Am I freak for charting meds as I pull them?

[Izzy11]

I just started working in a LTC facility and it's my first job out of school. It's taking me a long time to do the morning med pass, although I'm getting better at it. The nurse who oriented me said she saves time by signing out the midday meds at the same time she does the morning meds. Another nurse I worked with said he doesn't sign any meds out until the end of the shift because if you do it as you pull them then you have gaps, and you save a lot of time that way. And both of them pull the meds by memory and don't really look at the MAR.

Am I freak for actually signing out each med as I pull them?

[CapeCodMermaid, RN]

The nurse who does this was one who had (or thought she had) memorized all the meds, so she doesn't even open the MAR for the midday meds. She just pulls them and gives them without looking at the MAR at all. Her time saving is in not looking up each patient in the MAR.

She should be fired on the spot. This is a very dangerous practice. How does she know the med wasn't changed or discontinued?

[LockportRN]

If you did sign them out and there was an emergency, you would still have to intial the box, circle it, then write out on the back of the MAR why the med was not given.

[lumbarpain, ADN, RN]

Sign them out as you pull them, best way. Sometimes signing out meds at noon when you are doing morning meds may be a bad idea...if an issue comes up where you signed it off already that means you gave it already....its happened to me and other nurses who went ahead of themselves because later on they found out the med was discontinued and if you get too busy you may find yourself answering to the Nurse Manager on why you gave a med when it was dc'd. to your surprise because I nurse didnt pick up the dc order on it...and then you forgot to go back and circle it not given. It would be considered a med error. It happened to me when I first worked as a new grad....coumadin...the order was changed, I didnt know it, and the coumadin I gave when it was supposed to be a different dose.. The nurse who didnt pick up the order got in trouble...But I got written up also....I didnt think it was fair....but what is? I found myself doing extra work making sure orders were picked up properly which was a big headache but it saved my butt alot in the long run. If you have good people doing their jobs correctly, you wont have this problem.

[NamasteNurse, BSN, RN]

The nurses you work with are not unique in their practice. HOWEVER...when you are learning, DO IT THE RIGHT WAY! Flag your 1300 meds when you pass and sign for the 0900's. If someday (and trust me, it WILL happen) the DON or the pharmacy rep comes in at 1100 and wants to review you're MAR, you are gonna get in a heap of trouble if your 1300's are already signed out and you haven't given them! THINK about it! Do the right thing.

[thelema13]

Why sign meds on the MAR before giving them? What if pt refuses, throws med up, has expired, I could go on and on. Dangerous practice, ripe for litigation.....

[noc4senuf]

My staff are taught to give the med and then immediately sign it out. Do not sign out before giving. do not pre-fill your cups. If not follwed, they will be written up.

[lisaannej]

I'm not a nurse yet, but work as a med tech in an assisted living facility. I pull the med, sign for it, initial bubble pack, give med. If the resident refuses a med, I circle my initials, then document why, and waste the med. I do know of some med techs who don't use the MAR at all, pop the pills into the cup and place in back in cabinet beforehand (likes hours before giving meds), then sign for everything at the very end. Doing it that way scares me, I would forget something, like even forgetting to go back and actually give the meds. I don't really feel like using the MAR and signing at the time of giving med makes me go any slower.

[BrandonLPN, LPN]

OK, I'm going to play devil's advocate here....

Where I work, if a resident doesn't take a med for any reason (refusal, transfer to ED, death, whatever) the nurse initials the MAR and then circles his initials. So, no matter what, all those little boxes are going to have to be initialed any way... right? In other words, even if your resident is sent out, all you have to do is circle all the meds you aren't going to give. And, come on now, does that really make you a "bad" nurse? If I'm a good nurse who checks all my orders, pays attention to my residents and work my butt off, who cares if I pre-sign the MAR a little.There are so many way way WAY more important things to worry about in LTC.(just my opinion)

[noc4senuf]

Do you have a pharmacy that does med pass audits? Ours will deduct points for any meds signed out before given. In the many years I have been a nurse, it has always been... pass the meds and then sign. My nurses will be in trouble for not doing so.

[BrandonLPN, LPN]

I know best practice is to give the med, then sign. Like I said, playing devil's advocate. We all know at least *some* pre-signing goes on in all LTCs and I was just trying to explain from a med nurse's point of view.

I guess what I don't understand is how a nurse could ever be "caught" initialing the MAR before giving the med. As I said ALL the meds are going to have to be initialed (or initialed and circled) anyway. If someone refuses or is sent out when you've already signed their meds out, well just go back and circle your initials.When you say med pass audit, do you mean someone actually takes the MAR away from the LPN in the middle of a med pass and checks for pre-signing?? I wouldn't stay in such a place.

[BrandonLPN, LPN]

Now, before I sound like the worst nurse ever, perhaps I should clarify what I mean by "pre-signing".

When I'm at the med cart outside a pt's room I initial my meds as I pop them in the cup. Then I give them. If the pt refuses some or all of them I go back, waste the meds, and circle my initials and document as required. I don't see why that's any better or worse than waiting till after the pt takes them to initial everything. I don't men that in a sarcastic way either. I really just don't see how it's less safe or anything. If someone could give me a real reason why I shouldn't do it that way I'd listen.

[noc4senuf]

THe audits are done by standing and watching the nurse or TMA pass the meds, just as a state surveyor would.