LTC med nurses-Are you obeying all of the rules? - page 2

I just got a bunch of paperwork about meds at my LTC. According to the policy, I am required to check for all allergies each and every time before administering meds. I am also required to check for... Read More

  1. by   artsmom
    At my job, the night nurses are responsible for checking for expired meds on the carts once a week. Most do it, some definitely don't. Pay more attention to the stock meds- vitamins/liquid APAP/etc., things that are stock and not used frequently expire and can easily go unnoticed.
    As for all the patients not wearing ID bands- mention this to the unit manager. They should all have them on, perhaps she is unaware they don't. If I pass meds to my patients and they are not wearing one, they get one.
  2. by   Anne36
    Im brand new and last night I was given 26 patients on my own, (big surprise) I did not finish med pass by the end of my shift. ( I had a preceptor, so I was not on my own) At the end of the night my preceptor told me she thought part of my problem was that I was checking the med cards against the MAR. We are supposed to do that obviously, but some of the Nurses are so familiar with the meds that the patients are on, they dont even bother looking at the MAR and just pop the pills.

    artsmom, ID bands would be a dream come true for me. Ive only been at my first job for a few days and nobody wears an ID and they are in the hall or out of their rooms most of the time. The other nurses and aides are looking at me like I have 2 heads when I ask for a second person to identify because I just dont know all these people yet.
  3. by   artsmom
    Let them look at you then. If the pt can't tell me who they are and I don't know them, I always ask. Telling you not to check the cards against the MAR is terrible. I always check them. This weekend alone I found two cards with the wrong doses. I guess a lot of nurses don't look. You will develop a routine to improve your time, let that routine be a safe one!!
  4. by   CT Pixie
    I am very familiar with my patients and their meds as I've been on the same floor with a majority of the same patients for years now. By habit I pull their 'normal' meds from the drawer..however, before I pop them out of the pack, I always check them against the MAR. Many times, although they might still be on XYZ med..the dose has been increased or decreased, some have been D/C, new ones added, time of admistration might changed etc. I prefer to be safe and double check my meds against the MAR every patient, every med, every med pass. Like the poster above, I've found many cards with the right drug that the MAR has listed but the dose is higher/lower than what the MAR said (due to doctor changing mg amt). IE: Card-Lasix 40mg, MAR says 20mg twice a day d/t doc changing original order from 1x per day to giving lesser mg 2x per day. Or Card-Lasix 20mg twice a day MAR says 40mg once daily.

    You keep doing what you're doing and being safe.
  5. by   itsnowornever
    Quote from Anne36
    I know we were taught to do that in clinical but we were taught a lot of things in clinical that are not time effective. If we have 20-30 clients to pass meds on how would you be able to check the exp date on each packet of medication every time? One of the reasons we never got many patients in clinical is because it took forever to do med pass with an instructor. When I started my first job last week I was taking the time to pull meds, dot the entry and then go back and sign it after the med is given like you are supposed to, then I noticed that the experienced Nurses were not doing that, they were initialing when they pulled the med. Now I know why, after I passed meds on 28 clients. Anyway, the case manager for the floor saw me doing it and was not happy, probably because I am new and it is not correct to do so. She knows all the other Nurses are doing it. I also saw other Nurses passing meds that fell on the med cart when we are supposed to pop a new pill if it touchs anything. I am orienting and worry about how slow I am when I do everything by the book. It really increases my stress level. I am also on the ceiling about patient identification in these LTC facilites. There is nothing proper like an ID band, all I have is the word of the closest CNA that Im getting the right patient, because I dont know all the residents yet. There is a picture in the MAR, but it doesnt seem like the best way to make an ID on an elderly client.
    According to NCLEX, ATI and Kaplan a photo is acceptable :/
  6. by   itsnowornever
    I know it's hard to check for allergies but here is why: my dad is allergic to aspirin. He had a heart attack a few years ago. Despite having an allergy band on his arm, a RED folder indications an allergy EVERY 6hours they tried to give him aspirin. He finally blew up at a nurse because he was sick of them NOT reading the chart and just handing out meds willy nilly.

    Is this always the case? No. But it scared me enough that as a student I ALWAYS checked allergies before handing out a medication. It ticked some instructors off because it took an extra minute, but once I explained why I did it, they left me alone.
  7. by   merrywhiterose
    I work during the shift that gives the most meds. Some residents take 20 meds this shift. We also have to FIND the residents! They could be in their room, someone else's room, the dining room, outside...! With charting, glucose checks, breathing treatments, passing scheduled meds, giving PRN meds, doing other treatments, speaking to family members, residents, the Doctor, doing vital signs, paperwork, etc., there is NO POSSIBLE WAY that we could check each med. We have to rely on the Doctor & Pharmacy to give us the correct meds. With each new med order allergies are included.
  8. by   shouse81502
    Quote from Blackcat99
    I just got a bunch of paperwork about meds at my LTC. According to the policy, I am required to check for all allergies each and every time before administering meds. I am also required to check for expiration dates on each med before administering meds. So how many of you are checking for allergies each and every time you give a med? How many of you are checking for expiration dates each and every time you give a med? I have 30 patients. I certainly do not have time to do it period.
    I have 24-32 residents depending on the unit I am on and always check expiration dates. We get our meds in blister packs so it's easier. As for doing everything taught in clinical....ya right. Staying in compliance is hard enough blazing through the med pass...add everything else and we just hope the state doesn't pop in for a surprise check.
  9. by   teddycat1962
    As a med nurse in a ltc facility, no I don't check for allergies every time nor do I check for expiration dates. I was never even told this was something that I should be doing. Before they split the floor up I used to pass meds to 40 residents. You're right, we don't have the time to check this EVERY time, especially if we want to stay in compliance with the state. The pharmacy should be checking for allergies before they send the meds, and we only get a 30 day supply of (prescribed) meds so there's no need to worry about expiration date. (Hopefully our educational trainer doesn't see this...she'll be insisting we do this too as part of our med pass! lol)
  10. by   CapeCodMermaid
    Again, another instance of thinking a regulation or recommendation is silly or time consuming or make work.Giving a resident an expred medication or a medication they are allergic too could have far greater consequences than giving them a daily med an hour late.
  11. by   BrandonLPN
    Having a policy where the nurses have to check the expiration date of every pill before pouring it just isn't going to happen. All that will result in is nurses who lie. We have the third shift nurse do a "sweep" of the med cart once a week. Any med that is close to expiration is removed.
  12. by   morte
    I am thinking either you misunderstood, or i am misunderstanding you.....Do you really want me to check MS Smith for an allergy to ea of her meds (16) EVERY morning that i give them? This makes no sense, Any new allergies would (at least should) be passed on in report, and a simple glance at the top of the page should cover for ALL the meds at once. no new allergies, no more checking! [QUOTE=CapeCodMermaid;6979514]Again, another instance of thinking a regulation or recommendation is silly or time consuming or make work.Giving a resident an expred medication or a medication they are allergic too could have far greater consequences than giving them a daily med an hour late.[/QUOTE
  13. by   missdanap
    While the pharmacy, prescribing doctor, and nurse writing new orders should be mindful of cross checking the pt's allergies, ID, and correct order that doesn't always happen. I worked in a facility where a pt had a documented allergy to Dilantin. The doctor ordered Dilantin, the pharmacy sent the blister pack, and the nurse wrote the order on the MAR. If it hadn't been for checking the new med against the allergy list I would have given the Dilantin to the pt. I also worked in a facility where we received a pt from a LTC facility and a copy of the MAR was sent with the pt. The receiving nurse updated our med list by this MAR which ended up being for a completely different pt. The pt later ended up in ICU due to med errors. The MAR went through EMS, the receiving nurse, doctor, pharmacy, and floor nurse before figuring out the MAR was for the wrong pt. Bottom line-it is the nurse giving the med who will ultimately be held responsible.

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