How long did it take you to learn to be on time completing med passes?

Forever Sunshine, ASN, RN · Feb 26, 2010

I am in your shoes. Your exact shoes.

I am a new LPN in LTC, I am still on orientation but I am becoming more and more independant each day. Tonight was my first night doing an entire med pass for 24 patients(25 on the side but theres an empty bed). When I am totally on my own I will have to do meds for 50 patients(both sides of the unit).

It took me all night from 3:50-10:30 to give meds. I am thinking about how to do things in a different order for my next shift so I buy myself more time because when I'm on my own I'll have 25 more patients to do in addition to what I did today.

I don't have any tips but I can tell you .. you are not alone lol

The nurses have been telling me, go in room order. dont jump around. give everything at once(except for antibiotics, bp/heart meds, and narcotics). try not to let the happenings of the unit distract you(call bells, alarms, patients yelling nurse!").. i feel bad not helping the cnas they are wonderful they are so good with the patients.. but i have to concentrate on meds. not toileting.

transkat · Feb 26, 2010

I work med/surg full time in a hospital and pick up PRN and float to different units in a LTC facility. The time it takes to pass meds varies considerably depending on which unit I work and also, whether or not the aids working are experienced with the residents on the unit. There is also a variance in the hours I have to stay over which increases if there are a large number of medicare patients due to the required amount of charting (each includes an assessment and full set of vitals). If there is a new admit, transfer or a resident that is having a difficult day/night I will more than likely be staying past my scheduled time. I have had days where everything is complete and I leave after giving report. There have also been shifts that I was unable to do any charting and charted for six hours past my scheduled time to leave. I sometimes feel very inadequate when working in LTC. I think computerizing a list for each hall with resident's room#, name, pills whole or crushed, Medicare?, 02, G-tube/feeding, Accucheck/Insulin etc. would really help. Also, I think it is a good idea to go in room order--noting the resident's that need to be bumped up to the top of the list. This is a tough job. The more I get to know the residents the less I stress about things that aren't done yet. I'm learning (after about six weeks) how to prioritize meds. Some meds timing is more important than others. Hang in there.

SuesquatchRN, BSN, RN · Feb 26, 2010

The nurses orienting you are right. You'll fall into the rhythm soon. And they sound nice.

Congratulations and good luck!

NurseNinaFla · Feb 26, 2010

Once you are on your own start your med pass a half hour early for example if your meds are due @ 8am start @ 7:30 am,but have your cart stocked and ready to go before-hand,don't stop and toilet residents etc.. delegate your CNA's to do basic nursing dutys,prioritorize.. lets say a resident has fallen on the floor call the supervisor,assess resident have the CNA's pick them up if there is no injury return to your med pass as quickly as possible,make your calls and do paperwork later. The good thing about LTC is you pretty much know your residents and will pick up quickly how they take meds,what they want etc..you should do fine!

In the old days I had 70 residents at night took me about 2 hours to pass meds

meadowsong, ASN, RN · Feb 26, 2010

Really, IMHO, the MAR should have both names of the meds on it. It's a safety issue and it makes med passes so much easier. Granted, over time, you will learn all those meds very easily..........but this is something simple you can do to help ease things along. I would ask if it is okay to write both names in the MAR. I did this when I was training in and when Feb. came, the new MAR had both names listed for almost every med. Made me very happy because I work only PRN.

Other than that, I can only echo what everyone else has said. Over time you will learn all their names and passing meds becomes much more smoother. I live by my cheat sheet, I write down every treatment, blood sugar, O2, vital, insulin, odd med time, and so forth on there then cross them out as I go.

**Elektra6, ASN, BSN, RN** · Feb 26, 2010

Once I learned the residents it was much easier. I had between 25-30 depending on census, including a 4 bed subacute section. If you are going to have the same residents all the time don't stress, you will get it quickly. I worked 3-11 so it was a different than day shift. An example of how I did things:

1. Get report (we had a report sheet with residents room #'s on it) Note anything important.

2. Stock cart

3. I checked on any residents who came back from hospital, needed vitals for medicare charting, had an issue during day shift. This will save you time at the end and who wants to know a residents bad vitals at the END of the shift? You need that info stat. Deal with any problems you can now.

4. Get any fingersticks before dinner, give any 5 pm meds now.

5. Assist residents to dining hall, assist with feeding or work on MD orders at desk

6. As the residents return from the dining hall most go to activities or CNAs will begin to put them to bed, I tried to give the earliest PM meds to those in lounge or before going to sleep (within your compliance times.) You will get to know who likes to go to sleep early and who is awake longer. I always had 5-6 residents I knew were awake around 10 or wanted sleeping meds late so I saved them for last. Treatments I noted on my report sheet so I didn't forget. I mixed them in with the med pass. Say you have a cream to be applied to Mrs. H and she's awake in her room watching TV in her nightgown. Perfect time to assess skin and apply cream while also administering night meds. I've seen nurses run around at the end of the shift doing treatments and its a pain. You also want to avoid waking up residents to do a treatment. Same with your am pass. Do your treatments BEFORE they are dressed if possible. Especially woundcare on dayshift, it's much easier to do before they are dressed and it only takes a few minutes if you are organized.

7. Clean up and chart, give report to nightshift.

You will always have emergencies to deal with, get used to it, call your supervisor if you need help. On day shift a unit manager will help you a lot.

Good luck, have faith you will get it! :nurse:

imintrouble, BSN, RN · Feb 26, 2010

My first job was LTC. I am most proud of my performance there than anywhere else. LTC nurses will appreciate the following. I passed meds to about 30 pts. I knew who took pills whole, whole in pudding, applesauce, or ice cream. I knew who was crushed and what medium to put them in. Who liked ice water, tap water, juice, soda milk with their meds. What time certain residents wanted their prn tylenol. Who sat up to take pills, who wanted to stay in bed. Who wanted one med at a time and who swigged the whole cup. It took me about 6 months to be able to do all of the above without thinking about it. To see a name and know what to reach for. You'll be there before you know it. My hat's off to you.

CapeCodMermaid, RN · Feb 26, 2010

Once you are on your own start your med pass a half hour early for example if your meds are due @ 8am start @ 7:30 am,but have your cart stocked and ready to go before-hand,don't stop and toilet residents etc.. delegate your CNA's to do basic nursing dutys,prioritorize.. lets say a resident has fallen on the floor call the supervisor,assess resident have the CNA's pick them up if there is no injury return to your med pass as quickly as possible,make your calls and do paperwork later. The good thing about LTC is you pretty much know your residents and will pick up quickly how they take meds,what they want etc..you should do fine!
In the old days I had 70 residents at night took me about 2 hours to pass meds

Two things....70 patients? meds in 2 hours...do the math...less than 2 minutes a patient....hardly seems safe. And, suppose you don't have a supervisor to call? The bleeding resident on the floor takes priority over the med pass any day.

debRN0417 · Feb 27, 2010

I can't see giving 70 patients meds in 2 hours. I have been a nurse for 30 years and I am saying "No way"! There needs to be 2 nurses for this many paitents in order to be safe!

You have 1 hour before to one hour after the scheduled time. You can stagger the times for the med administration in prder to "be in compliance". For example half get meds at 8 am so you have from 7 to 9 to get their meds. If the others get theirs at 9 them you have from 8 till 10, and so forth...but you have to have the times scheduled on the MARS, of course and have physician approval adn I am certain a policy or something from the facility/DON about how to go about this.

Timing errors are most often confined to medications ordered before, with or after meals and not administered that way.

Also citations are given for medications administered 60 minutes earlier or later than scheduled ONLY if that wrong time error can cause the resident discomfort of jepordize the residents health and safety. You have to know your drug half-life because a drug scheduled at 9 am that is not given until 11 am, then the next day given at 9 am may cause a problem because of the half life of the drug... meds ordered "daily" usually are not a problem if late, but BEWARE you have to know your drugs and the physician should know if medications are not administered at the scheduled time.

NurseNinaFla · Feb 27, 2010

Hi DebRN,this was night shift many years ago and it did get to that point of unsafe,thats why I told my DON get another nurse or I walk..and no I'm not kidding 70 residents,start meds @ 5am end @ 7am..I did it and I was exhausted

debRN0417 · Feb 27, 2010

That is crazy. You risk not only your residents, but your license as well! I would not have done it either.