Giving meds in a timely manner

Specialties Geriatric

Published

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 before going to Physical Therapy. My shift begins at 7am. The residents get breakfast at 8am. Physical Therapy begins right after breakfast. They are picked up from the dining room for the most part. We are not allowed to give meds in the dining room. Not even allowed to bring it to them if they are finished and are just chatting. We aren't allowed to interupt their" dining experience". ( I think the experience is ruined when the meal arrives.:rolleyes: The food is terrible!). Now I've only had an hour from the time I arrived to get most of the meds out. It takes me until almost 11am if I'm not interuppted, which is rare. We are allowed an hour before the prescribed time and an hour after in order to get the meds out in a timely manner. Now, by 11 am, some of them are getting their 9 am meds. Then they may have meds due at 1 pm. that's 2 hrs until they may recieve them! My meds at noon are much less. If anyone has this problem, and they know what can be done to solve it, I would be ever so grateful. I've spoken to the DON, the administrator, the inservice director. They all agree that it's a problem, but don't have any solutions. The state is expected any day now and I am not going to be compliant.What do I do?:uhoh3:

Specializes in Clinical Research, Outpt Women's Health.

PHTLS -

You seem to have a very unique take on life. Different from a lot of the nurses on this forum. Would you indulge my curiosity and tell us a little about yourself? Thanks.

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Wow!

this was the difficulty when I was working in Long term Care also.

The State has such a lovely way of coming in and interrupting things and setting what seems to me as an impossible guideline for every little thing. There seems to be no evidance of "practicality" at all.Most of the patients were in my oppinion "victims" of Polypharmacy and at times I wondered if they would not "short out" with chemical imbalamces from all the meds they were recieving.

If the patient had a new complaint which you related to her physician, them he got the new med just added to the MAR without a review of all the rest he was on. At times you had to continue to post messages to the physician to get a situation taken care of. At times, you, the Nurse were the only advocate for the patient. I guess that's why I was so tired, as one Nurse put it, Dinner, what's that?

You, as a Nurse, know the right way you were taught to give meds and care for a patient. There are ways to adapt to these impossible situations, which takes some experience and knowledge, and you need to act in the best way possible, with the Golden Window in mind. Just do the best that you can and if things don't get done the way the State wishes, perhaps it is a good thing that they shadow you to see what you have to do. I know that the thought of that is scairy, but when I invited the Nurse from the Statew on a med pass(my colligues couldn't believe it) she was able to see some of the unrealistic things that they wanted us to do.

You have PT amd other things that needed to be prepared for and those CNAs that were working their hearts out with little or no hepl and it all falls into the Nightmare catagory. I sympathize wioth you all and perhaps if you all get together and can approach your DONs with your needs, perhaps that will help. It is forever going to be an up-hill battle I'm afraid. Don't give up.

Just remember, there is the State's way and the practical way.

macspuds30

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I am kind of hung up on the "not disturbing the dining experience".

Most people take their meds with meals at home. Right before they sit down, right after they get up and an awful lot of elderly people living in their own homes keep their meds right on the table so they see them when they sit down and don't forget!

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Ohhhh I feel the pain. My med pass is for 20 rehab patients and 10 long term care. The hallway I work is called "the bermuda triangle." Nurses go in and are never seen or heard from again.

We call it "The Island"! I have 26 on mine with 2 cnas on 3-11!

I had a shift like what you described last night...contemplated taking my sandwich in the bathroom so I could multitask :uhoh3: I didn't :rotfl:

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littleplaynurse......

BRAVO!!!!!!!!!!! You do anything but "play". Thanks to your courage and fortitude, residents are getting the care they deserve.

Now come on down to my facility and help me make the same change!!!

Sorry your health had to suffer though....

Take Care,

Tres

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Specializes in Gerontology, Med surg, Home Health.

Two things we do....IF the patient has a GTube, we always write QD meds at 6am. I've NEVER seen a surveyor show up that early to watch a med pass. And, if the pass is getting bogged down, we get the docs to write "Take with meals"..so if you always have those 5 people sitting in the dining room...sneaky but it works and there is no harm to the patient.

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littleplaynurse......

BRAVO!!!!!!!!!!! You do anything but "play". Thanks to your courage and fortitude, residents are getting the care they deserve.

Now come on down to my facility and help me make the same change!!!

Sorry your health had to suffer though....

Take Care,

Tres

Hello rebel_red! Even though it's been awhile since I last posted on this subject - the positive feedback still amazes me! Your response to my post made me laugh out loud. What a great sense of humor! You are absolutely right, though: we certainly do more than just PLAY (I just couldn't resist the "satire" in my user name). Your personality comes through so strong! I bet you wouldn't have any problems trying to make positive changes where you work. In any event, as you said in so many words, "there's always Wal Mart". Good luck in everything you do - and PLEASE don't lose that wonderful sense of humor.....it may be your (and my) salvation. Take care.

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Hello rebel_red! Even though it's been awhile since I last posted on this subject - the positive feedback still amazes me! Your response to my post made me laugh out loud. What a great sense of humor! You are absolutely right, though: we certainly do more than just PLAY (I just couldn't resist the "satire" in my user name). Your personality comes through so strong! I bet you wouldn't have any problems trying to make positive changes where you work. In any event, as you said in so many words, "there's always Wal Mart". Good luck in everything you do - and PLEASE don't lose that wonderful sense of humor.....it may be your (and my) salvation. Take care.

P.S. I must have left you scratching your head with the "Wal mart" line. I read your other posts and took a peek at your profile......just thought I'd clear that up....

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Specializes in Med-Surg, Rehab,Acute LTC ,PCU.

The truth is it is physically impossible to medicate 39 patients with morning meds in 2 hours. Your facility knows it and will do nothing to address it. Another sad truth is this is very commonplace in healthcare facilities across the US. This practice also leads to med errors. And someone has to be blamed when the state comes in and site the facility. You guessed it-the nurses. You are rushed to do not just meds but other duties such as patient teaching and good post-op care. Makes me flame!:angryfire

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The truth is it is physically impossible to medicate 39 patients with morning meds in 2 hours. Your facility knows it and will do nothing to address it. Another sad truth is this is very commonplace in healthcare facilities across the US. This practice also leads to med errors. And someone has to be blamed when the state comes in and site the facility. You guessed it-the nurses. You are rushed to do not just meds but other duties such as patient teaching and good post-op care. Makes me flame!:angryfire

You are right on target with your post. It is not possible to medicate that many pts. SAFELY, and do all the other things we are supposed to take care of. This is the very reason I left LTC; I wasn't willing to sacrifice my license over a med error that could have been avoided if we weren't constantly checking the clock to see how far behind we were in the med pass....

Passing meds under these conditions guarantees only one thing: it's only a matter of time before a serious med error occurs. No thank you. In the end, it all falls under the heading of "Patient Abuse" as far as I'm concerned, because their safety is constantly being compromised. When we complain about the load, the facility tries to downplay the seriousness of it. They are well aware of what's going on, but too cheap to add more nurses to the payroll. I don't know what the solution is for this widespread problem, as everyone suffers in the end....... :(

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Its impossible to pass meds too that many residents in 2 hours that is why there were so many med errors in the faility where I worked. What really got to me was that the DON knew about the errors and chose to turn her back. I wish there was more we could do to change it because I feel sorry for the residents.

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Its impossible to pass meds too that many residents in 2 hours that is why there were so many med errors in the faility where I worked. What really got to me was that the DON knew about the errors and chose to turn her back. I wish there was more we could do to change it because I feel sorry for the residents.

Most of the once a day meds can be spread out over less heavy med times thoughout the day. That would be the first step in managing the load.

LTC facilities have long "ignored" this problem because it is a method of repremanding nurses who for whatever reason need to be gotten rid of and they don't want to make a big stink. Just let go because s/he can't handle the job.

I have a very good, long time friend who is still DON at a LTC. She let me in on that hint many moons ago, it was when I was acting as her temporary ADON. Didn't want the job myself but did agree to help for awhile. I did, all done. Thank God!

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