Combining Med Passes

Specialties Geriatric

Published

I am struggling to get though my afternoon shift 3pm-10:30. I secretly DO NOT combine med passes as my fellow nurses say "there is no way to get through 40 residents with 5pm AND 8pm passes, everyone else does it". Here is my problem... they are right. I end my nights circling passes. Should I be leaving these passes blank, or circling with comment "sleeping" at 11pm? The med pass alone is overwhelming in such a tight time frame... btw, this is the dementia unit, several wound treatments, diabetics, etc. how do you do it? And YES only 2 residents don't have pm meds, and 35 have both 5pm and 8pm med passes. ANY SUGGESTIONS PLEASE

In SD, and no problems with state, problems meeting the hourly schedule was what initially prompted us to change to a more open format, we have had this set-up for three years now and it is a great stress relief, not to mention decrease in med errors since you are not racing a clock.

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I agree that it would be beneficial to talk to your nurse manager/DON and doctor and get these med times changed to something more workable so you can be in compliance and get the meds passed. Whatever you do don't just skip all the HS meds and leave blank or circle and write "sleeping"...that would certainly not fly with the state. If you can't get the times changed you're better off combining whatever you can and giving them all during your first med pass than not giving them at all and leaving the MAR blank or circling the HS med pass.

I would also see if the MD is willing to address the polypharmacy issue and DC some of the medications on this dementia floor.

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So..we've admitted to combining med passes. Is it "legal"? No.

I'm lucky in that we've done things at my place to prevent this. Med passess are 9-1-5-9 with the 9 and 5 being the heaviest passess. If we get meds that need to be timed differently, then we do it. (antibiotics/ pain meds etc)

Remember that you have the hr before and after to pass them so in a sence, if you have those meds that are timed differently you can pass them with you other passess. For example, our coumadins are at 6pm. I give them with the 5 pm med pass. We have it timed at 6 pm so that we have time to get the order changes back from the MD on lab day.

Since just about all of us have the same issues with getting the med pass done, getting the treatments done, etc...why cant we change the way meds are passed?

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I work in long term and I have 40-45 people....extremely hard....to get done you have to combine, but not give certain meds like sleeping pills until at least seven...that's just the it is....treatments,accuchecks and labs to do...

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Specializes in ICU.

We have changed our format to some ranges 4-7pm and 7-11pm. Some medications are still at five and 9 but with the ranges along with the q shift it helps. I start out passing the 4pm's and when I get close to 7pm I start passing them all. I have a few that need specifics so I pass my earlies with my people who have 9pm's and then when I come back around I do their 7-11 and 9pm's together. It reduces my medpass by 25%. It would be better to do them all together and reduce the number by 50% but for now this reduction has helped.

In all honesty I try my best to see each person only once. If I have to see you twice it more than doubles the work because now I have to convince you to take another round of pills. When they are crushed it makes more sense to give them one mouth full of disgusting rather than spread it out.

I hope LTC can shift away from the rigid minded med pass that does not allow for living. Heaven knows the residents hate it.

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Specializes in Foot care.

I don't have near the load some of you have, I'm in assisted living and technically don't have any treatments to do, but I'm the only nurse for ~75 residents, ~20 of which live in a locked dementia unit and if I get too many calls or interruptions at med times, it blows my schedule out of the water. I always spend extra time (1-2 hours, depending) after shift is done to do my paperwork. Most the trime I do that extra work "off the clock." This is my decision while I am learning; I prefer to do the best job I can and I do not want to have time pressure adding to the pressure I already feel. Outside of work I have no responsibilities to anyone but myself, so I have the flexibility to do this.

I administer medications mostly for the dementia unit, and I can't rush them or force them to adhere to my schedule. I have to act as though I have all the time in the world when I am talking to them, and I sometimes have to return many times to the same resident in order to get them to take the medication. I have three crushes. I do combine passes, using my knowledge of pharmacology to make educated decisions about what can be combined and when. I recently requested a doctor to write orders to reschedule the timing of medications from 4x daily to 2x daily, which would legalize what I already do, but I've not yet received a reply. I also sometimes "pre-pack" or "pre-pour" which I know is a no-no in most settings, but I'm not sure this holds true in assisted living which is a specialized environment with its own unique rules. In any case, I don't think I'm endangering anyone by doing this, and that's my personal bottom line. Pre-pouring while it can be done slowly with attention to the 5 rights is better than dispensing at lightning speed, from memory, etc.

Good luck.

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Specializes in ICU, CM, Geriatrics, Management.
... I always spend extra time (1-2 hours, depending) after shift is done to do my paperwork. Most the time I do that extra work "off the clock."... I also sometimes "pre-pack" or "pre-pour" which I know is a no-no in most settings...

Hi, Hot. Please don't consider these comments as critiques... only wanted to share info.

Working for the facility "off the clock" is a violation of labor laws in most, if not all, of the USA. And the employee and the employer both incur legal risks as a result.

"Pre-pouring" meds in an assisted living environment is also deemed unlawful in many jurisdictions. (Of course, I don't know where your facility is located.)

Good luck to you. Thanks for posting.

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Specializes in Foot care.

Not a problem. I do like to know what's what. As for the working off the clock issue, I considered that there are lots of legal reasons why this should not be done. I also have a relative who is a manager and she and I have had a discussion of time accounting systems and laws etc. Maybe I should just tell them to make me a salaried employee. :-)

Thanks for your response.

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We have changed our format to some ranges 4-7pm and 7-11pm. Some medications are still at five and 9 but with the ranges along with the q shift it helps. I start out passing the 4pm's and when I get close to 7pm I start passing them all. I have a few that need specifics so I pass my earlies with my people who have 9pm's and then when I come back around I do their 7-11 and 9pm's together. It reduces my medpass by 25%. It would be better to do them all together and reduce the number by 50% but for now this reduction has helped. In all honesty I try my best to see each person only once. If I have to see you twice it more than doubles the work because now I have to convince you to take another round of pills. When they are crushed it makes more sense to give them one mouth full of disgusting rather than spread it out. I hope LTC can shift away from the rigid minded med pass that does not allow for living. Heaven knows the residents hate it.

Hi i am very inpressed that you were able to reduce your time by 25%, can you give some info on it? would show me your policy on that, thanks!!!!

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Specializes in Gerontology, Med surg, Home Health.

There are several issues here--most nursing home residents take far too many meds so the first thing is to get rid of the unneeded ones. It takes time but in the end it's worth it. In most cases, there is no reason meds can't be given together. Having meds scheduled at 4,5,6,7,hs is preposterous. We just started scheduling our once a day meds so they can be given any time between 6am and 11:45 am. No one gets chased down the hall to take meds, they wake up when they want, have a leisurely breakfast, and then get their meds...pretty much like the would if they were at home.

Some meds, however, MUST be given on an empty stomach...Fosamax is one. In Massachusetts, you'll get tagged by DPH if you give Synthroid at any time other than 6am. As an industry, I think we are moving toward more realistic expectations. The one hour before and one hour after reg was first written, I think, when patients got one or two pills a day.

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