Combining Med Passes

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    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
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    Either give it at 5 altogether; or at hs altogether. That's just the nature of the beast. Circling it means the resident did not received it and you certainly can't hold or not give it just because they are sleeping. It is IMPOSSIBLE to give 5 and 8 med pass to 4o something residents and also do tx. Nurses certainly are not going to admit to cock tailing. Have the one orient you; really orient you to how they get the job done.
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    I noticed that other nurses didn't do treatments at all. I guess that is one way to save time.
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    I wonder if you could contact the doc that sees most of the pts and ask for an order that states okay to give 1600/1700 and 2000 meds together between this time and that time. I know that some you can't because you need so many hours between or they can't be combined, but many can be given together. That way you stay legal. I look forward to following this thread. I had a difficult time working LTC and giving 24pts meds. I can't imagine 35!! How can you even stay in that legal window and get it all done! I too saw many that didn't do treatments but charted them as done.
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    Ouch, can you imagine not changing dressing on pressure sores, and autoimmune skin diseases that require bid cleaning. the whole floor would slough away. I just don't like the anxiety of going into work wanting to do my best, and being forced to do things that could get me fired. My game plan is to contact our pharmacy (located who know where, but not near our city), and try to find out how to rearrange TID, BID where the original order does not specify 5pm or 8pm or HS. Hopefully they can help. Wish they stayed open after 5pm. Does everyone really just cocktail/combine passes?
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    I never give sleeping pills before HS, obviously. And certain meds are spread out for a reason (sinamet, depakote, pain meds, ABX, etc.) but anything else... well I seen no harm in combining other meds.

    I mean, seriously, who cares if Mrs. Jones gets her zocor and corerg at 5pm along with the rest of her pills? I KNOW coreg supposed to be BID (8am and 8pm), and that zocor is "best" at HS. But I bet the nurses who split up EVERY SINGLE med pass end up almost two hours late every time. So who's really committing more "med errors"?
    wearinwhite likes this.
  9. 3
    Realistic post.
    sallyrnrrt, tokidoki7, and wearinwhite like this.
  10. 0
    Quote from wearinwhite
    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
    hello, ladies ... i applaud all nurses ...

    i am just 2 weeks into float orientation on a ltc unit and a relatively new lpn grad. we have 4, 5, 6, 8 and 9 o'clock passes, neb txs and other wound/eye txs on one floor. i've just finished 3 days doing 20 pts and feel like i'll never get it ... i have to increase my speed to do the entire floor of 38 + pts. i asked my preceptor 'how and what can i do to get this right?'

    i combine the 4/5 meds, do the 6 pm nebs, eye drops and then combine 8/9 pm meds; some whole, some crush, some with applesauce or pudding, ntf, ptf, tube feeders, take orders off, etc. there has to be a way to increase my speed with med admin. and stay in the hour limitation. medications with parameters to include apical pulse/blood pressure take time. after 5 days passing meds, i have my moments of frustration but i do not give up. any ideas would help greatly and be much appreciated.

    i love nursing! wish i had taken this route 20 yrs ago!
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    It's really ridiculous for a LTC faclity to have a med pass at 4,5,6,8 and 9.

    I'm probably going to get blasted for this, but it IS okay in some cases to combine the 4pm and HS med passes so you only have to
    give a resident meds ONCE in your shift. The examples I mentioned above (ABX, pain meds, parkinsons meds, etc) are obvious exceptions.

    But, for the love of God, who CARES if mrs Smith gets a zocor at 5pm or gets her vitamins at bedtime! In the "real" world nobody except OCD cases splits their daily pills into 4 or 5 different freaking
    med times!

    And dont get me statred on the whole "lets wake all these 90 year olds at 6am to give them a synthroid" crap. It is OK for a LTC resident to get a synthroid with the rest of her 8am meds. NEWSFLASH: where I work we gave been giving EVERYONE'S synthroid at 8am and it has been INVARIABLY 100% COMPLETELY THERAPEUTIC! We measure TSH levels regularly, and we never have to increase the synthroid dose, so guess it must be working! I feel SO sorry for nurses who work in facilities that still have rigid medication times.

    Medications should be scheduled to be given ANY time during a shift (with the obvious exceptions I've mentioned). When will LTC be ruled by common sense and not ancient dogma?
    OhioTry, catlvr, sallyrnrrt, and 7 others like this.
  12. 2
    I'm with ya this, Brandon.

    This LTC's med admin philosophy is plainly nuts!
    LTCNS and Crispy Critter like this.


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