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 medications with food. At my... Read More

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    My facility policy is to update doc on all refused or held meds (oh as well at the patients POA, guardian etc). We had one patient who was always refusing the same meds, family finally just said to keep a list of the meds refused and the day/times and give them a call at the end of the week. LOL
    Sparrowhawk and Blackcat99 like this.

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    Quote from Blackcat99
    I am exhausted working in LTC. The constant interruptions etc etc etc. At this LTC, we have to call the doctor each time a patient refuses their meds!!!!!! That sure is a time waster. I have been getting most of my diabetics done OK. I am curious if all LTC'S have to call the doctor each time a patient refuses a med or is this just this LTC's facility?????
    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.
    Forever Sunshine and Blackcat99 like this.
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    Meds are allowed at mealtimes if the MAR specificies so at our facility. There are residents who want their pills at mealtime irregardless of facility policies, and sometimes they want them all at once. The nurse then has to contact the doctor to change the order to accommodate the resident unless the doctor deems the request totally unreasonable or unsafe.
    Blackcat99 likes this.
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    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.
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    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.
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    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.
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    ...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.
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    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.
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    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.
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    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.


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