LTC has changed-How do you give out 5pm meds now? - pg.2 | allnurses

LTC has changed-How do you give out 5pm meds now? - page 2

In the old days, we use to go inside the dining room and give patients their medications. Now I have discovered that it is against the rules now. I am always hearing that is is always best to give... Read More

  1. Visit  AngelRN27 profile page
    1
    My facility does not require us to contact the MD about refused meds until it has occured for the same med x3 as another poster mentioned. If this was the protocol at my facility, I would be calling the doc at least once a day! One incident of refusing meds shouldn't be reason to call a doc (depending on the med, of course). Also, not every "refusal" is legitimate. You have to know your residents... some residents are just confused or need to feel some sense of control in order to reduce anxiety. There are several residents at my facility that will always refuse meds if given at a certain time (i.e. before dinner) but will gladly take them if offered again right after their meal... it all depends...
    Blackcat99 likes this.
  2. Visit  wyogypsy profile page
    1
    I have only had to notify them after the third time the patient refused them, and that I did by fax. I bet your facility doctors hate getting those calls, what are they supposed to do about it? If it is a pattern of refusal the med could be DC'd, or is there another way to give it to them such as crush it and dissolve it in hot chocolate?
    Blackcat99 likes this.
  3. Visit  Blackcat99 profile page
    1
    The nurses have told me that they don't have time to call the doctor each time a med is refused. Therefore, they say they lie and pretend the med was given. They said they will only call the doctor if the med is an important med like coumadin.
    spiderslap likes this.
  4. Visit  morte profile page
    2
    ...and THIS is what is provoked by asinine policies such as this. The unintended sequelae of their actions.....
    Quote from Blackcat99
    The nurses have told me that they don't have time to call the doctor each time a med is refused. Therefore, they say they lie and pretend the med was given. They said they will only call the doctor if the med is an important med like coumadin.
    spiderslap and Blackcat99 like this.
  5. Visit  NamasteNurse profile page
    3
    If we called the doc because a res refused meds, we'd get out ear bitten off and handed to us. He barely wants to hear about falls that have no injury. Generally we save those incidentals for one big call, or write it in his book for rounds. However if a med is refused two days in a row or if we had to hold it for parameters twice, then of course he has to be called.

    As to the med pass issue, NYS law says you cannot give meds in the dining room, period. Do some facilities allow it informally? Yes. I have worked in a place that DID allow us to have our cart outside the DR and run back and forth, since a nurse has to be in the DR during meals, this was 'killing two birds with one stone'. That's only on the floor DR not the main DR. Absolutely no meds in the main DR.

    Generally, I start my 5PM pass as soon as I get to work, count and get report, which is around 345. I do all insulins first, then everything else. Generally I try to be done with the meds by 5 which is dinner time, because where I work now, everything stops when the trays arrive and everyone helps pass trays and feed. AFter dinner I do sennas, and the 'lesser' important meds and any people I couldn't find before.
  6. Visit  NamasteNurse profile page
    1
    Quote from artsmom
    Every time they refuse is a bit much. Our policy is if they refuse a med more than 3x we call and let the doctor know. Like we don't have enough to do, now call the doctor when Betty Boop refuses her colace because she has had diarrhea all day.

    If Betty Boop had diarrhea all day, and refuses colace, I'd call that "nursing judgement" and just let it go. I'd circle my initials on the MAR and comment on the diarrhea
    Blackcat99 likes this.
  7. Visit  BrandonLPN profile page
    1
    Our doctor would rip my head off if I called him because Daisy refused a pill(s). Don't these facilities have a sick call book? Our doctor checks the sick call book every weekday.
    Blackcat99 likes this.
  8. Visit  morte profile page
    1
    what happens if the doctor specifiically orders a med WITH meals?
    Quote from NamasteNurse
    If we called the doc because a res refused meds, we'd get out ear bitten off and handed to us. He barely wants to hear about falls that have no injury. Generally we save those incidentals for one big call, or write it in his book for rounds. However if a med is refused two days in a row or if we had to hold it for parameters twice, then of course he has to be called.

    As to the med pass issue, NYS law says you cannot give meds in the dining room, period. Do some facilities allow it informally? Yes. I have worked in a place that DID allow us to have our cart outside the DR and run back and forth, since a nurse has to be in the DR during meals, this was 'killing two birds with one stone'. That's only on the floor DR not the main DR. Absolutely no meds in the main DR.

    Generally, I start my 5PM pass as soon as I get to work, count and get report, which is around 345. I do all insulins first, then everything else. Generally I try to be done with the meds by 5 which is dinner time, because where I work now, everything stops when the trays arrive and everyone helps pass trays and feed. AFter dinner I do sennas, and the 'lesser' important meds and any people I couldn't find before.
    Blackcat99 likes this.
  9. Visit  BrandonLPN profile page
    1
    Quote from NamasteNurse
    If we called the doc because a res refused meds, we'd get out ear bitten off and handed to us. He barely wants to hear about falls that have no injury. Generally we save those incidentals for one big call, or write it in his book for rounds. However if a med is refused two days in a row or if we had to hold it for parameters twice, then of course he has to be called. As to the med pass issue, NYS law says you cannot give meds in the dining room, period. Do some facilities allow it informally? Yes. I have worked in a place that DID allow us to have our cart outside the DR and run back and forth, since a nurse has to be in the DR during meals, this was 'killing two birds with one stone'. That's only on the floor DR not the main DR. Absolutely no meds in the main DR. Generally, I start my 5PM pass as soon as I get to work, count andget report, which is around 345. I do all insulins first, then everything else. Generally I try to be done with the meds by 5 which is dinner time, because where I work now, everything stops when the trays arrive and everyone helps passtrays and feed. AFter dinner I do sennas, and the 'lesser' important meds and any people I couldn't find before.
    This seems absurd to me. I park my med cart right in the DR during supper. Best time to get everyone all at once.
    Blackcat99 likes this.
  10. Visit  Blackcat99 profile page
    1
    I sure wish we were allowed to park our med carts outside the DR at mealtimes.I think it is always best to give meds with meals. However, we are not allowed to bring our carts off our unit period. So what usually happens is that our 5pm meds are given very late.
    spiderslap likes this.
  11. Visit  morte profile page
    1
    If the evening meal is served at 5 pm the times need to be changed. depending what meds we are talking. If you are talking prevacid or such they need to be ~ 1/2 hour before meal, CA++ can be after. etc.
    Quote from Blackcat99
    I sure wish we were allowed to park our med carts outside the DR at mealtimes.I think it is always best to give meds with meals. However, we are not allowed to bring our carts off our unit period. So what usually happens is that our 5pm meds are given very late.
    Blackcat99 likes this.
  12. Visit  spiderslap profile page
    4
    Isnt it ridiculous sometimes? I feel like i can hardly do anything without being interrupted constantly. Patients asking for things, unlocking doors for aides, keeping people from falling, and of course the phone, among other things on the infinite list. Contradictory rules, like not interrupting med passes, but having to do just that at all times. Or the rule about no meds in halls or dining rooms, but they give me 28 pts, no med tech, multiple ivs or feeding tubes, and many fall risks who should have a one to one. How can this be done on time or safely? I wish i knew how ltc nurses could speak up for themselves. I know a lot of ppl are afraid to admit they dont always play by the rules, but it needs to be addressed. Im a new nurse working per diem with new pt assignments every shift. I follow the rules and end up waaaayyyyyy behind. Then forced to try and give txs and do basically all my charting for an hour or two after my shift. Unless theres a highly guarded hack i still need to learn, i sincerely hope some force sheds light on the impossible list of responsibilities of ltc nurses.
  13. Visit  BrandonLPN profile page
    1
    "No meds in the dinning room" is sheer stupidity. It is the most natural time/place to take them.

    Stupid rules are meant to be broken.
    Blackcat99 likes this.


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