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

[Blackcat99]

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 LTC, we cannot go into the dining room, we can't have our med carts outside the dining room either. We cannot give pills out to the patients sitting out in the lobby. Also I was told that blood sugars and insulin cannot be given in the hallways. So it's kind of if the patient is not in their room for their 5pm meds then they will get them late the time being whenever they choose to return to their rooms. Some don't choose to return to their rooms until 9pm or later. So how do you give out your 5pm meds when no one is in their rooms?

[GLORIAmunchkin72]

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.

[AngelRN27]

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...

[wyogypsy, RN]

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]

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.

[morte, LPN, LVN]

...and THIS is what is provoked by asinine policies such as this. The unintended sequelae of their actions.....

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.

[NamasteNurse, BSN, RN]

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.

[NamasteNurse, BSN, RN]

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

[BrandonLPN, LPN]

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.

[morte, LPN, LVN]

what happens if the doctor specifiically orders a med WITH meals?

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.

[BrandonLPN, LPN]

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]

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.

[morte, LPN, LVN]

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.

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.