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?

[spiderslap]

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.

[BrandonLPN, LPN]

"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.

[CapeCodMermaid, RN]

Stupid rules are meant to be broken? Do you want someone interrupting YOUR meal? Probably not.

We have lots of residents who request to have their meds with their dinner...so we write the order that way and put it in the care plan. I have people who will NOT leave an activity when it's time for a blood glucose check so we care plan it. It should be what the resident wants...not about what the company wants or what the nurse wants.

Long Term Care is a rapidly changing industry, especially in buildings where there are short term, skilled residents. On one hand, it is supposed to be a homelike environment. On the other it's a med surg floor without the same number of nurses on a med surg floor.

My facility is pushing to start a CHF program and a cardiopulmonary program. I can't get the marketing/admissions liaison to get it.....anyone who has training can push lasix...that's not the skill. The problem is, the patient (not really a resident since they are short term) is quite ill and needs to be monitored and assessed. So while I'm in there pushing lasix and assessing the effect, the rest of my 22 patients are on the call bell needing pain medication or falling or complaining about the dinner. The government needs to reassess the reimbursement rates so I can have more RNs to take care of the sicker patients they want us to take.

[betweenus64, LPN]

Hi there. I work in a facility where the sup is hard to get along with. I want to try to learn more from this place I work, but she is making my life hard and am now feeling I can't do anything right, always trying to find stuff i do wrong and blurt it out instead of come to me. And talking about people behind their backs, I heard her doing this. Really, where do they find sup's that are like this? I am a good nurse and am tired of the down talking to me and I have expressed my feelings to another sup over us. Anyone give me ideas on how to handle myself when issues come up while working, I'm tired of crying and feeling worthless. I just started this job and know I am doing the best job I can. I need to fill my head with good things instead of having someone try to take it all away!

[RLtinker, LPN]

My understanding is that it is a state rule and by association a company policy not to give meds in the dinning room. But it is also the one time all the residents that haven't got their meds are all in one place and I have to be in the dinning room at dinner time anyways. Typically, once it is time to pass trays all the meds are passed anyways, its just that some residents are in the dinning room 1-2 hours before meal time. I have one diabetic that spends 75% of her day in the dinning room reading her books. On events days, such as when we have a singer or bingo, nearly all the residents are in the dinning hall when I get there at 3pm and stay there until after meal time. So if I didn't pass meds in the dinning room, most of the resident wouldn't get their 5pm meds until 7pm. I was even told by my DON that we are not supposed to give meds in the dinning room, but they look the other way when we do it. Just don't do it when state is in the building, no joke. While I can understand no insulin shots or accuchecks in the dinning room, I am curious as to what the rational is for this no med in the dinning room rule is.

[betweenus64, LPN]

Hi RLtinker, thank you for your response, and yesterday I went in and spoke to the ADON, I was informed there is no policy to giving meds in the dining room, yet I can bet they did not say anything to this girl continually getting on my case about everything I do. I actually told them I think we have a communication issue, and I am sure they took her side., was told I have to work with her. Well, you know....I will but I am staying far away from her and trying not to say or do anything that will get me in more trouble, sad but true I have to feel like this. She told them I did not want help, yet when I went to her and said I did not know how to do an injection she would not get up and help me. I guess that is okay, oh well, I was told I could always use the drug book in the med room, I told them I thought this is why I have a supervisor., guess I was wrong. The funny thing is that when I work when she is not there, nothing is said to me that I have done something wrong. Sounds funny right. I am sure she is just jealous or something...heck, she has the issue not me.

[NutmeggeRN, BSN]

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?????

That is crazy!

[morte, LPN, LVN]

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[TD=class: sqtdq, bgcolor: #EDF1F7, colspan: 2] [h=1]Rules are mostly made to be broken and are too often for the lazy to hide behind”[/h][/TD]

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[TD=colspan: 2] Douglas MacArthur quotes (American General who commanded the Southwest Pacific Theatre in World War II, 1880-1964

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[withasmilelpn]

Stupid rules are meant to be broken? Do you want someone interrupting YOUR meal? Probably not.

We have lots of residents who request to have their meds with their dinner...so we write the order that way and put it in the care plan. I have people who will NOT leave an activity when it's time for a blood glucose check so we care plan it. It should be what the resident wants...not about what the company wants or what the nurse wants.

Long Term Care is a rapidly changing industry, especially in buildings where there are short term, skilled residents. On one hand, it is supposed to be a homelike environment. On the other it's a med surg floor without the same number of nurses on a med surg floor.

My facility is pushing to start a CHF program and a cardiopulmonary program. I can't get the marketing/admissions liaison to get it.....anyone who has training can push lasix...that's not the skill. The problem is, the patient (not really a resident since they are short term) is quite ill and needs to be monitored and assessed. So while I'm in there pushing lasix and assessing the effect, the rest of my 22 patients are on the call bell needing pain medication or falling or complaining about the dinner. The government needs to reassess the reimbursement rates so I can have more RNs to take care of the sicker patients they want us to take.

Actually quite a lot of them always took their meds at their meals. Some people actually have insisted I give them to them on the toilet no matter how much I protest I can come back. (Yuck.) Most people are very casual about their meds (sometimes too casual taking when they feel like it or not and that's how they end up on our skilled unit.) I can manage not to give them at mealtimes with the fact that I know my Residents because I'm the regular day nurse. How the heck a float manages to do this I don't know. So inevitably I'm not the one violating policy - so care plans aren't going to get changed. Float nurses really have it tough though. But I do unfortunately violate policy anyway as management wanted no meds given anywhere but rooms which is impossible and ALL the nurses violate it. I never do anything invasive ever though. They don't ever even comment on meds being given in the lounge anymore. Should be interesting though when the state comes, because it's still our official facility policy.

As far as the home like environment- such a disappointment. I was all for the changes, kitchen on the unit, activities by staff, less medical driven, and stayed put through the frustrating building process for two years. The result? A homelike environment sort of in looks but now every unit has multiple rooms for short term Patients along with our true LTC Residents. More patients that are short term with increasingly more medical needs that could care less about activities taking all the time from my actual long term patients that now have LESS activities because the 2 aides for 20 can't manage to do it, and even if they did have time are too burnt out to care. (Used to have 3 because the units overlapped but now have to make do with 2 and a sometime float that does showers because of how the 'households' are arranged.) They also gave the aides housekeeping jobs and laundry to do - because that's how you'd run a 'household.' Now we never have supplies when we need them and the place is always dirty. (It gets done but only when there is no patient care) Then with the influx of former med surg worthy patients, Nurses are swamped with time consuming tasks. Nurses now do bladder scans, EKGs, IVs, wound vacs, juggle PT OT, and multiple appointments and copious charting of course. I like the medical aspect of it, but I think the government and industry itself needs to face facts and commit to one direction or the other. I don't think the two types of patients mix well. Short termers don't take advantage of our kitchen like our long term, the LTC Residents scare them.