlissl2ebecca
    If I were to go to my DON or the doctor and say hey.. lets not give any medicine after 7 or 8 pm.. they would probably give me some long answer why that won't work or something about regulations and think obscenities in their head. Sure, we could make QID medicines BID with larger doses, but the doctor orders it the way its ordered for a reason. I worded the "Thats what they're here for" part wrong. ... A lot of residents get QID medicines which are spaced 6 hours apart for a reason. Standard time for that is 3, 9, 3 and 9. If I could go with out waking a single resident up, believe me I would..
    Give it a try. I bet that if you do, they would be impressed by your initiative. Sure not every med pass at 9 pm could be changed, but a lot of them can be. The docs don't often think about the timing of the meds in terms of it fitting into the patient's life, meals, sleep timing, etc. Believe me, I'm an NP student and one of my rotations was in a nursing home with a geriatric NP. It wasn't something we would really think about, but a couple patients, the nurses came to us and pointed out that the timing was a problem and we were able to drastically rearrange and simplify the pass. Give it a shot, pick out a patient where it's a real problem and discuss it.
  6. by   Spidey's mom
    Quote from middlekane
    Give it a try. I bet that if you do, they would be impressed by your initiative. Sure not every med pass at 9 pm could be changed, but a lot of them can be. The docs don't often think about the timing of the meds in terms of it fitting into the patient's life, meals, sleep timing, etc. Believe me, I'm an NP student and one of my rotations was in a nursing home with a geriatric NP. It wasn't something we would really think about, but a couple patients, the nurses came to us and pointed out that the timing was a problem and we were able to drastically rearrange and simplify the pass. Give it a shot, pick out a patient where it's a real problem and discuss it.
    I like your style.

    Work with the pharmacist, the docs, the other nurses to come up with a system that makes sense.

    This antiquated system needs fixing - "The emperor is naked".

    steph
  7. by   Spidey's mom
    Quote from Suesquatch
    We had leeway to set a lot of times ourselves.

    If we had someone who needed to be given meds off-times for specific reasons we documented the heck out of it. For example, I had one man who would refuse and everyone, down to the DON, knew the objective was to get his QD meds into him whenever.

    When changing times, though, be careful of interactions. Somewhat innocuous seeming things can be contraindicated - iron inhibits Synthroid, for example, and the ubiquitous 6 a.m. tummy meds usually deleteriously interact with, well, everything.
    This is why it is essential to have the pharmacist and docs work with you.

    steph
  8. by   lvlissl2ebecca
    Quote from middlekane
    Give it a try. I bet that if you do, they would be impressed by your initiative. Sure not every med pass at 9 pm could be changed, but a lot of them can be. The docs don't often think about the timing of the meds in terms of it fitting into the patient's life, meals, sleep timing, etc. Believe me, I'm an NP student and one of my rotations was in a nursing home with a geriatric NP. It wasn't something we would really think about, but a couple patients, the nurses came to us and pointed out that the timing was a problem and we were able to drastically rearrange and simplify the pass. Give it a shot, pick out a patient where it's a real problem and discuss it.
    I appreciate your post. I think I will give it a try as I thought about this thread last night and what I said about them thinking obscenities and then I thought... why do I care? Atleast I can give it a try. So, thank you for your insight. I don't mean to offend anyone when I tell the truth and say these things. I don't like the way that long term facilities work at all. a 31:1 nurse/patient ratio tops it all off. No, they aren't in critical condition, but all of them are demanding and time consuming in their own way. I do try my best to do everything the way it is supposed to be done, and with all of the things that go on in one 8 hour shift its hard to even get a moment to think about that (which sadly enough is low on the priority list with falls,neurochecks, meds, and treatments, doctors etc). I know I'm preachin to the choir.. my point is I may just go in on one of my days off and go speak to my DON about this.
  9. by   SunbabiLPN
    I remember all too well what it was like to be a new nurse in LTC. I was also an agency nurse so I always was assigned the worst halls. It takes time to learn how to manage your time efficiently it doesnt happen overnight. Doing things by the book does bring great satisfaction as you said when the noc nurse commented on all your patients resting soundly. There are shortcuts that you will learn along the way but it is never safe to alter med times. Soon you will be able to do a million things at once and you will be done with your work, charting and treatments on time. Until that day comes just breathe in peace and breathe out stress. Your day will come trust me.
  10. by   gt4everpn
    Well I;m an LPN new to the LTC and it is a lot to give our morning and afternoon meds to 40 patients + other tasks!! I try to do things as properly and efficiently as I can! I usually give everything within an hour before or after the ordered time, meds like BP, pain, etc.. are important!! I can understand giving 5pm and 9pm meds at once, but then again I'm cautious in saying that it is right!! For instance what if the order states Calcium 600 mg at 5pm and again at 9pm, I wouldnt want to give someone 1200mg at 9pm, if I can give them their second 600mg 9pm dose at 8pm before they go to sleep I will instead of double dosing them!! Remember double dosing isnt good!! Its bad enough the elderly have poor pharmcokinetics in general and they are more sensitive to drugs! This is unrelated to meds, but I remember once there was an order to call the M.D for a FS >200 before starting this patients GT feeding, I took it and it was 205 or 208(cant remember), I called the M.D and things were resolved but a nurse I was working with told me that I didnt have to call the M.D and to let a 205 FS slide! I didnt want to ! Maybe I'm too fresh outta school, I just feel more secure doing things the right way, Hey what ever happened to CYOA??
  11. by   The Hated Consultant
    First and foremost, you need to look at policy and procedure. One of the first things a surveyor usually asks for on the entrance interview is a med pass schedule. If you're giving medications scheduled for 1700 at 0900, those will be medication errors related to time. And too, your more alert residents will tell on you if you're being observed: "Where's my _____? I always get it now."

    The nurse you spoke to is right...with some medications, like the Senokot, it usually doesn't matter what time you give them. But your nursing judgment has to come into play. You don't want to give something like Lasix too late in the evening, for example; when it kicks in, some older people may try to get out of bed without assistance and fall. I always cite a concern with Digoxin being given after 1800. Most old folks go to bed earlier than the average bear, and if there is an immediate problem with a decreased pulse rate, how will you know? Antacids can interfere with the absorption of some medications, so you need to space them. Synthroid should always be given on an empty stomach, 30 minutes before a meal or 2-3 hours after. You get the drift.

    Always follow manufacturer's specifications for administration of medications. There is a difference between specifications and recommendations. But again, nursing judgment comes into play. If you're giving somebody on a whopping dose of Prilosec NSAIDs on an empty stomach, could the Prilosec dose be lowered or even eliminated with simple common sense tactics?

    Taking ownership and initiative also is a step. If you see medications that can be moved to another time without interactions, or one that shouldn't be crushed to put down an enteral tube, for example, take the initiative and get the time of administration or the dosage form changed. (If the doc refuses to change the dosage form of a non-crushable medication, he has to address his reasons in his notes.)

    This is an excellent topic; thank you for sharing.
  12. by   oncnursemsn
    This posting is where experience, what we're taught in school and reality have a major collision. As nursing instructor, and a still practicing nurse, I am always struck by how rigidly we teach our students the "5 Rights" and expect them to do so perfectly with their 1 patient. That same new grad may end up in LTC with 30+ patients- and the "rules" that were beaten into their head goes out the window. I know- I worked briefly in a LTC facility after having a hip replaced. I though it would be easier then working on the acute care floor. As all the readers of this post are laughing hysterically, I found out that my 42 patients and 2 ton med cart were not a good fit for my bum hip. I switched teams with the other nurse (90 patients and 2 licensed nurses...) and realized that the other nurse was doing all his meds for 3-11 in 1 med pass. So that's why he was sitting down and I was runny my a** off! My elderly residents asked at the 4pm pass "where are the rest of my meds?" Needless to say that stint didn't last long....

    I agree with those who have posted on this forum about communicating with DON, MD, pharm and the resident themselves to get realistic times and then all will be good. Legal nurse, happy resident and meds given correctly.
  13. by   The Hated Consultant
    Excellent points about the collision of experience and reality.

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