LTC question

[GLORIAmunchkin72]

How do you deal with this: A resident is going LOA for 3 or 4 days and wants all her meds "to go". Many of the meds are bubblepacks and some are in individual bottles, some are narcotics. There are AM meds, noon meds, 2 pm meds 5-6 pm meds and HS meds, and sometimes they want you to get it ready in half an hour or so. This happens a lot around Xmas and can be quite a challenge.

[jax2130]

don'tcha just despise this? i had this constantly happening to me when i was doing LTC. fortunately, for the majority of my employment at the facility, the pharmacy we contracted with allowed us to call them at least 72 hrs in advance and they would pre-package all of the resident's meds for the length of time that he/she was going LOA. UNFORTUNATELY, they didn't do narcs...so what we did, at the suggestion of our DON, was use the narcs the resident already had in stock, take the specific amount of pills for the length of the LOA, sign them out in the narc book as "given LOA" and have the resident co-sign. it still was a lot to do, considering the # of med passes per day, and the length of time it took to do med pass, AND the fact that the resident "needs the meds right now because he/she is leaving in 2 hours and can't possibly wait another 5 minutes!"

however, we have since changed pharmacies and the new pharmacy doesn't pre-package. ugh. fortunately, i changed my status to PRN before i had to deal w/ this atrocious mess. but i know the nurse on the other wing had to package 5 days worth of meds for a resident, and she about went ballistic!

[GLORIAmunchkin72]

Thanks for your response. Pharmacy's participation is nice but they too would need some kind of advanced notice. This is not a problem if the resident is only going away for part of the day or even a whole day; anymore than that and you end up with a whole bunch of little envelopes to hand the family.

[not now, RN]

We had a little form we filled out where we listed each med and how many are remaining in the bubble pack before family took them home, this included narcs. The family signed the form when the took the meds verifying what they are taking and the amount. When they returned the meds were recounted with family present and they signed verifying how many the resident returned with. The form was provided by the pharmacy so it was the policy.

Some family would write the time the med had to be given on the card so they didn't get confused although I don't know if that's ok with state...

[jax2130]

oh the happy, happy, joy, joys of working LTC! our residents, depending on their diagnosis and condition, needed prior approval from their MD before going on an extended LOA (anymore than 3 days, depending on the MD). we actually had one resident change MDs and lose her LOA privileges. the former MD allowed the resident to go out-of-state for a week to visit family. when the resident switched to the house MD, he denied the resident any longer than a 2 day LOA stating "if you're ok to be gone for a week, you should be ok to not even be here at all." personally, i think this is a violation of the resident's rights; but i'm not the MD. but this resident had gone LOA for a week before out of state and did just fine. good grief. i felt awful for the resident. us nurses tried to pull through for the resident, but the MD wouldn't listen.

anyway, we do have some residents who will go out for the day and that's not a problem, but those little white envelopes do get kind of annoying! and before we changed pharmacies, our meds were still wrapped individually in boxes. we just now changed to the bubble packs when we changed pharmacies. it was a MESS when i left full time and went PRN. we couldn't send the boxes back because ins. wouldn't cover them, so the residents would be out a whole heck of a lot of money. awful. and we got new carts that are absolutely ginormous. and i'm saying that because , well, i'm 5'nothing, 105# soaking wet. pushing those things down the hall was horrible for me! i always joked that i needed a separate license issued to me to "drive one of these things!"

anyway, i just thought i'd throw in my 2 cents. i'm only doing PRN now. but that's where i began...LTC. i feel like i've lost some of my skills as a new nurse, because we really never had any IVs, we didn't take vents, and we didn't take fresh trachs. oh well. have any of you dealt w/ kaplan university? i've signed up for their online certificate for forensic nursing, but i think i might call tomorrow and back out. i'm having a funny feeling i can't quite put my finger on it...hmmm...

[Daytonite, BSN, RN]

We specifically had small envelopes that we put all the meds into, sealed and sent home with the patient. We basically pre-poured the patient's medications for the days and times they would be out of the facility and clearly labeled these small envelopes with the day and time the patient should take the pills. We signed out the narcotics that we gave to the patient. If the patient brought any of the narcotics back in, they were added back to the narcotic count.

[morte, LPN, LVN]

It is my understanding, in at least one of the two states in which i practice, that nurses arent allowed to "dispense" meds in this fashion.....they have to come from pharm in individual containers.

[GLORIAmunchkin72]

Morte, I have a feeling that you are right, but this is a widespread and accepted practice at my facility. One time I refused to do these little envelope jobbies and the ADON ended up doing it. (Res. was leaving for a couple of days and there were narcotics involved. They brought one back that they didn't use and I refused to put it back and somebody else had to destroy it: How could I be sure that it was what it was?).

It is my understanding, in at least one of the two states in which i practice, that nurses arent allowed to "dispense" meds in this fashion.....they have to come from pharm in individual containers.