Am I freak for charting meds as I pull them?

[Izzy11, NP]

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?

[handyrn]

Actually, I think you are doing it the correct way. The others are taking illegal shortcuts. Sadly enough, this tends to be common practice in LTC.

[Kashia, ASN, LVN]

Unfortunately many LTC facilities- in order to fulfill your job requirements and keep your job- put nurses in the situation of legally jepordizing your lic - I mean its nothing on them! Its on you.

However my #1 priority is patient safety and this means not making med error.

Overtime, nurses devise their own system in order to get meds to pts. It does become much easier over time- esp if you are on staff in one place.

You can observe and learn what others are doing and ultimately you will come to a place of your own system.

you will see nurses do things you will never do and nurses you can draw from their routines and make a part of your own. it takes time.

my advice- never do anything you feel uncomfortable doing! no matter who tells you! use your own inner nurse to guide you haha

but to answer your question- I sign out each med as it is given. it is the only way I have ever found to be confident in what I gave to whom and when. and it is the legal way too.

I put a dot when I pull med, and initial when given when I walk back to cart.

I am not the faster runner on the block but I do what I feel is safest. period.

be patient with yourself ( no one else will! ) good luck and blessings

[kenyacka]

Never chart something before it's done. In my state, that's a good way to lose your license (or in my case cert for CNA) and get blacklisted.

[tyvin, BSN, RN]

As has been said of course you are suppose to sign out as you pass but in LTC many nurses are forced to take short cuts. When I oriented to LTC I had a nurse like you except this one didn't sign out anything until the end of the pass and relied on her memory. She was lightening fast and that answers any one's question as to how some nurses can pass in the allotted time.

As I became experienced and stayed on one floor I found myself doing the same thing and even pre-pouring the afternoon meds. I quit because in most cases it is so stressful and it's something that can't be done correctly without cutting corners and cheating (in most cases).

They are not bad nurses but nurses who are forced to adhere to an environment that is set up to fail. When survival of the fittest rears its head in a supposedly civilized scenario, the ones who fight are forced to summit to techniques that ensure success.

[FLArn]

You are absolutely doing it the correct way. A little hint -- use "sticky note flags" to mark the pages of patients you have midday meds for as you pull your AM meds. It will save you a lot of time later. Also I quickly scan for "holes" at the end of each pass. I use 1 color flags for lunch meds, and a different one for later meds. you will find a way that works for you.

'

[Forever Sunshine, ASN, RN]

I sign for it as I pop it in the cup or else I don't know if I pulled it or not.

[Sun0408, ASN, RN]

Why would you sign something off if it had not been given yet?? What if the resident refuses one med or another, or has a emergency before you give.. Would you then have to back track??

I can see signing soon after giving but not before. You must forgive me, I don't work LTC though.

[scg08rn]

Never sign before actually administering the med! what if you walk in the room and the patient is unresponsive or critical change in status? I used to work sub-acute rehab, the sister of long term care, i used to put a very small dot in the box where i am to sign the med as i poured it in the cup. Also, I saved the wrappers and put them in order on the top of the cart so I can easily check to make sure I gave it and signed as I discarded it. This comes with time and a good practice and routine. Don't get yourself down the wrong track that can be harmful to your patients and your license. I never pre-poured meds, if I did, I kept them in the wrapper and checked one last time as I opened them to the order in the MAR.

[SammiJoRNBSN]

When I worked in an LTC facility, I used a paper MAR and would make a little dot c my pen as I pulled the med and verified it against the MAR. Once I actually administered the med, I would come back and sign it off. I totally understand how things are different in LTC...but that does not mean it's legal!!! It's unfair to you to jeopardize your license and REALLY unfair to the resident who may suffer from a med error. Best wishes!

[Forever Sunshine, ASN, RN]

Why would you sign something off if it had not been given yet?? What if the resident refuses one med or another, or has a emergency before you give.. Would you then have to back track??

I can see signing soon after giving but not before. You must forgive me, I don't work LTC though.

If they refused it, I would go back circle my initials and write "ref" below the signature.

Then on the back of the MAR.. fully document the refusal.

[CapeCodMermaid, RN]

Pour chart and pass or pour pass and chart. Either way is correct as long as you are consistent. I've always popped, initialed, and handed out the meds. If they refuse I go back an circle. Never rely on memory. And suppose you were called away? All those blank spots...how would I know what meds the residents had or didn't have?