Meds at bedside

Disablednurse · Apr 1, 2003

The way that it worked is on the MAR, the order reads that resident states that he/she administered own meds. Nurse is still responsible for checking pulse, B/P r/t meds taken. We only had 2 or 3 residents that qualified to be able to do that. The meds that they chose to do this on were usually eye drops or ointments. But in the regs, that choice has to be given to residents that are fully alert and oriented. We were sited once because one of the residents that was fairly alert told the state surveyors that they wanted to self administer their meds and we would not allow them to do it.

redshiloh · Apr 1, 2003

Believe it or not, threats of loss of licensure/job don't help. We are hoping to appeal to them by showing what can happen to a patient when meds are left at bedside.

OBNURSEHEATHER · Apr 1, 2003

But if they don't care about their own livelihood, why would they care about someone else's?

Disablednurse · Apr 1, 2003

We never actually left anything other than ointments or eye drops and made sure that the CNAs knew that if they got it out they would be written up. We made sure that they knew what it was for and when to apply it. We also got them to apply it in front of us at least once to make sure that they knew what to do, since it is their right. I did not agree with it, but had no choice. The med nurses and tx nurses did not mind and knew that they were responsible for it, ultimately. They would get the orders and the interdisciplinary team would check for orientation, locked drawer, etc. and care plan it. It did make me very nervous to do it.

P_RN, ADN, RN · Apr 1, 2003

DisabledNurse doesn't that kind of take the "skilled" out of skilled nursing for the purpose of medicare payment to the LTC?

Disablednurse · Apr 1, 2003

Not really, as they are skilled for other things, also when they are in the skilled unit they are getting OT, PT, and ST to help them regain the ability to do for themselves. They may be skilled for diabetes with insulin dependence, COPD with oxygen, etc.

Rustyhammer · Apr 1, 2003

The only exception I can think of is maybe inhalers and for those to be left you should have an order "may keep at bedside".

-Russell

OBNURSEHEATHER · Apr 1, 2003

I give all the psych/CD patients their ointmenats to keep at the bedside. I don't wanna be grabbing them all the time! :eek:

Disablednurse · Apr 1, 2003

We had to have the order May keep at bedside. Our doctors would give anybody an order to keep meds at bedside, but everyone that had the order did not get to keep it there. If they had any confusion, we had to care plan their confusion and chart appropriately so that we did not have to leave it at bedside.

baseline · Apr 1, 2003

One of the major rules of passing medications. Watch the patient take the med. Period.

maeyken · Apr 2, 2003

As a student I've noticed a lot of nurses signing for meds and leaving them at the bedside. When I questioned this, they said "oh, I know the patient, I know he/she will take them." They also say that at home, the patient will take their meds when they want to, so why does it matter if they take their qod or bid med whenever they want in hospital... they will at home anyway.

I gotta admit, I did this once. Not with a med though, just a multivitamin. My patient was eating breakfast, and told me she wanted to take it after her meal. So I left it there. An hour later I walked in, and the vitamin was still sitting there! When I asked her about it, she told me she forgot, and apologised a lot... but it just goes to show how easily it can happen. I've never left ANYTHING by the bedside since then! That was enough of a scare for me!

Disablednurse · Apr 2, 2003

When we talk about meds at bedside in LTC, that does not mean taking med during med pass and leave them there for them to take at will. We are referring to mostly ointments and drops that the MD and IDCP team feel that the resident is oriented enough to apply themselves. No one where I worked ever kept any p.o. meds at the bedside. That would be too dangerous.