Leave me alone when I'm passing meds!!!!!

Specialties Geriatric

Published

How would you answer this question?

When nurses are interrupted during medication administration, errors can occur in practice. What percentage of the time do nurses make mistakes when interrupted during medication administration?

a. 22%

b. 31%

c. 74%

d. 100%

The correct answer is "c" 74%.

In a study by Westbrook, et al. (2010), the authors found that interruptions occurred in about 53% of medication administration events resulting in at least one procedural error in 74% of patients, and one clinical error in 25% of administrations. Although many errors were considered to be minor, 2.7% were considered to be major errors resulting in complications or mortality.

The take home point here is that nurses are interrupted frequently during medication administration and that mistakes happen frequently, some leading to catastrophic results. Seek a quiet environment when you give medications and give your peers a break, by leaving them alone during their medication administration.

From:

Westbrook, et al. (2010). Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med, 26(170); 683.

Med pass interruptions are my biggest pet peeve! I do not mind patients/residents or family members interrupting...but Staff?? Unacceptable!

Social workers, and therapy staff are usually the worst offenders. I make them wait, my residents and their safety are first priority. I do not think that a med pass in LTC setting should be interrupted by staff, unless it is a true emergency (fall, bleeding issue, etc)

I see this an example of a systems problem that gets blamed on individuals and causes unnecessary friction. If a patient's nurse is occupied for an hour (or 2+) straight doing a long med pass, are the NAs and PTs really supposed to wait til the nurse is done? On the other hand, a nurse *shouldn't* be frequently interrupted during a med pass, and certainly not when they have a strict two-hour time frame to pour, administer, and chart meds for 30 patients.

Solution? The usual, a more realistic patient load that allows the nurse the flexibility to juggle several competing, constantly changing priorities.

Regardless, the note idea is good! If the message isn't urgent, everyone can agree to a notes system where no one interrupts the med nurse for any non-urgent issues, and the nurse 'checks her messages' every hour or two. Maybe have a dedicated communications notebook that all personnel can use to exchange written communication.

Specializes in Geriatrics, Home Health.
can I shove this on my management people who just recently gathered us licensed nurses and chastised us for focusing only on medpass, that we should pay more attention to our surroundings and answer call lights, etc. "Customer service, guys. Remember, customer service." is what our admin said.

At my last job, I was chastised for focusing on my meds. "You're a nurse; you need to respond to call lights and crises." At my current job, I was chastised for responding to a fall (and the associated paperwork) while everyone else was out smoking. "You're a med nurse; you need to focus on your meds!" I was told the same when I caught a miscalculation in the MAR, which meant we'd been giving the resident too much of a med. I can't win.

Specializes in Assessment coordinator.

A way you can help yourself not to be interrupted during med pass is to take the time to "make rounds" quickly before you begin. Then you have a list and the patients know you know what they need. Give an honest apraisal of when you will be back with what they need.

Families and phone calls should be told that you are passing meds, anticipated to be done at X o'clock and they can expect a return call between X30 and Y o'clock. In LTC, if everyone gets on board, it works smoothly. I appreciate the fact that you want your med pass to be safe and effective. I like it and I support you. Make rounds on your patients before you start, and you will get a lot of info.

Thanks for caring about what you do.

Specializes in Rehab, Infection, LTC.
Well if my patients needs something regardless if the nurse is doing her MED pass or not I tell him or her right then because I might forget. Multi-tasking is necessity for nursing screw your MED pass.
and you wonder why you haven't had a raise in 3 years :uhoh3:
Specializes in LTC, ER, ICU, Psych, Med-surg...etc....

Wel if we had enough nurses just to do the med pass timely, and a nurse who could just field calls and questions and doctors stuff, and a nurse who could just do the PRN's and a nurse who could just do all the paperwork, and a nurse who could just go to all the meetings, and a nurse who could just...........

Specializes in Pediatric Private Duty; Camp Nursing.

I'm glad to have found this thread, it validates my own feelings about interruptions. My CNA's are awesome. I don't bug them and they don't bug me. They know I will respond immediately during a med pass if they are giving care and have the pt turned and ready for a new sacral dressing. It's just good time management to give up those three minutes right then. Often they've already grabbed the dressing and supplies for me. And I never insult them by asking them to get a bathroom bell when I can clearly see they are engaged in another task. I KNOW they know it is ringing. I often express my trust in them and they know I do not micromanage them. They appreciate this. I know not every nurse is lucky enough to have such seasoned, caring staff under them.

MY biggest problem right now is our new ADON on our floor. I used to have a great one who had tact about when to approach us and when to leave us alone. This new lady is very sweet and asks things nicely, but she comes to me ALL DAY LONG with things. She comes back from the department head morning meetings with a laundry list of follow-ups and problems to iron out, 95% of them having to do with situations of which I have no part or knowledge. Tuesday she walked up to me at least 12 times with "My dear..." and asking me what I knew about this appointment. Or a consult from three weeks ago. Or a skin tear with no skin sheet in the book. Or a treatment that was d/c'ed last month but is appeared again in the printout of this month's TAR. And I must call this doctor to find out if he wants a straight cath done to repeat a UA that came back contaminated. And THEN I get a call from another floor's ADON to ask follow-up questions about things I WAS involved in the day before. These ADON's have no respect for the med pass. Administration is so interested in dotting i's and crossing t's that they risk harm to their residents (and ultimately, MORE paperwork). It drives me crazy. After reading this thread, I think I'm going to have a talk with this new floor ADON. (She's not new to the building, just our floor.) Thanks for the opportunity to vent!

Specializes in Med Surg, Tele, Geriatrics, home infusion.

loved what you had to say Sue, sounds so familiar you have no idea. Lately I swear between the new unit manager (3rd one in a year) the 7-3 supervisor, 7-3 desk nurse, 2 7-3 med nurses plus the 5 7-3 cnas not to mention the DON if she stops by shift change turns into an interrogation. for roughly 45minutes I'm giving report to somebody, defending things 3-11 did, fielding questions about why my cnas did or didn't do something. It's exhausting, I'm trying to finish my nurse's notes and get out of there; which is hard on a busy unit 11-7 because so much of what you chart about happens between 5 and 7am so you can only pre chart so much, mind you I have on average usually 15 skilled and 28 or so LTC patients for just me and 2 or 3 cnas plus I'm generally there as agency or per diem meaning I know what I received in report or what came up during my shift. But they have no consideration for your time just interrupt you with questions rather than look it up in the chart or notes themselves. If management everywhere worked as a floor nurse just one shift a month maybe they'd have a little respect and appreciation for the amount of multitasking and crap we deal with. Maybe even encourage them to help make our lives simpler so we can do our jobs better. I.E. 5 pg forms for a 1/2 cm skin tear that someone reports to you in the last 30mins of your shift..."full vs q shift" and wanting a "full assessment q shift" for weeks even after whatever acute onset of whatever passes. Leave to much BS work on our "to do list" and don't be shocked that we start skipping over it. All these nursing homes taking on skilled rehab patients for the $$, with all the extra nursing work that entails, yet don't think you need to change their staffing levels...throw me an extra cna for 4 hrs when what I need is a 2nd nurse!

-ok end rant :smokin: I feel so much better!

I don't have a problem with CNAs coming to me with issues during med pass. Even if it's just letting me know they are going on break or that so and so needs something for pain. This lets me know to deviate from my regular med pass routine and hit that room next. I don't want the CNAs I work with to NOT tell me something because they are afraid of coming up to my cart because it's "med pass" time. However, I do have a problem with family members coming up to me to get them ice from the machine or TAKING spoons, straws and whatnot off my cart without asking.

Oh yah, I hate when family members take stuff of my cart without asking. My goodness - just ask! I'm gonna say yes! Common courtesy, please!

My facility doesn't have a no interruption during med pass rule. They would never ever allow it. In fact, during med pass, because I'm so "busy" passing meds to 30 residents, my weekday supervisor insists I carry the portable phone around on my cart to field the oh-so-important "i would like to speak with pt so and so". Now, I really do have to interrupt my med pass, put meds away if I'm popping 'em out, lock my cart, walk the portable down to the other end of the hall for a patient that isn't even mine to repeat to her 5 times, "the phone is for you! it's so and so!" sheesh! :banghead:

The CNAs on my shift are usually pretty good about interruptions. If I need them to follow up with me on something, I expect I'll be interrupted at some point. But I'm happy they come back and let me know what I needed to know about whichever patient(s). Yah, I get so and so needs a pain pill from time to time. To sing the same tune other nurses on here have said, it's the other staff (non floor nurses & cnas) that are the worst offenders. Especially that goofy supervisor of mine. He's there looking over all the paperwork to make sure it's all correct, but doesn't give a d*** about whether or not I'm in the middle of something, be it med pass, patient care, charting, etc. And so much of it is not urgent! Grr! :flamesonb

Sigh...I'm happy I have a job, I'm happy I have a job, I'm happy I have a job... :D

It's nice to get it off my chest though!

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