Giving meds in a timely manner - page 3

I would like to know if any of you have a problem getting your meds out in a timely manner. I have a rehab unit of 39 residents. They ALL have many meds. Most of them need to be premedicated for pain... Read More

  1. by   LPN1974
    Quote from Blackcat99
    :chuckle When I worked day shift at LTC I was never able to pass out the meds in a timely manner. I would see a resident right in front of me and would get the meds ready. Before I could actually give him his meds I would be constantly interrupted with phone calls "Doctor Jones on Line one" and "so and so just fell." So by the time I got back to that resident his pills were pre-poured and he was long gone. I got tired of being made to feel "like a criminal" because the meds were never on time. I quit that job and will never work as a med nurse at LTC on days or evenings again. :hatparty:
    You make a very good point. I did work a part time job for awhile in a nursing home, about 2 years. A nursing home is certainly different than the job I have now, where our people are in 7 different homes. {See my post above}.
    Phone calls, especially, interrupting the med pass are just unreal. Family, doctors, family and friends of staff......it was just terrible. We had several CNAs working there who were from Africa, and here in the US going to school, and working to put themselves thru school here. Well, they have a different accent than us, and administration had told them not to answer the phone, because if it was patients family they couldn't understand them, so guess who that left to answer the phone on evenings? The nurse, of course.
    I got to where I just didn't answer it alot of times, because MOST of the time it was staff phone calls. If I had a call in to the doctor or were expecting a return call I would try to stay close to the telephone.
    For many reasons, this one included, I quit that job and do NOT ever want to go back to nursing home work, if I can help it. I will have to be on starvation.
  2. by   Fiona59
    I would mark "withheld" and document that the resident was asleep. After a week or two of this, I was able to get the hs meds moved to 1830 or 1900, or even changed to prn (if they woke up before midnight it was given). Sometimes warm milk worked wonders at 0200...

    The amount of meds given in LTC makes the mind boggle. Why am I giving a 92yo woman premarin? Does she really need calcium supplements, when she doesn't weight bear, uses a w/ch or gerichair? Managed to get the colace cancelled by keeping really good BM records!
  3. by   LaShell
    eeer, memories of rehab... nope believe it or not it's the state that's concerned with their dining experience. when they are doing surveys, that is one of the things they look for--that we aren't giving meds in the dining room. from my experience, many patients didn't mind getting meds during their meal, and many of them preferred to take meds with food to help get them down.

    I worked at two subacutes and it was on a rare occasion that meds got done on time. also, we couldn't always start passing meds right at the beginning of our shift because residents didn't want all their meds on an empty stomach before breakfast, or they're stuck in the bathroom, or they don't want to be woken up so early...... Many bad habits were done by the staff, like putting meds in cups and taping them shut with the pt's initials on them and then passing them all quickly before breakfast.

    so sad we don't have the time/staff to do our jobs correctly and risk our licenses..........

    Quote from meownsmile
    People wait in line at restaurants all the time correct? I'm not a LTC person here so my opinoin is worth zilch, but if they demand you not "interrupt" their dining experience maybe they should let you take care of "business" before they enter the dining room.

    Granted it is important for them to keep their nutrition up but its just as important that they get their meds etc. My guess is the state is going to be less concerned that they have their dining experience interrupted as they will be that the meds are given in a timely manner.
  4. by   SKM-NURSIEPOOH
    Quote from ragingmomster
    "...i am guessing that some patients are up early enough to get cardiac meds during the 11-7 shift. i know 11-7 nurses are busy in the am with blood sugars etc. but adding 2-3 regular meds should not be impossible...."
    most 11p-7a nurses work alone! typical ltc units have two hallways made-up of residents ranging from 29, 30, up to 33 patient per hallway. the 11p-7a shift nurse has to give meds to both sides. now imagine just how time consuming waking-up most (if not all) of these patients for *one* or *two* pills just so that the day shift nurses don't have 'all those pills' to give. can you imagine how pissed-off most of the oriented folks would be? cuz one would have to start such a med pass that's written for 6:30a at approx: 5 to 5:15am in order to get the morning fbs & to wake those poor unfortunate souls up for one or two pills. now...do most people typically wake-up to start their daily routine that early in the morning? i think not!

    the answer isn't passing off the buck to 11p-7a shift nurses...the answer would be the facility reviewing the necessity of all the polypharmacy most mds write. is it necessary for patient to take soooooo many pills daily? it has been proven via literature that polymedicating patient causes more problems from all of the adverse reactions....often times leaving residents with what is called polypharmacy caused dementia.

    something to consider before passing the buck/workload onto nurses who typically are scheduled to work the units alone. they have to do *many* tasks within that time frame which benefits the residents & the unit overall. the night shift nurses are the ones who have all those *extra duties* they have to perform cuz everyone else "don't have time" to do. they not only have meds, & tx...but they also have their nightly, discharge from either hospitalization from the previous shift or death (night shift typically get the most death...usually early mornings i.e.), & monthly summaries, nightly v.s., change or set-up o2 concentration bottles/tubings, 24* chart audits, mars/tars change & review for the new month, re-order stock/meds for the unit; double check all upcoming appointments for those residents who have to go out on pass to their mds or to have a particular procedure done that's not offered at the facility....etc....etc. get the picture? night nurses don't have it all easy....nor do they sleep the night away as many may suspect. heck....many don't even take a break cuz there isn't even an opened cafeteria about! nope...night nurses will eat at the desk while doing their nightly audits/checks.

    as a former night shift nurse (& soon to be returning), i take great exception to the notion that *2* or *3* routine meds thrown onto the night shift wouldn't be "impossible" for those nurses. that smacks of either total ignorance or lack of respect for what your night nurses do on a daily basis :angryfire . if it weren't for your co-workers....many who prefer to work days/evenings wouldn't have their pick of shifts...many would be forced to work 7p-7a....etc.

    cheers!
    moe
    Last edit by SKM-NURSIEPOOH on Jan 31, '05
  5. by   CapeCodMermaid
    Quote from Fiona59
    I would mark "withheld" and document that the resident was asleep. After a week or two of this, I was able to get the hs meds moved to 1830 or 1900, or even changed to prn (if they woke up before midnight it was given). Sometimes warm milk worked wonders at 0200...

    The amount of meds given in LTC makes the mind boggle. Why am I giving a 92yo woman premarin? Does she really need calcium supplements, when she doesn't weight bear, uses a w/ch or gerichair? Managed to get the colace cancelled by keeping really good BM records!
    AMEN sister! What's the point of half the meds we give out? They come to us on all sorts of meds they've been taking for years because none of the docs has the time or inclination to do a thorough review to see if they actually need them. I want to clone my GYN doc. He said he would have a rule that everyone only gets 3 meds. If they need more, the doc would have to decide which of the first 3 to get rid of.
  6. by   CoffeeRTC
    remember the Beers List? What ever happened to that? What about the QIs..res on 9 or more meds? Why does that 92 yo lady need premarin? We also have many residents getting blood sugar checks 2-4 times a day when they are norm??
    I like the 3 meds rule. Heck I would even settle with 5!
  7. by   sassynurse78
    I am glad to know that I am not the only one with these problems. We have two units of 42 pts each. Days has 3 nurses to divide these units, second two nurses and nights one. So I defiantly agree that nights cannot take on the extra burden. I don't know where anyone ever got the idea that evenings are any better time wise so we only need two nurses. (seems like almost all of our pts, get meds bid which is 9am and 5pm) I often hear well days has to deal with dr calls, which I found to mostly be an untrue statement since they all call back at 5pm when we are trying to pass all these meds....the bottom line is that managment knows but chooses to ignore the fact that two many pts and two few nurses equal a disaster. If we as nurses continue to find ways to "be in compliance" why would management ever have to deal with the problem appropiatly? Like By hiring a couple more nurses!! I for one am not of the opinion that I need to go and make lists and call docs to make my med pass within compliance. I feel like I am just proving to the management that too few nurses can work. I love my pts, and even have a great respect for the facility, however I don't care if the facility gets fined for not being in compliance with med pass. I am one person I give 150% daily. When nurses are giving that much effort then it is the facilities responsibility to step in, if they don't it is their fine.

    Sorry to vent here, I do not intend to offend anyone, I just wish on some subjects like this one that we would stick together and make the folks in charge take some of the responsibility. This post touched a nerve because this is such a daily issue at my facility that our management has chosen to shrug their shoulders on saying they don't know how to fix it. After as many times as we have went to them, I just feel like it will be their problem when we get fined.
  8. by   panurse101
    Our ltc facility has the same problem, I think this is a common problem in ltc. One thing that we do try to look at, is to see if any med times can be changed. If its a daily med, ask why cant the med be given at 12 or 1pm, try to break them up. It should help relieve some of the "pain".
  9. by   littleplaynurse
    Wow! - this post surely opened a Pandora's Box, and for obvious reasons. You certainly can see by the response that you are not alone in this situation. It's across the board. Last year I took a position with a LTC facility, and from day #1 the med pass was NOT do-able......at first I blamed myself (new facility, not knowing the residents yet, not having my own "system" down yet, etc....). I found myself going thru the MAR every morning and making a list of pts. who were going out to appts., needed premedication for PT, blood sugars/insulins, and those who were on scheduled narcs for pain management......these people took precedence over the others.....

    No matter how I tried - by the end of 2 months these were still the ONLY pts. who were actually receiving their meds on time. I was becoming a little more unglued with each passing day - because it began to take on a personal tone - (i.e. ..maybe it IS just me..) When I mentioned it to the other nurses, they all said, "It's not you - it's the med pass. It can't be done in a timely manner". I asked them why this had not been brought to the attention of the DON and the response was, "it won't do any good - YOU can mention it to her if you think you can change it....."

    Lots of support, right? I figured what the hell? I can't continue to work like this. I felt like I was on a treadmill going nowhere fast........I swallowed my pride and went to the DON (on 3 separate occasions) I told her that this was not in compliance, and that I felt strongly that this was now a patient safety issue. I asked her why the times couldn't be changed, and/or why some of the "unnecessary" meds couldn't be DC'd......her response? "It's not that simple. You just don't go around changing med times......Let me worry about the safety of the patients - just do the best you can and don't worry about it. As long as they GET their meds, that's all that matters"......H-E-L-L-O???? I found myself coming in earlier and earlier (and not punching in until the shift started), and leaving later and later - determined that I was going to make this work. In the end, I was so stressed and worn down that I ended up with pneumonia. I KNEW I would be out for at least 2 weeks - and rather than leave them short staffed and having to call out sick until I recovered, it became my excuse to resign.

    I can't tell you what a failure I felt like - it felt just as bad as if I had been fired. My self esteem was in the toilet. As it turned out, I ended up being sick for a month - so leaving the job was the wisest decision for many reasons. Four weeks to the day after I resigned, I received a handwritten note from the Staff Development Coordinator (who was on vacation when I left). I will treasure this note for the rest of my life. She said that she was so sorry that I had resigned, and so wished that I could have just hung on a little bit longer (to see the fruits of my labor).......

    She went on to explain that after I left, they were forced to use Agency for the lst time in 6 yrs. They ended up with a different agency nurse every single day for 3 weeks - because NONE of them would come back after the first day - and they had all complained to the DON.

    In the end - she told me that the DON was forced to do the following: The one person med pass I struggled with for 2 months, had to be changed to a 3 person med pass. Also, the pharmacy and the MD's were in the process of changing med times, in addition to DC'ing all "unnecessary meds", as I had suggested....... even though I could have gone back there - the wounds were so deep and the experience left such a bad taste in my mouth - I swore I would never go back there again. I have no regrets about my decision, because I felt totally vindicated when I read her note.......maybe I wasn't able to benefit from the changes that eventually took place - but I felt good knowing that OTHER nurses could now do their jobs and not feel like there was something wrong with THEM.

    I know this is a very long reply - but the bottom line is this - you need to protect your license. Patient safety IS an issue. I am hopeful that you can advocate for them until your facility agrees to making some changes so that you can do your job to the best of your ability.....I wish you the very best of luck.
  10. by   LPN1974
    her response? "It's not that simple. You just don't go around changing med times....

    Your DON just didn't want to fool with it, in short she didn't CARE about the hassle you were going thru everyday.
    It isn't the doctors who set the TIMES.....they set the frequency.
    If he says QID, that's all he is saying. He doesn't care if it's 7-11-3-7 or 9-1-5-9.
    The facility is the one who sets the policy on what times the med rounds are.
    The times can be reset to give more time for the med passes to be completed.
    We just recently did the same thing at my job. I work in MR/DDS, and we have 7 homes to give meds to people, with about 20 people served in each home. The times were reset to accommodate med rounds at 7-11-3-7 and 8-12-4-8.
    We now have more time to get the meds done, and we are in compliance with state regs.
    My DON just did this herself. No MD approval required.
    Of course, it still remains to be said that LTC facilities traditionally work the med nurses short handed. They won't hire more nurses to do what one has been doing unless they actually get into trouble for it.
    It's all about money.
    Last edit by LPN1974 on Mar 22, '05
  11. by   littleplaynurse
    I agree with you - that when is all said and done, it really IS about the money. If these places would hire more nurses this problem wouldn't even be an issue. I just can't fathom how a lawsuit brought against a LTC would be less expensive than adding another one or two nurses to the payroll........ and yes - my DON just couldn't be bothered - until she was FORCED to make some changes. It only goes to prove once again that if we don't continually advocate for ourselves and the patients who depend on us for their care - no one else will............
  12. by   irishnurse67
    I recently took a job w/an agency going to nursing homes about one day a week. (My regular job is on a med-surg flr.) The nurses in nursing homes act like it's a totally foreign concept to give meds within an hour of the time they're scheduled. If it can't be done, then some meds need to be d/c'd or more nurses need to be pushing pills.
  13. by   pediatriclpn
    I think the state regs need to be changed so that med passes can once again be done in the dining room, or with me and my cart outside the dining room, and me taking their meds to them. And what about the pt who gets OOB early and won't go into a bathroom, or back to their room for their insulin injection? What does the state say about that? Isn't it infringing on their rights to get their meds where they want them and in a timely manner? I have NEVER in all the time that I worked LTC, had someone complain about me giving meds with a meal. I have had pts complain because I was late, because they wanted to take their meds with breakfast, and me being new was later with their meds than they were used to.

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